延迟关节骨折患者手术时间的驱动因素:多中心定性研究
Emily A Schultz1, Jessica M Welch, William Cross
1From the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (Schultz, Gardner, and Kamal), the Department of Orthopaedic Surgery, Duke University, Durham, NC (Welch and DeBaun), the Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN. (Cross and Holte), the Department of Orthopaedic Surgery, Scripps Clinic, San Diego, CA. (Shah), the Department of Orthopaedic Surgery, Kaiser Permanente, Oakland, CA (Mansuripur), the Department of Orthopaedic Surgery, Boston University, Boston, MA (Kain), the Department of Orthopaedic Surgery, Precision Orthopedics and Sports Medicine, Irving, TX. (Lee), the Department of Orthopaedic Surgery, OrthoArkansas, Little Rock, AR. (Burn), the Department of Orthopedic Surgery, OHSU-Hillsboro Medical Center, Hillsboro, OR. (Hall), the Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA (Willey), the Department of Orthopaedic Surgery, University of Arizona Phoenix, Phoenix, AZ (McKee), the Department of Orthopaedic Surgery, Orthopedic Physician Associates, Seattle, WA (Pang), the Department of Orthopaedic Surgery, White Plains Hospital Physician Associates, White Plains, NY. (Douglass), the Department of Orthopaedic Surgery, NYU Langone Health, New York, NY. (Egol), the Department of Orthopaedic Surgery, University of Texas at Austin, Austin, TX (Laverty), the Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO. (Miller), the Department of Orthopaedic Surgery, Prisma Health (Jeray), the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Schenker), the Novant Health Fracture Clinic, UNC SOM-Charlotte, Charlotte, NC. (Cannada), the Department of Orthopaedic Surgery, University of Miami, Coral Gables, FL (Hernandez), the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Mehta), the Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA (Wustrack, Morshed and Shapiro), the Department of Orthopaedic Surgery, Salem Orthopedics, Salem, OR. (Mitchell), and the Department of Surgery (Morris, Harris) and the Department of Health Policy (Baker), Stanford University, Stanford, CA.
对于关节骨折患者来说,手术 (TTS) 的时间延迟增加了死亡风险. 包括患者健康和护理协调在内的八个关键主题被确定为美国医院延误的驱动因素.
科学领域:
- 整形外科手术 整形外科手术
- 医疗保健管理的管理
- 实施科学 实施科学
背景情况:
- 关节骨折手术延迟时间 (TTS) 与患者不良结果有关,包括死亡率增加.
- 虽然建议进行早期手术 (24-48小时内),但改善TTS的策略产生了不一致的结果.
- 了解导致TTS延迟的具体因素在美国不同的医疗保健环境中对于有针对性的干预至关重要.
研究的目的:
- 确定美国各医疗机构中关节骨折患者手术延迟时间 (TTS) 的主要驱动因素.
- 为制定量身定制的改进策略提供信息,以减少TTS延迟.
主要方法:
- 从22个美国医院系统中对25名利益相关者 (24名骨科外科医生,1名护士) 进行了半结构面试.
- 实施研究和理论领域框架的综合框架指导了采访过程.
- 采访成绩单使用代,结合感应和演方法来分析,以确定总体主题.
主要成果:
- 八个主要主题成为推迟TTS的驱动因素:患者健康,结构性健康驱动因素,护理协调,优先级,改善气候,可用性,激励结构和赋权.
- 这些主题代表了在不同医院系统中影响TTS的因素的全面概述.
- 这些发现强调了TTS延迟在关节骨折护理中的多方面的性质.
结论:
- 该研究确定了八个重要主题,这些主题有助于延迟全国范围内关节骨折患者的手术时间.
- 这些发现为卫生系统确定特定地点的TTS延迟驱动因素提供了基础.
- 基于这些已识别的驱动因素,可以制定和实施有针对性的改进计划,以提高患者的护理和结果.
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