Hammond Christina L, Pinnington Lorraine L, Phillips Margaret F
Rehabilitation Research and Education Group, School of Community Health Sciences, University of Nottingham, Derby, UK.
BMC Health Serv Res. 2009 Mar 5;9:44. doi: 10.1186/1472-6963-9-44.
Research has shown that a number of patients, with a variety of diagnoses, are admitted to hospital when it is not essential and can remain in hospital unnecessarily. To date, research in this area has been primarily quantitative. The purpose of this study was to explore the perceived causes of inappropriate or prolonged lengths of stay and focuses on a specific population (i.e., patients with long term neurological conditions). We also wanted to identify interventions which might avoid admission or expedite discharge as periods of hospitalisation pose particular risks for this group.
Two focus groups were conducted with a convenience sample of eight primary and secondary care clinicians working in the Derbyshire area. Data were analysed using a thematic content approach.
The participants identified a number of key causes of inappropriate admissions and lengths of stay, including: the limited capacity of health and social care resources; poor communication between primary and secondary care clinicians and the cautiousness of clinicians who manage patients in community settings. The participants also suggested a number of strategies that may prevent inappropriate admissions or reduce length of stay (LoS), including: the introduction of new sub-acute care facilities; the introduction of auxiliary nurses to support specialist nursing staff and patient held summaries of specialist consultations.
Clinicians in both the secondary and primary care sectors acknowledged that some admissions were unnecessary and some patients remain in hospital for a prolonged period. These events were attributed to problems with the current capacity or structuring of services. It was noted, for example, that there is a shortage of appropriate therapeutic services and that the distribution of beds between community and sub-acute care should be reviewed.
研究表明,许多患有各种疾病的患者在并非必要时入院,且可能不必要地长期住院。迄今为止,该领域的研究主要是定量研究。本研究的目的是探讨住院时间不当或过长的感知原因,并聚焦于特定人群(即患有长期神经系统疾病的患者)。我们还希望确定哪些干预措施可以避免入院或加快出院,因为住院期间对该群体构成特殊风险。
对德比郡地区的8名初级和二级护理临床医生进行了便利抽样,组成两个焦点小组。采用主题内容分析法对数据进行分析。
参与者确定了一些导致不当入院和住院时间过长的关键原因,包括:卫生和社会护理资源有限;初级和二级护理临床医生之间沟通不畅;以及社区环境中管理患者的临床医生的谨慎态度。参与者还提出了一些可能防止不当入院或缩短住院时间的策略,包括:引入新的亚急性护理设施;引入辅助护士以支持专科护理人员;以及患者持有的专科会诊总结。
二级和初级护理部门的临床医生都承认,一些入院是不必要的,一些患者住院时间过长。这些情况归因于当前服务能力或结构方面的问题。例如,有人指出,缺乏适当的治疗服务,社区和亚急性护理之间的床位分配应重新审视。