Goldman Joanne, Reeves Scott, Wu Robert, Silver Ivan, MacMillan Kathleen, Kitto Simon
Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Wilson Centre, University Health Network, Toronto, ON, Canada.
J Gen Intern Med. 2015 Oct;30(10):1454-60. doi: 10.1007/s11606-015-3306-6. Epub 2015 Apr 14.
Interprofessional collaboration is an important aspect of patient discharge from a general internal medicine (GIM) unit. However, there has been minimal empirical or theoretical research that has examined interactions that occur between medical residents and other healthcare professionals in the discharge process. This study provides insight into the social processes that shape and characterize such interactions.
To explore factors that shape interactions between medical residents and other healthcare professionals in relation to patient discharge, and to examine the opportunities for negotiations about discharge between these professional groups.
A qualitative ethnographic approach using observations, interviews and documentary analysis.
Healthcare professionals working in a GIM unit in Canada.
Sixty-five hours of observations were undertaken in a range of settings (e.g. interprofessional rounds, medical and nursing rounds, nursing station) in the unit over a 17-month period. A maximum variation sampling approach was used to identify healthcare professionals working in the unit. Twenty-three interviews were completed, recorded and transcribed verbatim. A directed content approach using theories of medical dominance and negotiated order was used to analyze the data.
The organization of clinical work in combination with clinical teaching influenced interprofessional interactions and the quality of discharge in this GIM unit. While organizational activities (orientation and rounds) and individual activities (e.g. role modeling, teaching) supported negotiations between medical residents and other healthcare professionals around discharge, participants had varied perspectives about their effectiveness.
This study illuminates social factors and processes that require attention in order to address challenges with interprofessional collaboration and discharge in GIM. These findings have implications for medical education, workplace learning, patient safety and quality improvement.
跨专业协作是普通内科（GIM）病房患者出院过程中的一个重要方面。然而，关于住院医师与其他医疗保健专业人员在出院过程中发生的互动，实证或理论研究极少。本研究深入探讨了塑造此类互动并使其具有特征的社会过程。
探讨影响住院医师与其他医疗保健专业人员在患者出院方面互动的因素，并研究这些专业群体之间就出院事宜进行协商的机会。
采用观察、访谈和文献分析的定性人种学方法。
在加拿大一个普通内科病房工作的医疗保健专业人员。
在17个月的时间里，在该病房的一系列场所（如跨专业查房、医护查房、护士站）进行了65小时的观察。采用最大差异抽样法确定在该病房工作的医疗保健专业人员。完成了23次访谈，进行了录音并逐字转录。使用医学主导理论和协商秩序理论的定向内容分析法对数据进行分析。
临床工作的组织与临床教学相结合，影响了该普通内科病房的跨专业互动和出院质量。虽然组织活动（入职培训和查房）和个人活动（如树立榜样、教学）支持住院医师与其他医疗保健专业人员围绕出院进行协商，但参与者对其有效性的看法各不相同。
本研究阐明了在普通内科中应对跨专业协作和出院挑战时需要关注的社会因素和过程。这些发现对医学教育、职场学习、患者安全和质量改进具有启示意义。
