Full capacity protocol (FCP) is an internationally recognized intervention designed to address emergency department (ED) crowding. Despite FCP international recognition and positive effects on hospital performance measures, many hospitals, even the most crowded ones, have not implemented FCP. We conducted this study to identify the core components of FCP, explore the key barriers and facilitators associated with the FCP implementation, and provide practical recommendations on how to overcome those barriers. To identify the core components of FCP, we used a non-experimental approach. We conducted semi-structured interviews with key informants (e.g., division chiefs, medical directors) involved in the implementation of FCP. We used the Consolidated Framework for Implementation Research (CFIR) to guide data collection and analysis. We used a template analysis approach to determine the relevance of the CFIR constructs to implementing the FCP. We analyzed the responses to the interview questions about FCP definition and FCP key principles, compared different hospitals’ FCP official documents, and consulted with the original FCP developer. We then used an adaptation framework to categorize the core components of FCP into three main groups. Finally, we summarized practical recommendations for each barrier based on information provided by the interviewees. A total of 32 interviews were conducted. We observed that FCP has evolved from the idea of transferring boarded patients from ED hallways to inpatient hallways to a practical hospital-wide intervention with several components and multiple levels. The key determinant of successful FCP implementation was collaboration with inpatient nursing staff, as they were often reluctant to have patients boarded in inpatient hallways. Other determinants of successful FCP implementation were reaching consensus about the criteria for activation of each FCP level and actions in each FCP level, modifying the electronic health records system, restructuring the inpatient units to have adequate staffing and resources, complying with external regulations and policies such as fire marshal guidelines, and gaining hospital leaders’ support. The key determinant in implementing FCP is creating a supportive and cooperative hospital culture and encouraging key stakeholders, including inpatient nursing staff, to acknowledge that crowding is a hospital-wide problem that requires a hospital-wide response.

中文翻译：

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什么是全容量协议，如何成功实施？

全容量协议（FCP）是国际上公认的干预措施，旨在解决急诊部（ED）拥挤的问题。尽管FCP获得了国际认可并对医院绩效指标产生了积极影响，但许多医院，即使是最拥挤的医院，也没有实施FCP。我们进行了这项研究，以识别FCP的核心组成部分，探索与FCP实施相关的主要障碍和促进者，并就如何克服这些障碍提供实用的建议。为了确定FCP的核心组成部分，我们使用了一种非实验方法。我们对参与FCP实施的关键信息提供者（例如部门负责人，医疗主管）进行了半结构化采访。我们使用了实施研究综合框架（CFIR）来指导数据收集和分析。我们使用模板分析方法来确定CFIR构造与实施FCP的相关性。我们分析了有关FCP定义和FCP关键原则的访谈问题，对不同医院的FCP正式文件进行了比较，并咨询了FCP的原始开发者。然后，我们使用适应框架将FCP的核心组件分为三个主要类别。最后，我们根据受访者提供的信息总结了每种障碍的实用建议。总共进行了32次采访。我们观察到，FCP已从将登机患者从ED走廊转移到住院走廊的想法演变为具有多个组成部分和多个层次的医院范围内的实际干预措施。成功实施FCP的关键因素是与住院护理人员的合作，因为他们通常不愿让患者登上住院走廊。成功实施FCP的其他决定因素包括：关于激活每个FCP级别和每个FCP级别的动作的标准，修改电子健康记录系统，重组住院单元以拥有足够的人员和资源，遵守外部法规和政策等方面达成共识。作为消防元帅的指导方针，并获得医院领导的支持。实施FCP的关键决定因素是营造一种支持性和合作性的医院文化，并鼓励包括住院护理人员在内的主要利益相关者认识到拥挤是整个医院的问题，需要整个医院的回应。