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1.
MMWR Morb Mortal Wkly Rep ; 69(35): 1221-1226, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32881855

RESUMO

Health care personnel (HCP) caring for patients with coronavirus disease 2019 (COVID-19) might be at high risk for contracting SARS-CoV-2, the virus that causes COVID-19. Understanding the prevalence of and factors associated with SARS-CoV-2 infection among frontline HCP who care for COVID-19 patients are important for protecting both HCP and their patients. During April 3-June 19, 2020, serum specimens were collected from a convenience sample of frontline HCP who worked with COVID-19 patients at 13 geographically diverse academic medical centers in the United States, and specimens were tested for antibodies to SARS-CoV-2. Participants were asked about potential symptoms of COVID-19 experienced since February 1, 2020, previous testing for acute SARS-CoV-2 infection, and their use of personal protective equipment (PPE) in the past week. Among 3,248 participants, 194 (6.0%) had positive test results for SARS-CoV-2 antibodies. Seroprevalence by hospital ranged from 0.8% to 31.2% (median = 3.6%). Among the 194 seropositive participants, 56 (29%) reported no symptoms since February 1, 2020, 86 (44%) did not believe that they previously had COVID-19, and 133 (69%) did not report a previous COVID-19 diagnosis. Seroprevalence was lower among personnel who reported always wearing a face covering (defined in this study as a surgical mask, N95 respirator, or powered air purifying respirator [PAPR]) while caring for patients (5.6%), compared with that among those who did not (9.0%) (p = 0.012). Consistent with persons in the general population with SARS-CoV-2 infection, many frontline HCP with SARS-CoV-2 infection might be asymptomatic or minimally symptomatic during infection, and infection might be unrecognized. Enhanced screening, including frequent testing of frontline HCP, and universal use of face coverings in hospitals are two strategies that could reduce SARS-CoV-2 transmission.


Assuntos
Anticorpos Antivirais/sangue , Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Centros Médicos Acadêmicos , Adulto , Doenças Assintomáticas , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Estudos Soroepidemiológicos , Estados Unidos/epidemiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-32602672

RESUMO

This study aimed to evaluate perceptions of safety and preparedness among health workers caring for coronavirus disease 2019 (COVID-19) patients before and after a multi-professional simulation-based course in Pakistan. Health workers' perceptions of preparedness, safety, and their willingness to care for COVID-19 patients were measured before and after they attended a simulation-based training course to prepare them to care for COVID-19 patients at Combined Military Hospital Landi Kotal Cantt, from March 1 to April 30, 2020. The participants' perceived level of safety and preparedness to care for COVID-19 patients before the simulation-based course was low, but increased after completing it (P<0.05). They felt confident and were significantly more willing to care for patients with COVID-19 or other infections requiring strict isolation. Simulation-based training is an effective tool to improve perceptions of risk and readiness to deal with COVID-19 among medical and non-medical health workers in Pakistan.


Assuntos
Infecções por Coronavirus/terapia , Relações Interprofissionais , Recursos Humanos em Hospital/educação , Recursos Humanos em Hospital/psicologia , Pneumonia Viral/terapia , Treinamento por Simulação/métodos , Adulto , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Pandemias , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Avaliação de Programas e Projetos de Saúde , Segurança , Autoeficácia , Adulto Jovem
6.
J Hosp Infect ; 106(1): 102-106, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32593608

RESUMO

Staff working in units that were highly exposed to coronavirus disease 2019 were invited to participate in a 6-month study on the carriage and seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The results from visits on Day 1 and Day 15 show that 41 cases of SARS-CoV-2 infection were confirmed by reverse transcriptase polymerase chain reaction and/or serology in 326 participants (overall infection rate 12.6%). The presence of comorbidities or symptoms at the time of sample collection was a risk factor for infection, but working as a physician/nurse was not a risk factor. Universal screening in high-risk units, irrespective of symptoms, allowed the identification of asymptomatic and potentially contagious infected workers, enabling them to self-isolate for 7 days.


