关键词: 儿童, 院内转运, 田野研究, 障碍因素分析

Abstract: Background:Few studies have focused on the adherence to and implementation barriers of clinical practice guideline recommendations. Objective:To assess compliance with the Clinical Practice Guidelines for IntraHospital Transport of Pediatric Patients (2023) among medical staff in the emergency department and PICU and to identify the implementation barriers. Design:Field study Methods:The research was carried out in the emergency department, PICU, and general wards of Children's Hospital of Fudan University. Through participation in the practice of medical staff during intrahospital transport of critically ill children, field notes were used to describe the current situation of oneway transport from the emergency department or PICU to general wards, as well as to analyze the barriers to implementing recommendations in the guideline. Based on recommendations 15 of the guideline, the PICUtotargetdepartment process (Appendix 2G in the guideline), was divided into three phases (pretransport, during transport, and upon arrival at the receiving department) and 10 specific indicators. Descriptive observation, interviews, focus observation, and selective observation were employed to collect data. A template analysis method was used to extract baseline data from the field notes and analyze compliance with specific indicators and barriers. Main outcome measures:Barriers to adhering to recommendations of 15 in the guideline. Results:From January 1st to March 21st, 2024, 49 intrahospital transports of critically ill children involving 25 medical staff (7 emergency nurses, 7 PICU doctors, and 11 PICU nurses) were observed. Ten transports were from the emergency department to the PICU, and 18 and 21 were from the PICU to internal and surgical wards, respectively. The 25 participating medical staff had an average age of 31.3±5.0 years, and the children transported (49 cases) had an average age of 70.0±48.6 months. The average transport time was 16.1±6.0 minutes, with an average bedside handoff time of 6.8±3.5 minutes. Bedside handoffs were interrupted in 11 cases, and two adverse events were recorded during transport: forgetting to carry tube feeding and a child vomiting en route. The 10 indicators across the three phases of transport (pretransport, during transport, and upon arrival at the receiving department) showed partial compliance with the guideline recommendations. The transport decisionmaking, child placement, and inquiry indicators generally aligned with the guideline; the monitoring, telephone communication, and transport planning indicators partially complied, while transport personnel, equipment and medication preparation, evaluation and documentation, and handoff of the child's condition did not meet the guidelines The preparation for receiving the child was in line with the recommendations. Potential barriers to guideline implementation included low enthusiasm among medical staff for adopting new practices, lack of effective communication mechanisms between departments, gaps between recommended practice and clinical situations, poor adherence to specific guideline evidence, and insufficient innovation in the guideline recommendations. Conclusion:Adherence to the guideline recommendations for intrahospital transport of critically ill children is poor. Barriers include insufficient awareness among medical staff regarding the safety of intrahospital transport and a gap between the guideline recommendations and actual clinical transport scenarios.

Key words: Children, Intra-hospital transport, Field study, Barrier factor analysis