Groene Raluca Oana, Orrego Carola, Suñol Rosa, Barach Paul, Groene Oliver
Faculty of Health and Social Care, London South Bank University, Keyworth Street, K2 Building, London SE1 6NG, UK.
BMJ Qual Saf. 2012 Dec;21 Suppl 1(Suppl_1):i67-75. doi: 10.1136/bmjqs-2012-001174. Epub 2012 Oct 30.
Handover practices at hospital discharge are relatively under-researched, particularly as regards the specific risks and additional requirements for handovers involving vulnerable patients with limited language, cognitive and social resources.
To explore handover practices at discharge and to focus on the patients' role in handovers and on the potential additional risks for vulnerable patients.
We conducted qualitative interviews with patients, hospital professionals and primary care professionals in two hospitals and their associated primary care centres in Catalonia, Spain.
We identified handover practices at discharge that potentially put patients at risk. Patients did not feel empowered in the handover but were expected to transfer information between care providers. Professionals identified lack of medication reconciliation at discharge, loss of discharge information, and absence of plans for follow-up care in the community as quality and safety problems for discharge handovers. These occurred for all patients, but appeared to be more frequent and have a greater negative effect in patients with limited language comprehension and/or lack of family and social support systems.
Discharge handovers are often haphazard. Healthcare professionals do not consider current handover practices safe, with patients expected to transfer information without being empowered to understand and act on it. This can lead to misinformation, omission or duplication of tests or interventions and, potentially, patient harm. Vulnerable patients may be at greater risk given their limited language, cognitive and social resources. Patient safety at discharge could benefit from strategies to enhance patient education and promote empowerment.
医院出院时的交接流程相对缺乏研究，尤其是涉及语言、认知和社会资源有限的弱势患者的交接所存在的特定风险和额外要求方面。
探讨出院时的交接流程，重点关注患者在交接中的作用以及弱势患者可能面临的额外风险。
我们对西班牙加泰罗尼亚地区两家医院及其相关基层医疗中心的患者、医院专业人员和基层医疗专业人员进行了定性访谈。
我们发现了出院时可能使患者面临风险的交接流程。患者在交接过程中感觉自己没有权力，但却被期望在医疗服务提供者之间传递信息。专业人员指出，出院时缺乏用药核对、出院信息丢失以及社区后续护理计划缺失是出院交接中的质量和安全问题。这些问题在所有患者中都存在，但在语言理解能力有限和/或缺乏家庭及社会支持系统的患者中似乎更为频繁且负面影响更大。
出院交接往往很随意。医疗保健专业人员认为当前的交接流程不安全，患者在没有权力理解和采取行动的情况下被期望传递信息。这可能导致信息错误、检查或干预的遗漏或重复，甚至可能对患者造成伤害。鉴于弱势患者的语言、认知和社会资源有限，他们可能面临更大的风险。出院时的患者安全可受益于加强患者教育和促进赋权的策略。