Assuntos
Doenças Assintomáticas , Infecções por Coronavirus/imunologia , Testes Diagnósticos de Rotina/estatística & dados numéricos , Testes Diagnósticos de Rotina/normas , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/imunologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa/estatística & dados numéricos , Reação em Cadeia da Polimerase Via Transcriptase Reversa/normas , Adulto , Bélgica , Betacoronavirus/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Medição de Risco , Fatores de Risco , Estudos Soroepidemiológicos
9.
PLoS One ; 15(5): e0232848, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32374771

RESUMO

BACKGROUND: Sub-Saharan Africa (SSA) has an increasing non-communicable disease burden. Tanzania has an incidence of more than 35,000 cancer cases per year with an 80% mortality rate. Hematological malignancies account for 10% of these cases. The numbers will double within the next 10 years due to demographic changes, better diagnostic capabilities and life style changes. Kilimanjaro Christian Medical Centre established a Cancer Care Centre (CCC) in December 2016 for a catchment area of 15 million people in Northern Tanzania. This article aims to display the hematological diagnosis and characteristics of the patients as well as to describe the advancements of hematologic services in a low resource setting. METHODS: A cross-sectional analysis of all hematological malignancies at CCC from December 2016 to May 2019 was performed and a narrative report provides information about diagnostic means, treatment and the use of synergies. RESULTS: A total of 209 cases have been documented, the most common malignancies were NHL and MM with 44% and 20%. 36% of NHL cases, 16% of MM cases and 63% of CML cases were seen in patients under the age of 45. When subcategorized, CLL/SLL cases had a median age was 56.5, 51 years for those with other entities of NHL. Sexes were almost equally balanced in all NHL groups while clear male predominance was found in HL and CML. DISCUSSION: Malignancies occur at a younger age and higher stages than in Western countries. It can be assumed that infections play a key role herein. Closing the gap of hematologic services in SSA can be achieved by adapting and reshaping existing infrastructure and partnering with international organizations.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Neoplasias Hematológicas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idade de Início , Idoso , Institutos de Câncer/estatística & dados numéricos , Área Programática de Saúde , Criança , Pré-Escolar , Estudos Transversais , Diagnóstico Tardio , Feminino , Previsões , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/patologia , Neoplasias Hematológicas/terapia , Humanos , Lactente , Recém-Nascido , Cooperação Internacional , Linfoma não Hodgkin/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Mieloma Múltiplo/epidemiologia , Programas Nacionais de Saúde , Especificidade de Órgãos , Recursos Humanos em Hospital/estatística & dados numéricos , Sistema de Registros , Distribuição por Sexo , Tanzânia/epidemiologia , Adulto Jovem
10.
J Hosp Infect ; 105(3): 430-433, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32360337

RESUMO

This study was conducted to predict the preventive behaviours of healthcare workers (HCWs) towards COVID-19 based on the Protection Motivation Theory (PMT). This cross-sectional and analytical study was conducted on 761 HCWs in Hamadan, Iran, using multi-stage random sampling. The preventive behaviours against COVID-19 among HCWs were assessed at a relatively desirable level. Based on the PMT, threat and coping appraisal were predictors of protection motivation to conduct COVID-19 preventive behaviours (P<0.001). The intention was also predictive of COVID-19 preventive behaviours (P<0.001). Consideration of personnel's self-efficacy and their knowledge regarding the effectiveness of protective behaviours in designing staff training programmes are recommended.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Pandemias/prevenção & controle , Recursos Humanos em Hospital/psicologia , Pneumonia Viral/prevenção & controle , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Motivação , Recursos Humanos em Hospital/educação , Recursos Humanos em Hospital/estatística & dados numéricos , Autoeficácia , Adulto Jovem
11.
MMWR Morb Mortal Wkly Rep ; 69(15): 472-476, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: covidwho-52245

