Martin Lynn, Hirdes John P
Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada.
BMC Health Serv Res. 2014 Oct 3;14:457. doi: 10.1186/1472-6963-14-457.
Recognition that integrated services can lead to more efficient and effective care has made the principle of integration a priority for health systems worldwide for the last decade. However, actually bringing fully integrated services to life has eluded most health care organizations. Mental health has followed the rule, rather than the exception, when it comes integrating services. The lack of effective mechanisms to evaluate the needs of persons across mental health care services has been an important barrier to communication between professionals involved in care. This study sought to understand communication among inpatient and community-based mental health staff during transfers of care, before and after implementation of compatible assessment instrumentation.
Two focus groups were held with staff from inpatient (n = 10) and community (n = 10) settings in an urban, specialized psychiatric hospital in Ontario (Canada) - prior to and one year after implementation of compatible instrumentation in the community program. Transcripts were coded and aggregated into themes.
Very different views of current communication patterns during transfers of care emerged. Inpatient mental health staff described a predictable, well-known process, whereas community-based staff emphasized unpredictability. Staff also discussed issues related to trust and the circle of care. All agreed that compatible assessments in inpatient and community mental health settings would facilitate communication through use of a common assessment language. However, no change in communication patterns was reported one year post implementation of compatible instrumentation.
Though all participants agreed on the potential for compatible instrumentation to improve communication during transfers of care, this cannot happen overnight. A number of issues related to trust, evidence-based practice, and organizational factors act as barriers to communication. In particular, staff noted the need for the results of comprehensive mental health assessments to be transformed into meaningful, user-friendly clinical summaries to facilitate uptake of assessment information, and consequently use of a common assessment language across mental health settings.
在过去十年中，认识到综合服务可带来更高效和有效的护理，这使得整合原则成为全球卫生系统的优先事项。然而，让完全整合的服务成为现实却困扰着大多数医疗保健组织。在整合服务方面，精神卫生领域遵循的是常规情况，而非例外。缺乏有效的机制来评估跨精神卫生保健服务的人员需求，一直是参与护理的专业人员之间沟通的重要障碍。本研究旨在了解在实施兼容的评估工具之前和之后，住院和社区精神卫生工作人员在护理转接过程中的沟通情况。
在加拿大安大略省一家城市专科医院，对住院部（n = 10）和社区部（n = 10）的工作人员进行了两次焦点小组讨论——一次在社区项目中实施兼容工具之前，另一次在实施一年之后。对访谈记录进行编码并归纳为主题。
在护理转接过程中，出现了对当前沟通模式截然不同的看法。住院精神卫生工作人员描述了一个可预测、广为人知的过程，而社区工作人员则强调不可预测性。工作人员还讨论了与信任和护理圈子相关的问题。所有人都同意，住院和社区精神卫生环境中的兼容评估将通过使用共同的评估语言来促进沟通。然而，在实施兼容工具一年后，未报告沟通模式有任何变化。
尽管所有参与者都认同兼容工具在护理转接过程中改善沟通的潜力，但这并非一蹴而就。一些与信任、循证实践和组织因素相关的问题成为沟通的障碍。特别是，工作人员指出，需要将全面精神卫生评估的结果转化为有意义、便于用户使用的临床摘要，以促进评估信息的采用，并因此在精神卫生环境中使用共同的评估语言。
