PDF(Pubmed)
Abstract：
BACKGROUND: Repeated paracentesis for ascites can place significant demands on the emergency department (ED). A new general internist-led outpatient procedure clinic to alleviate this demand required ED staff and patients to accept this transition of care.
OBJECTIVE: This qualitative study evaluates barriers and facilitators to implementing the FLuid ASPiration (FLASP) clinic in a safety net hospital.
METHODS: The FLASP clinic opened during the COVID-19 pandemic in March 2021. From February to April 2022, semi-structured interviews were conducted with: 10 ED physicians and nurses; 5 FLASP clinic patients; and 4 patients receiving paracentesis in the ED. Interviews were recorded, transcribed, and analyzed using a Grounded Theory approach for themes categorized by Theory of Planned Behavior (TPB) domains including: attitudes/knowledge; social norms; and logistics.
RESULTS: Thematic analysis found that ED staff appreciated reduced demand for paracentesis, but barriers included: lack of knowledge; concerns about unstable patients and patient expectations (norms); and scheduling logistics. FLASP clinic patients had only favorable themes: belief in clinic safety; positive relationship with staff; and clinic efficiency. Patients using the ED for paracentesis expressed only concerns: possible need for testing or hospitalization; care usually in the ED; and unclear clinic scheduling.
CONCLUSIONS: This study reveals challenges to transitioning sites of care for paracentesis including the need for greater ED staff education and standardizing methods to triage patients to appropriate site of care. Greater support and education of ED patients about the benefits of an outpatient procedure clinic may also reduce ED burden for paracentesis.
OBJECTIVE: This qualitative study evaluates barriers and facilitators to implementing the FLuid ASPiration (FLASP) clinic in a safety net hospital.
METHODS: The FLASP clinic opened during the COVID-19 pandemic in March 2021. From February to April 2022, semi-structured interviews were conducted with: 10 ED physicians and nurses; 5 FLASP clinic patients; and 4 patients receiving paracentesis in the ED. Interviews were recorded, transcribed, and analyzed using a Grounded Theory approach for themes categorized by Theory of Planned Behavior (TPB) domains including: attitudes/knowledge; social norms; and logistics.
RESULTS: Thematic analysis found that ED staff appreciated reduced demand for paracentesis, but barriers included: lack of knowledge; concerns about unstable patients and patient expectations (norms); and scheduling logistics. FLASP clinic patients had only favorable themes: belief in clinic safety; positive relationship with staff; and clinic efficiency. Patients using the ED for paracentesis expressed only concerns: possible need for testing or hospitalization; care usually in the ED; and unclear clinic scheduling.
CONCLUSIONS: This study reveals challenges to transitioning sites of care for paracentesis including the need for greater ED staff education and standardizing methods to triage patients to appropriate site of care. Greater support and education of ED patients about the benefits of an outpatient procedure clinic may also reduce ED burden for paracentesis.
摘要：
背景：反复进行腹水穿刺会对急诊科（ED）提出重大要求。为减轻这种需求，新的由普通内科医生领导的门诊手术诊所需要ED工作人员和患者接受这种护理过渡。
目的：这项定性研究评估了在安全网医院实施FLuidASPiration（FLASP）诊所的障碍和促进因素。
方法：FLASP诊所在2021年3月COVID-19大流行期间开业。从2022年2月至4月，对以下人员进行了半结构化访谈：10名ED医师和护士；5名FLASP临床患者；和4名在ED接受穿刺的患者。采访被记录下来，转录，并使用扎根理论方法对按计划行为理论（TPB）领域分类的主题进行分析，包括：态度/知识；社会规范；和物流。
结果：主题分析发现，ED工作人员赞赏对穿刺的需求减少，但障碍包括:缺乏知识;对不稳定患者和患者期望(规范)的担忧;和调度后勤.FLASP临床患者只有有利的主题：对临床安全的信念；与员工的积极关系；和临床效率。使用ED进行穿刺的患者仅表示担忧：可能需要进行测试或住院；通常在ED中进行护理；并且不清楚临床安排。
结论：本研究揭示了改变穿刺术护理地点所面临的挑战，包括需要更多的ED工作人员教育和标准化方法来将患者分诊到适当的护理地点。对ED患者进行有关门诊手术诊所的益处的更多支持和教育也可以减轻穿刺的ED负担。
目的：这项定性研究评估了在安全网医院实施FLuidASPiration（FLASP）诊所的障碍和促进因素。
方法：FLASP诊所在2021年3月COVID-19大流行期间开业。从2022年2月至4月，对以下人员进行了半结构化访谈：10名ED医师和护士；5名FLASP临床患者；和4名在ED接受穿刺的患者。采访被记录下来，转录，并使用扎根理论方法对按计划行为理论（TPB）领域分类的主题进行分析，包括：态度/知识；社会规范；和物流。
结果：主题分析发现，ED工作人员赞赏对穿刺的需求减少，但障碍包括:缺乏知识;对不稳定患者和患者期望(规范)的担忧;和调度后勤.FLASP临床患者只有有利的主题：对临床安全的信念；与员工的积极关系；和临床效率。使用ED进行穿刺的患者仅表示担忧：可能需要进行测试或住院；通常在ED中进行护理；并且不清楚临床安排。
结论：本研究揭示了改变穿刺术护理地点所面临的挑战，包括需要更多的ED工作人员教育和标准化方法来将患者分诊到适当的护理地点。对ED患者进行有关门诊手术诊所的益处的更多支持和教育也可以减轻穿刺的ED负担。