RESUMO

On February 26, 2020, the first U.S. case of community-acquired coronavirus disease 2019 (COVID-19) was confirmed in a patient hospitalized in Solano County, California (1). The patient was initially evaluated at hospital A on February 15; at that time, COVID-19 was not suspected, as the patient denied travel or contact with symptomatic persons. During a 4-day hospitalization, the patient was managed with standard precautions and underwent multiple aerosol-generating procedures (AGPs), including nebulizer treatments, bilevel positive airway pressure (BiPAP) ventilation, endotracheal intubation, and bronchoscopy. Several days after the patient's transfer to hospital B, a real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2 returned positive. Among 121 hospital A health care personnel (HCP) who were exposed to the patient, 43 (35.5%) developed symptoms during the 14 days after exposure and were tested for SARS-CoV-2; three had positive test results and were among the first known cases of probable occupational transmission of SARS-CoV-2 to HCP in the United States. Little is known about specific risk factors for SARS-CoV-2 transmission in health care settings. To better characterize and compare exposures among HCP who did and did not develop COVID-19, standardized interviews were conducted with 37 hospital A HCP who were tested for SARS-CoV-2, including the three who had positive test results. Performing physical examinations and exposure to the patient during nebulizer treatments were more common among HCP with laboratory-confirmed COVID-19 than among those without COVID-19; HCP with COVID-19 also had exposures of longer duration to the patient. Because transmission-based precautions were not in use, no HCP wore personal protective equipment (PPE) recommended for COVID-19 patient care during contact with the index patient. Health care facilities should emphasize early recognition and isolation of patients with possible COVID-19 and use of recommended PPE to minimize unprotected, high-risk HCP exposures and protect the health care workforce.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional , Recursos Humanos em Hospital , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Adulto , California/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Pandemias , Equipamento de Proteção Individual/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Medição de Risco
12.
Acta Biomed ; 91(3-S): 29-34, 2020 04 10.
Artigo em Inglês | MEDLINE | ID: covidwho-46526

RESUMO

One week after the World Health Organization (WHO) declared the 2019 novel coronavirus (2019-nCoV) outbreak a global health emergency we conducted a survey to explore knowledge and attitudes on 2019-nCoV, recently renamed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in a large cohort of hospital staff. A representative sample of 2,046 hospital staff of a large university hospital in northern Italy (54% healthcare workers and 46% administrative staff, overall response rate: 25%) was administered an online questionnaire: overall there is good knowledge on 2019-nCoV control measures. The mean of correct answers for questions on general aspects of 2019-nCoV epidemic was 71.6% for HCWs and 61.2% for non-HCWs. The mean of correct answers for questions on 2019-nCoV patient management was 57.8% among HCWs. Nevertheless, on recommended precautions, also among healthcare workers there is still much to do in order to promote effective control measures and correct preventive behaviours at the individual level.


Assuntos
Infecções por Coronavirus , Coronavirus , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral , Betacoronavirus , Defesa Civil , Estudos de Coortes , Surtos de Doenças , Pessoal de Saúde , Hospitais de Ensino , Humanos , Controle de Infecções , Itália , Inquéritos e Questionários
13.
Br J Nurs ; 29(7): 426-430, 2020 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-32279559

RESUMO

BACKGROUND: Knowledge of traditional and complementary medicine (TCM) and its use by patients are essential for patient safety. AIMS: To examine knowledge of TCM among practitioners in a nephrology unit and their advice to patients. METHODS: This was a descriptive, observational, cross-sectional study. Sociodemographic data were collected and an ad hoc closed response survey was used. FINDINGS: This study included 62 practitioners, of whom: 32.26% had been trained in TCM, with no significant differences between professional groups; 41.93% used TCM and 67.74% recommended TCM to patients, with no significant difference between personal use and training received. The majority (62.90%) approved of TCM being included in clinical practice, 77.42% were in favour of it being included in formal health teaching programmes, 27.42% said patients had requested information on TCM and 50% knew it could interact with conventional treatment. CONCLUSION: Although the majority of practitioners had not been trained in TCM, they were interested in including such treatments in clinical practice. They recommended TCM to patients, but neither training nor personal experience were significant factors in relation to these recommendations. Training in TCM is required to ensure advice is safe.


