英国紧急部门工作人员对 NHS 111 First 的看法：定性访谈研究。
Emergency department staff views of NHS 111 First: qualitative interview study in England.
机构信息
Primary Healthcare Sciences, University of Oxford, Oxford, UK
Faculty of Health Sciences, University of Southampton, Southampton, UK.
出版信息
Emerg Med J. 2023 Sep;40(9):636-640. doi: 10.1136/emermed-2022-212947. Epub 2023 Jul 6.
BACKGROUND
NHS 111 is a phone and online urgent care triage and assessment system that aims to reduce UK ED demand. In 2020, 111 First was introduced to triage patients before entry to the ED and to offer direct booking for patients needing ED or urgent care into same-day arrival time slots. 111 First continues to be used post pandemic, but concerns about patient safety, delays or inequities in accessing care have been voiced. This paper examines ED and urgent care centre (UCC) staff experiences of NHS 111 First.
METHOD
Semistructured telephone interviews were conducted with ED/UCC practitioners across England between October 2020 and July 2021 as part of a larger multimethod study examining the impact of NHS 111 online. We purposively recruited from areas with high need/demand likely to be using NHS 111 services. Interviews were transcribed verbatim and coded inductively by the primary researcher. We coded all items to capture experiences of 111 First within the full project coding tree and from this constructed two explanatory themes which were refined by the wider research team.
RESULTS
We recruited 27 participants (10 nurses, 9 doctors and 8 administrator/managers) working in ED/UCCs serving areas with high deprivation and mixed sociodemographic profiles. Participants reported local triage/streaming systems predating 111 First continued to operate so that, despite prebooked arrival slots at the ED, all attendances were funnelled into a single queue. This was described by participants as a source of frustration for staff and patients. Interviewees perceived remote algorithm-based assessments as less robust than in-person assessments which drew on more nuanced clinical expertise.
DISCUSSION
While remote preassessment of patients before they present at ED is attractive, existing triage and streaming systems based on acuity, and staff views about the superiority of clinical acumen, are likely to remain barriers to the effective use of 111 First as a demand management strategy.
背景
NHS 111 是一个电话和在线紧急护理分诊和评估系统，旨在减少英国急诊部的需求。2020 年，111 先遣队被引入，对进入急诊部的患者进行分诊，并为需要急诊部或紧急护理的患者提供直接预约当天到达时段的服务。111 先遣队在大流行后仍在继续使用，但人们对患者安全、护理延迟或获取护理的不平等表示担忧。本文探讨了急诊部和紧急护理中心（UCC）工作人员对 NHS 111 先遣队的体验。
方法
作为一项更大的多方法研究的一部分，我们于 2020 年 10 月至 2021 年 7 月期间在英格兰各地对急诊部/UCC 从业者进行了半结构化电话访谈，该研究旨在检查 NHS 111 在线的影响。我们有目的地从需求高/需求大的地区招募人员，这些地区可能会使用 NHS 111 服务。访谈内容逐字转录，并由主要研究人员进行归纳编码。我们对所有项目进行编码，以捕捉 NHS 111 先遣队在整个项目编码树中的体验，并从这些项目中构建了两个解释性主题，这些主题由更广泛的研究团队进行了完善。
结果
我们招募了 27 名参与者（10 名护士、9 名医生和 8 名行政人员/管理人员），他们在 ED/UCC 工作，服务于高贫困地区，社会人口学特征混合。参与者报告说，111 先遣队之前的分诊/分流系统仍在运行，因此，尽管在急诊部有预订的到达时段，但所有就诊者都被引导到一个单一的队列中。这被参与者描述为工作人员和患者感到沮丧的一个原因。受访者认为远程基于算法的评估不如面对面评估可靠，因为面对面评估可以利用更细致的临床专业知识。
讨论
虽然在患者到达急诊部之前对其进行远程评估很有吸引力，但基于严重程度的现有分诊和分流系统，以及工作人员对临床敏锐度优越性的看法，可能仍然是有效使用 111 先遣队作为需求管理策略的障碍。
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