Rising Kristin L, Padrez Kevin A, O'Brien Meghan, Hollander Judd E, Carr Brendan G, Shea Judy A
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
University of California San Francisco School of Medicine, San Francisco, CA.
Ann Emerg Med. 2015 Apr;65(4):377-386.e3. doi: 10.1016/j.annemergmed.2014.07.015. Epub 2014 Aug 27.
Reasons for recurrent emergency department (ED) visits have been examined primarily through administrative data review. Inclusion of patients' perspectives of reasons for ED return may help inform future initiatives aimed at reducing recurrent utilization. The objective of this study is to describe the personal experiences and challenges faced by patients transitioning home after an ED discharge.
We performed semistructured qualitative interviews of adult patients with an unscheduled return to the ED within 9 days of an index ED discharge. Questions focused on problems with the initial discharge process, medications, outpatient care access, social support, and health care decisionmaking. Themes were identified with a modified grounded theory approach.
Sixty interviews were performed. Most patients were satisfied with the discharge process at the index discharge, but many had complaints about the clinical care delivered, including insufficient evaluation and treatment. The primary reason for returning to the ED was fear or uncertainty about their condition. Most patients had a primary care physician, but they rarely visited a physician before returning to the ED. Patients cited convenience and more expedited evaluations as primary reasons for seeking care in the ED versus the clinic.
Postdischarge factors, including perceived inability to access timely follow-up care and uncertainty and fear about disease progression, are primary motivators for return to the ED. Many patients prefer hospital-based care because of increased convenience and timely results. Further work is needed to develop alternative pathways for patients to ask questions and seek guidance when and where they want.
急诊复诊的原因主要通过行政数据审查进行研究。纳入患者对急诊复诊原因的看法可能有助于为未来旨在减少复诊率的举措提供参考。本研究的目的是描述急诊出院后回家的患者所面临的个人经历和挑战。
我们对在首次急诊出院后9天内非计划返回急诊的成年患者进行了半结构化定性访谈。问题集中在初始出院过程、药物、门诊就医、社会支持和医疗决策方面的问题。采用改良的扎根理论方法确定主题。
进行了60次访谈。大多数患者对首次出院时的出院过程感到满意，但许多人对所提供的临床护理有抱怨，包括评估和治疗不足。返回急诊的主要原因是对自身病情的恐惧或不确定。大多数患者有初级保健医生，但他们在返回急诊之前很少看医生。患者将便利性和更快的评估作为在急诊而非诊所就医的主要原因。
出院后的因素，包括感觉无法获得及时的后续护理以及对疾病进展的不确定和恐惧，是返回急诊的主要动机。许多患者更喜欢基于医院的护理，因为其便利性增加且结果及时。需要进一步开展工作，为患者开发在他们希望的时间和地点提问和寻求指导的替代途径。