Assuntos
Terapias Complementares , Conhecimentos, Atitudes e Prática em Saúde , Medicina Tradicional , Nefrologia , Recursos Humanos em Hospital/psicologia , Adulto , Estudos Transversais , Feminino , Departamentos Hospitalares , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos em Hospital/estatística & dados numéricos , Espanha
14.
Acta Biomed ; 91(3-S): 29-34, 2020 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-32275264

RESUMO

One week after the World Health Organization (WHO) declared the 2019 novel coronavirus (2019-nCoV) outbreak a global health emergency we conducted a survey to explore knowledge and attitudes on 2019-nCoV, recently renamed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in a large cohort of hospital staff. A representative sample of 2,046 hospital staff of a large university hospital in northern Italy (54% healthcare workers and 46% administrative staff, overall response rate: 25%) was administered an online questionnaire: overall there is good knowledge on 2019-nCoV control measures. The mean of correct answers for questions on general aspects of 2019-nCoV epidemic was 71.6% for HCWs and 61.2% for non-HCWs. The mean of correct answers for questions on 2019-nCoV patient management was 57.8% among HCWs. Nevertheless, on recommended precautions, also among healthcare workers there is still much to do in order to promote effective control measures and correct preventive behaviours at the individual level.


Assuntos
Infecções por Coronavirus , Coronavirus , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral , Betacoronavirus , Defesa Civil , Estudos de Coortes , Surtos de Doenças , Pessoal de Saúde , Hospitais de Ensino , Humanos , Controle de Infecções , Itália , Inquéritos e Questionários
15.
MMWR Morb Mortal Wkly Rep ; 69(15): 472-476, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-32298249

RESUMO

On February 26, 2020, the first U.S. case of community-acquired coronavirus disease 2019 (COVID-19) was confirmed in a patient hospitalized in Solano County, California (1). The patient was initially evaluated at hospital A on February 15; at that time, COVID-19 was not suspected, as the patient denied travel or contact with symptomatic persons. During a 4-day hospitalization, the patient was managed with standard precautions and underwent multiple aerosol-generating procedures (AGPs), including nebulizer treatments, bilevel positive airway pressure (BiPAP) ventilation, endotracheal intubation, and bronchoscopy. Several days after the patient's transfer to hospital B, a real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2 returned positive. Among 121 hospital A health care personnel (HCP) who were exposed to the patient, 43 (35.5%) developed symptoms during the 14 days after exposure and were tested for SARS-CoV-2; three had positive test results and were among the first known cases of probable occupational transmission of SARS-CoV-2 to HCP in the United States. Little is known about specific risk factors for SARS-CoV-2 transmission in health care settings. To better characterize and compare exposures among HCP who did and did not develop COVID-19, standardized interviews were conducted with 37 hospital A HCP who were tested for SARS-CoV-2, including the three who had positive test results. Performing physical examinations and exposure to the patient during nebulizer treatments were more common among HCP with laboratory-confirmed COVID-19 than among those without COVID-19; HCP with COVID-19 also had exposures of longer duration to the patient. Because transmission-based precautions were not in use, no HCP wore personal protective equipment (PPE) recommended for COVID-19 patient care during contact with the index patient. Health care facilities should emphasize early recognition and isolation of patients with possible COVID-19 and use of recommended PPE to minimize unprotected, high-risk HCP exposures and protect the health care workforce.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional , Recursos Humanos em Hospital , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Adulto , California/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Pandemias , Equipamento de Proteção Individual/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Medição de Risco
16.
BMC Public Health ; 20(1): 316, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164624

