Robert Wood Johnson Clinical Scholars Program-Yale University School of Medicine, New Haven, Connecticut, USA.
J Hosp Med. 2012 May-Jun;7(5):376-81. doi: 10.1002/jhm.1928. Epub 2012 Feb 29.
Improving hospital discharge has become a national priority for teaching hospitals, yet little is known about physician perspectives on factors limiting the quality of discharge care.
To describe the discharge process from the perspective of housestaff physicians, and to generate hypotheses about quality-limiting factors and key strategies for improvement.
Qualitative study with in-depth, in-person interviews with a diverse sample of 29 internal medicine housestaff, in 2010-2011, at 2 separate internal medicine training programs, including 7 different hospitals. We used the constant comparative method of qualitative analysis to explore the experiences and perceptions of factors affecting the quality of discharge care.
We identified 5 unifying themes describing factors perceived to limit the quality of discharge care: (1) competing priorities in the discharge process; (2) inadequate coordination within multidisciplinary discharge teams; (3) lack of standardization in discharge procedures; (4) poor patient and family communication; and (5) lack of postdischarge feedback and clinical responsibility.
Quality-limiting factors described by housestaff identified key processes for intervention. Establishment of clear standards for discharge procedures, including interdisciplinary teamwork, patient communication, and postdischarge continuity of care, may improve the quality of discharge care by housestaff at teaching hospitals.
提高医院出院率已成为教学医院的国家重点，但对于住院医师对限制出院护理质量的因素的看法知之甚少。
从住院医师的角度描述出院过程，并对质量限制因素和改进的关键策略提出假设。
采用定性研究方法，对 2010 年至 2011 年在 2 个独立的内科培训项目中的 29 名内科住院医师进行深入的面对面访谈，包括 7 家不同的医院。我们使用定性分析的恒定性比较方法来探讨影响出院护理质量的经验和看法。
我们确定了 5 个统一的主题，描述了被认为限制出院护理质量的因素：（1）出院过程中的竞争优先级；（2）多学科出院团队内部协调不足；（3）出院程序缺乏标准化；（4）患者和家属沟通不良；（5）缺乏出院后反馈和临床责任。
住院医师描述的质量限制因素确定了干预的关键流程。明确规定出院程序的标准，包括跨学科团队合作、患者沟通和出院后的连续性护理，可能会提高教学医院住院医师的出院护理质量。
