Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation

BACKGROUND: Increasing pressure on emergency services has led to the development of different models of care delivery including GPs working in or alongside emergency departments (EDs), but with a lack of evidence for patient safety outcomes. AIM: This study aimed to explore how care processes work a...

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Autores principales: Cooper, Alison, Carson-Stevens, Andrew, Edwards, Michelle, Davies, Freya, Donaldson, Liam J, Anderson, Pippa, Cooke, Matthew, Dale, Jeremy, Evans, Bridie Angela, Harrington, Barbara, Hepburn, Julie, Hibbert, Peter, Hughes, Thomas, Porter, Alison, Siriwardena, Aloysius Niroshan, Snooks, Helen, Edwards, Adrian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544118/
https://www.ncbi.nlm.nih.gov/pubmed/34048363
http://dx.doi.org/10.3399/BJGP.2021.0090
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author Cooper, Alison
Carson-Stevens, Andrew
Edwards, Michelle
Davies, Freya
Donaldson, Liam J
Anderson, Pippa
Cooke, Matthew
Dale, Jeremy
Evans, Bridie Angela
Harrington, Barbara
Hepburn, Julie
Hibbert, Peter
Hughes, Thomas
Porter, Alison
Siriwardena, Aloysius Niroshan
Snooks, Helen
Edwards, Adrian
author_facet Cooper, Alison
Carson-Stevens, Andrew
Edwards, Michelle
Davies, Freya
Donaldson, Liam J
Anderson, Pippa
Cooke, Matthew
Dale, Jeremy
Evans, Bridie Angela
Harrington, Barbara
Hepburn, Julie
Hibbert, Peter
Hughes, Thomas
Porter, Alison
Siriwardena, Aloysius Niroshan
Snooks, Helen
Edwards, Adrian
author_sort Cooper, Alison
collection PubMed
description BACKGROUND: Increasing pressure on emergency services has led to the development of different models of care delivery including GPs working in or alongside emergency departments (EDs), but with a lack of evidence for patient safety outcomes. AIM: This study aimed to explore how care processes work and how patient safety incidents associated with GPs working in ED settings may be mitigated. DESIGN AND SETTING: Realist methodology with a purposive sample of 13 EDs in England and Wales with different GP service models. The study sought to understand the relationship between contexts, mechanisms, and outcomes to develop theories about how and why patient safety incidents may occur, and how safe care was perceived to be delivered. METHOD: Qualitative data were collected (observations, semi-structured audio-recorded staff interviews, and local patient safety incident reports). Data were coded using ‘if, then, because’ statements to refine initial theories developed from an earlier rapid realist literature review and analysis of a sample of national patient safety incident reports. RESULTS: The authors developed a programme theory to describe how safe patient care was perceived to be delivered in these service models, including: an experienced streaming nurse using local guidance and early warning scores; support for GPs’ clinical decision making, with clear governance processes relevant to the intended role (traditional GP approach or emergency medicine approach); and strong clinical leadership to promote teamwork and improve communication between services. CONCLUSION: The findings of this study can be used as a focus for more in-depth human factors investigations to optimise work conditions in this complex care delivery setting.
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spelling pubmed-85441182021-11-12 Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation Cooper, Alison Carson-Stevens, Andrew Edwards, Michelle Davies, Freya Donaldson, Liam J Anderson, Pippa Cooke, Matthew Dale, Jeremy Evans, Bridie Angela Harrington, Barbara Hepburn, Julie Hibbert, Peter Hughes, Thomas Porter, Alison Siriwardena, Aloysius Niroshan Snooks, Helen Edwards, Adrian Br J Gen Pract Research BACKGROUND: Increasing pressure on emergency services has led to the development of different models of care delivery including GPs working in or alongside emergency departments (EDs), but with a lack of evidence for patient safety outcomes. AIM: This study aimed to explore how care processes work and how patient safety incidents associated with GPs working in ED settings may be mitigated. DESIGN AND SETTING: Realist methodology with a purposive sample of 13 EDs in England and Wales with different GP service models. The study sought to understand the relationship between contexts, mechanisms, and outcomes to develop theories about how and why patient safety incidents may occur, and how safe care was perceived to be delivered. METHOD: Qualitative data were collected (observations, semi-structured audio-recorded staff interviews, and local patient safety incident reports). Data were coded using ‘if, then, because’ statements to refine initial theories developed from an earlier rapid realist literature review and analysis of a sample of national patient safety incident reports. RESULTS: The authors developed a programme theory to describe how safe patient care was perceived to be delivered in these service models, including: an experienced streaming nurse using local guidance and early warning scores; support for GPs’ clinical decision making, with clear governance processes relevant to the intended role (traditional GP approach or emergency medicine approach); and strong clinical leadership to promote teamwork and improve communication between services. CONCLUSION: The findings of this study can be used as a focus for more in-depth human factors investigations to optimise work conditions in this complex care delivery setting. Royal College of General Practitioners 2021-10-19 /pmc/articles/PMC8544118/ /pubmed/34048363 http://dx.doi.org/10.3399/BJGP.2021.0090 Text en © The Authors https://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Research
Cooper, Alison
Carson-Stevens, Andrew
Edwards, Michelle
Davies, Freya
Donaldson, Liam J
Anderson, Pippa
Cooke, Matthew
Dale, Jeremy
Evans, Bridie Angela
Harrington, Barbara
Hepburn, Julie
Hibbert, Peter
Hughes, Thomas
Porter, Alison
Siriwardena, Aloysius Niroshan
Snooks, Helen
Edwards, Adrian
Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation
title Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation
title_full Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation
title_fullStr Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation
title_full_unstemmed Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation
title_short Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation
title_sort identifying safe care processes when gps work in or alongside emergency departments: a realist evaluation
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544118/
https://www.ncbi.nlm.nih.gov/pubmed/34048363
http://dx.doi.org/10.3399/BJGP.2021.0090
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