RESUMO

BACKGROUND: Organisational culture (OC) has increasingly become a crucial factor in defining healthcare practice and management. However, there has been little research validating and adapting OCAI (organisational culture assessment instrument) to assess OC in healthcare settings in developing countries, including Vietnam. The purpose of this study is to validate the OCAI in a hospital setting using key psychometric tests and confirmatory factor analysis (CFA). METHODS: This is a cross-sectional study. Self-administered structured questionnaire was completed by 566 health professionals from a Vietnamese national general hospital, the General Hospital of Quang Nam province. The psychometric tests and CFA were utilized to detect internal reliability and construct validity of the instrument. RESULTS: The Cronbach's alpha coefficients (α-reliability statistic) ranged from 0.6 to 0.8. In current culture, the coefficient was 0.80 for clan and 0.60 for adhocracy, hierarchy and market dimension, while in expected culture, the coefficient for clan, adhocracy, hierarchy, and market dimension was 0.70, 0.70, 0.70 and 0.60, respectively. The CFA indicated that most factor loading coefficients were of moderate values ranging from 0.30 to 0.60 in both current and expected culture model. These models are of marginal good fit. CONCLUSIONS: The study findings suggest that the OCAI be of fairly good reliability and construct validity in measuring four types of organisational culture in healthcare setting in resource-constrained countries such as Vietnam. This result is a first step towards developing a valid Vietnamese version of the OCAI which can also provide a strong case for future research in the field of measuring and managing organisational culture.


Assuntos
Assistência à Saúde/organização & administração , Cultura Organizacional , Inquéritos e Questionários , Adulto , Estudos Transversais , Análise Fatorial , Feminino , Hospitais Gerais , Humanos , Masculino , Recursos Humanos em Hospital/psicologia , Recursos Humanos em Hospital/estatística & dados numéricos , Psicometria , Reprodutibilidade dos Testes , Vietnã
17.
Am J Public Health ; 110(5): 693-695, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32191525

RESUMO

The objective of the Los Angeles County, California (LAC), health care personnel (HCP) influenza vaccination improvement intervention was to increase HCP influenza vaccination coverage during the 2016-2017 influenza season via targeted outreach to LAC acute care hospitals. We selected 13 facilities for intervention and received tailored recommendations from a menu of evidence-based practices. Following the season, each hospital in the intervention group experienced a significant increase in vaccination coverage, which increased the LAC countywide average for all hospitals by 5%, from 74% to 79%.


Assuntos
Hospitais de Condado/estatística & dados numéricos , Programas de Imunização/organização & administração , Vacinas contra Influenza/administração & dosagem , Recursos Humanos em Hospital/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Humanos , Programas de Imunização/estatística & dados numéricos , Los Angeles , Avaliação de Programas e Projetos de Saúde , Estações do Ano
18.
BMC Health Serv Res ; 20(1): 145, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32103748

RESUMO

BACKGROUND: In-hospital cardiac arrests (IHCA) occur commonly and are associated with poor survival and variable outcomes. This study aimed to directly survey IHCA responders to understand their perceptions of resuscitation care. METHODS: As part of a quality improvement initiative, we surveyed participating providers of IHCAs at our institution from Jan 2014 to May 2016. The survey included unstructured free text feedback, which was the focus of this study. We systematically coded the free text and organized identifiable latent themes using thematic analysis. We used the natural timeline of an IHCA - pre-arrest, arrest, and post-arrest - for organization of the identifiable latent themes, and created a separate category for holistic remarks that arched across the timeline. RESULTS: We identified 172 IHCAs with a mean of 1.7 responses per arrest (range: 1-8 responses). The mean age of this patient population was 59 years at the time of arrest, and 107 (62%) were men. We identified several themes - [1] issues around code activation and code status characterized the pre-arrest period [2] ,team interactions and issues around supplies/equipment dominated the intra-arrest period, and [3] code cessation and transitions of care typified the post-arrest period. Holistic remarks focused on attentiveness paid by the arrest team to patient comfort and family. Some comments reflected positive experiences but most focused on areas of improvement consistent with the initiative's purpose. In certain cases, we identified a tension between the need to balance established resuscitation protocols with flexibility required by real-life circumstances. CONCLUSIONS: Directly surveying those who participated in IHCAs led to novel insights about their experiences. Our findings suggest that parsing through such qualitative feedback can help hospitals identify areas of improvement, modulate expectations, temper emotions, and refine protocols.


