Strategies for adapting under pressure: an interview study in intensive care units.

Autor:	Page B; Department of Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK bethan.page@kcl.ac.uk.; Cicely Saunders Institute, King's College London, London, Greater London, UK., Irving D; Department of Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK., Carthey J; Human Factors and Patient Safety, Jane Carthey Consulting, Chiswick, UK., Welch J; National Institute for Health and Care Research Central London Patient Safety Research Collaborative, University College London Hospitals NHS Foundation Trust, London, UK., Higham H; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.; Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Vincent C; Department of Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK.
Jazyk:	angličtina
Zdroj:	BMJ quality & safety [BMJ Qual Saf] 2024 Aug 23. Date of Electronic Publication: 2024 Aug 23.
DOI:	10.1136/bmjqs-2024-017385
Abstrakt:	Background: Healthcare systems are operating under substantial pressures. Clinicians and managers are constantly having to make adaptations, which are typically improvised, highly variable and not coordinated across teams. This study aimed to identify and describe the types of everyday pressures in intensive care and the adaptive strategies staff use to respond, with the longer-term aim of developing practical and coordinated strategies for managing under pressure. Methods: We conducted qualitative semi-structured interviews with 20 senior multidisciplinary healthcare professionals from intensive care units (ICUs) in 4 major hospitals in the UK. The interviews explored the everyday pressures faced by intensive care staff and the strategies they use to adapt. A thematic template analysis approach was used to analyse the data based on our previously empirically developed taxonomy of pressures and strategies. Results: The principal source of pressure described was a shortage of staff with the necessary skills and experience to care for the increased numbers and complexity of patients which, in turn, increased staff workload and reduced patient flow. Strategies were categorised into anticipatory (in advance of anticipated pressures) and on the day. The dynamic and unpredictable demands on ICUs meant that strategies were mostly deployed on the day, most commonly by flexing staff, prioritisation of patients and tasks and increasing modes of communication and support. Conclusions: ICU staff use a wide variety of adaptive strategies at times of pressure to minimise risk and maintain a reasonable standard of care for patients. These findings provide the foundation for a portfolio of strategies, which can be flexibly employed when under pressure. There is considerable potential for training clinical leaders and teams in the effective use of adaptive strategies. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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