Coleman Eric A, Berenson Robert A
Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Aurora, Colorado 80011, USA.
Ann Intern Med. 2004 Oct 5;141(7):533-6. doi: 10.7326/0003-4819-141-7-200410050-00009.
Transitional care has been defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care in the same location. Transitional care, which primarily concerns the relatively brief time interval that begins with preparing a patient to leave one setting and concludes when the patient is received in the next setting, poses challenges that distinguish it from other types of care. Many transitions are unplanned, result from unanticipated medical problems, occur in "real time" during nights and on weekends, involve clinicians who may not have an ongoing relationship with the patient, and happen so quickly that formal and informal support mechanisms cannot respond in a timely manner. This article describes the challenges involved in and potential solutions for improving the quality of transitional care.
过渡性护理被定义为一系列旨在确保患者在不同地点之间转移或在同一地点的不同护理级别之间转换时，医疗保健的协调与连续性的行动。过渡性护理主要涉及从为患者准备离开一个环境开始，到患者在下一个环境中被接收时结束的相对短暂的时间间隔，它带来了一些使其有别于其他类型护理的挑战。许多过渡是无计划的，由意外的医疗问题导致，在夜间和周末的“实时”发生，涉及可能与患者没有持续关系的临床医生，而且发生得非常迅速，以至于正式和非正式的支持机制无法及时做出反应。本文描述了改善过渡性护理质量所涉及的挑战及潜在解决方案。
