Chunqing Lin1, Li Li2, Liang Chen3, Yunjiao Pan3, Jihui Guan3. 1. Semel Institute for Neuroscience and Human Behavior, Center for Community Health, The University of California at Los Angeles, Los Angeles, CA. Electronic address: lincq@ucla.edu. 2. Semel Institute for Neuroscience and Human Behavior, Center for Community Health, The University of California at Los Angeles, Los Angeles, CA. 3. Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China.
Abstract
BACKGROUND: Service providers are often inadequately compliant with standard precaution protocols. This study used bottleneck analysis to identify the weakest link in standard precaution implementation and its associated challenges in hospitals. METHODS: Bottleneck analysis was conducted in 12 hospitals in Fujian Province, China. In each hospital, a focus group was organized among the key informants to illustrate the sequential steps of standard precaution implementation graphically. The level of difficulty and the specific challenges associated with each step were discussed. RESULTS: The sequential activities of standard precaution implementation generally start with making budget for personal protection equipment (PPE), followed by procurement, storage/inventory, in-hospital distribution, in-department distribution, usage/monitoring, and recycling of PPE. Service providers' improper use of PPE was the primary bottleneck. The reasons for improper use of PPE included high workload, time constraints, the sense of wearing PPE would interfere with clinical judgment, and various misconceptions. Making financial planning, recycling, and procurement of PPE were the secondary bottlenecks. CONCLUSIONS: Bottleneck analysis is useful to illustrate workflow in healthcare systems and pinpoint constraints in standard precaution implementation. Institutional changes, including targeted provider training, adjustment of providers' workloads, and allocation of budget, are suggested strategies to address the identified bottlenecks in standard precaution.
BACKGROUND: Service providers are often inadequately compliant with standard precaution protocols. This study used bottleneck analysis to identify the weakest link in standard precaution implementation and its associated challenges in hospitals. METHODS: Bottleneck analysis was conducted in 12 hospitals in Fujian Province, China. In each hospital, a focus group was organized among the key informants to illustrate the sequential steps of standard precaution implementation graphically. The level of difficulty and the specific challenges associated with each step were discussed. RESULTS: The sequential activities of standard precaution implementation generally start with making budget for personal protection equipment (PPE), followed by procurement, storage/inventory, in-hospital distribution, in-department distribution, usage/monitoring, and recycling of PPE. Service providers' improper use of PPE was the primary bottleneck. The reasons for improper use of PPE included high workload, time constraints, the sense of wearing PPE would interfere with clinical judgment, and various misconceptions. Making financial planning, recycling, and procurement of PPE were the secondary bottlenecks. CONCLUSIONS: Bottleneck analysis is useful to illustrate workflow in healthcare systems and pinpoint constraints in standard precaution implementation. Institutional changes, including targeted provider training, adjustment of providers' workloads, and allocation of budget, are suggested strategies to address the identified bottlenecks in standard precaution.
Authors: Bryan E Bledsoe; Richard J Sweeney; Ross P Berkeley; Korey T Cole; Wesley J Forred; Larry D Johnson Journal: Prehosp Emerg Care Date: 2014-01-08 Impact factor: 3.077
Authors: Robert R Muder; Candace Cunningham; Ellesha McCray; Cheryl Squier; Peter Perreiah; Rajiv Jain; Ronda L Sinkowitz-Cochran; John A Jernigan Journal: Infect Control Hosp Epidemiol Date: 2008-08 Impact factor: 3.254