Assuntos
Atitude do Pessoal de Saúde , Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Recursos Humanos em Hospital/psicologia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos em Hospital/estatística & dados numéricos , Pesquisa Qualitativa , Melhoria de Qualidade
19.
BMC Health Serv Res ; 20(1): 74, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005238

RESUMO

BACKGROUND: Guideline-based processes for the assessment of chest pain are lengthy and resource intensive. The IMProved Assessment of Chest Pain Trial (IMPACT) protocol was introduced in one Australian hospital Emergency Department (ED) to more efficiently risk stratify patients. The theoretical domains framework is a useful approach to assist in identifying barriers and facilitators to the implementation of new guidelines in clinical practice. The aim of this study was to understand clinicians' perceptions of facilitators and barriers to the use of the IMPACT protocol. METHODS: Guided by the theoretical domains framework, semi-structured interviews with nine ED clinical staff (medical and nursing) were undertaken in 2016. Content analysis was conducted independently by two researchers to identify those theoretical domains that facilitated or hindered protocol use. RESULTS: Domains most often reported as fundamental to the use of the IMPACT protocol included 'social/professional role and identity', 'environmental context and resources' and 'social influences'. These factors seemingly influenced professional confidence, with participants noting 'goals' that included standardisation of practice, enhanced patient safety, and reduced need for unnecessary testing. The domain 'environmental context and resources' also contained the most noted barrier - the need to inform new members of staff regarding protocol use. Opportunities to overcome this barrier included modelling of protocol use by staff at all levels and education - both formal and informal. CONCLUSIONS: A range of domains were identified by ED staff as influencing their chest pain management behaviour. Fundamental to its use were champions/leaders that were trusted and accessible, as well as social influences (other staff within ED and other specialty areas) that enabled and supported protocol use. Research investigating the implementation and perceived use of the protocol at other sites, of varied geographical locations, is warranted.


Assuntos
Atitude Frente a Saúde , Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência , Acesso aos Serviços de Saúde , Medição da Dor/métodos , Recursos Humanos em Hospital/psicologia , Adulto , Austrália , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos em Hospital/estatística & dados numéricos , Pesquisa Qualitativa
20.
BMC Health Serv Res ; 20(1): 43, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948462

RESUMO

BACKGROUND: Patients' involvement in patient safety has increased in healthcare. Use of checklists may improve patient outcome in surgery, though few have attempted to engage patients' use of surgical checklist. To identify risk elements of complications based on patients' and healthcare workers' experiences is warranted. This study aims to identify what the patients and healthcare workers find to be the risk elements that should be included in a patient-driven surgical patient safety checklist. METHOD: A qualitative study design where post-operative patients, surgeons, ward physicians, ward nurses, and secretaries from five surgical specialties took part in focus group interviews. Eleven focus groups were conducted including 25 post-operative patients and 27 healthcare workers at one tertiary teaching hospital and one community hospital in Norway. Based on their experiences, participants were asked to identify perceived risks before and after surgery. The interviews were analysed using content analysis. RESULTS: Safety risk factors were categorised as pre-operative information: pre-operative preparations, post-operative information, post-operative plans and follow-up. The subcategories under pre-operative information and preparations were: contact information, medication safety, health status, optimising health, dental status, read information, preparation two weeks before surgery, inform your surgical ward, planning your own discharge, preparation on admission and just before surgery. The subcategories under post-operative information, further plans and follow-up were: prevention and complications, restriction and activity, medication safety, pain relief, stomach functions, further care and appointments. Both healthcare workers and patients express the need for a surgical patient safety checklist. CONCLUSION: A broad spectre of risk elements for a patient safety checklist were identified. Developing a surgical safety checklist based on these risk elements might reduce complications and unwanted errors. TRAIL REGISTRATION: The study is registered as part of a clinical trial in ClinicalTrials.gov: NCT03105713.


Assuntos
Lista de Checagem , Participação do Paciente , Segurança do Paciente , Recursos Humanos em Hospital/psicologia , Procedimentos Cirúrgicos Operatórios , Adulto , Idoso , Feminino , Grupos Focais , Hospitais Comunitários , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Recursos Humanos em Hospital/estatística & dados numéricos , Pesquisa Qualitativa , Gestão de Riscos , Centros de Atenção Terciária
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