Johnson Julie K, Farnan Jeanne M, Barach Paul, Hesselink Gijs, Wollersheim Hub, Pijnenborg Loes, Kalkman Cor, Arora Vineet M
Faculty of Medicine, Centre for Clinical Governance Research, University of New South Wales, Sydney, NSW 2052, Australia.
BMJ Qual Saf. 2012 Dec;21 Suppl 1:i97-105. doi: 10.1136/bmjqs-2012-001215. Epub 2012 Nov 1.
Safe patient transitions depend on effective communication and a functioning care coordination process. Evidence suggests that primary care physicians are not satisfied with communication at transition points between inpatient and ambulatory care, and that communication often is not provided in a timely manner, omits essential information, or contains ambiguities that put patients at risk.
Our aim was to demonstrate how process mapping can illustrate current handover practices between ambulatory and inpatient care settings, identify existing barriers and facilitators to effective transitions of care, and highlight potential areas for quality improvement.
We conducted focus group interviews to facilitate a process mapping exercise with clinical teams in six academic health centres in the USA, Poland, Sweden, Italy, Spain and the Netherlands.
At a high level, the process of patient admission to the hospital through the emergency department, inpatient care, and discharge back in the community were comparable across sites. In addition, the process maps highlighted similar barriers to providing information to primary care physicians, inaccurate or incomplete information on referral and discharge, a lack of time and priority to collaborate with counterpart colleagues, and a lack of feedback to clinicians involved in the handovers.
Process mapping is effective in bringing together key stakeholders and makes explicit the mental models that frame their understanding of the clinical process. Exploring the barriers and facilitators to safe and reliable patient transitions highlights opportunities for further improvement work and illustrates ideas for best practices that might be transferrable to other settings.
患者的安全转诊依赖于有效的沟通和良好运转的护理协调流程。有证据表明，初级保健医生对住院护理和门诊护理之间转诊点的沟通不满意，而且沟通往往不及时，遗漏重要信息，或包含使患者面临风险的模糊内容。
我们的目的是展示流程映射如何阐明门诊和住院护理环境之间当前的交接实践，识别有效护理转诊的现有障碍和促进因素，并突出质量改进的潜在领域。
我们进行了焦点小组访谈，以促进与美国、波兰、瑞典、意大利、西班牙和荷兰的六个学术健康中心的临床团队开展流程映射活动。
总体而言，各地点患者通过急诊科入院、住院护理以及出院返回社区的流程具有可比性。此外，流程映射突出了向初级保健医生提供信息方面的类似障碍、转诊和出院信息不准确或不完整、缺乏与对应同事协作的时间和优先级，以及对参与交接的临床医生缺乏反馈。
流程映射有效地汇聚了关键利益相关者，并明确了构成他们对临床流程理解的思维模式。探索安全可靠的患者转诊的障碍和促进因素，突出了进一步改进工作的机会，并阐明了可能适用于其他环境的最佳实践思路。
