Crossing the handover chasm: Clinicians' perceptions of barriers to the early detection and timely management of severe sepsis and septic shock

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• 作者：Claudia T. Matthaeus-Kraemer ; MA^a ; ^{claudia.matthaeus@med.uni-jena.de" class="auth_mail" title="E-mail the corresponding author} ; ^{claudia.matthaeus@uni-jena.de" class="auth_mail" title="E-mail the corresponding author} ; Daniel O. Thomas-Rueddel ; MD^a ; ^b ; ^{daniel.thomas@med.uni-jena.de" class="auth_mail" title="E-mail the corresponding author} ; Daniel Schwarzkopf ; MSc^a ; ^{daniel.schwarzkopf@med.uni-jena.de" class="auth_mail" title="E-mail the corresponding author} ; Hendrik Rueddel ; MD^a ; ^b ; ^{hendrik.rueddel@med.uni-jena.de" class="auth_mail" title="E-mail the corresponding author} ; Bernhard Poidinger ; MD^b ; ^{poidinger@gmx.at" class="auth_mail" title="E-mail the corresponding author} ; Konrad Reinhart ; MD^a ; ^b ; ^{konrad.reinhart@med.uni-jena.de" class="auth_mail" title="E-mail the corresponding author} ; Frank Bloos ; MD ; PhD^a ; ^b ; ^{frank.bloos@med.uni-jena.de" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Critical care ; Quality improvement ; Focus group discussion ; Qualitative research ; Barriers to treatment
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：36
• 期：Complete
• 页码：85-91
• 全文大小：432 K

文摘

The purpose was to identify barriers to the early detection and timely management of severe sepsis throughout the emergency department (ED), general ward (GW), intermediate care unit (IMC), and the intensive care unit (ICU).

Materials and methods

Five multicenter focus group discussions with 29 clinicians were conducted. Discussions were based on a moderation guide were recorded and transcribed. Qualitative analysis was performed according to the principles of the concept mapping method and the framework approach.

Results

The major causes of the delayed detection and treatment could be summarized in a framework of communication errors and handover difficulties throughout patients' course of treatment, which can be divided into 5 core areas: inadequate histories before hospital admission; poorly coordinated handovers between the ambulance service and the ED; delayed patient transfer between the ED and the GW as well as delays in patient transfers between the GW and the ICU by, for example, a lack of bed capacity and a shortage of staff. Generally, participants from all wards mentioned that the urgency with which septic patients needed to be treated was not communicated.

Conclusions

Our study shows the need to improve intra- and interunit handover processes in hospital care, which would ensure a holistic treatment concept, thereby improving patient care.