Ellis Kerri A, Connolly Ann, Hosseinnezhad Alireza, Lilly Craig M
Kerri A. Ellis is an assistant clinical professor in the Graduate School of Nursing and an acute care nurse practitioner in the Department of Medicine at UMass Memorial Medical Center, Worcester, Massachusetts. Ann Connolly is a nurse practitioner in the Department of Medicine at UMass Memorial Medical Center. Alireza Hosseinnezhad is a physician in the Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts. Craig M. Lilly is a professor in the Departments of Medicine, Anesthesiology, and Surgery, and in the Clinical and Population Health Research Program at the Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Am J Crit Care. 2015 Nov;24(6):496-500. doi: 10.4037/ajcc2015332.
To increase the frequency of communication of patient information between acute and primary care providers. A secondary objective was to determine whether higher rates of communication were associated with lower rates of hospital readmission 30 days after discharge.
A validated instrument was used for telephone surveys before and after an intervention designed to increase the frequency of communication among acute care and primary care providers. The communication intervention was implemented in 3 adult intensive care units from 2 campuses of an academic medical center.
The frequency of communication among acute care and primary care providers, the perceived usefulness of the intervention, and its association with 30-day readmission rates were assessed for 202 adult intensive care episodes before and 100 episodes after a communication intervention. The frequency of documented communication increased significantly (5/202 or 2% before to 72/100 or 72% after the intervention; P < .001) and the communication was considered useful by every participating primary care provider. Rates of rehospitalization at 30 days were lower for the intervention group than the preintervention group, but the difference was not statistically significant (41/202 or 23% vs 16/88 or 18% of discharged patients; P = .45; power 0.112 at P = .05).
The frequency of communication episodes that provide value can be increased through standardized processes. The key aspects of this effective intervention were setting the expectation that communication should occur, documenting when communication has occurred, and reviewing that documentation during multiprofessional rounds.
提高急症护理与初级护理提供者之间患者信息的沟通频率。次要目的是确定更高的沟通频率是否与出院后30天内较低的再入院率相关。
在一项旨在提高急症护理与初级护理提供者之间沟通频率的干预措施前后，使用经过验证的工具进行电话调查。该沟通干预措施在一所学术医疗中心两个校区的3个成人重症监护病房实施。
对沟通干预措施实施前的202例成人重症监护病例和实施后的100例病例，评估了急症护理与初级护理提供者之间的沟通频率、对干预措施的感知有用性及其与30天再入院率的关联。记录在案的沟通频率显著增加（干预前为5/202或2%，干预后为72/100或72%；P<.001），且每位参与的初级护理提供者都认为沟通是有用的。干预组出院后30天的再住院率低于干预前组，但差异无统计学意义（202例出院患者中的41例或23%对88例出院患者中的16例或18%；P=.45；在P=.05时检验效能为0.112）。
通过标准化流程可以提高有价值的沟通事件的频率。这项有效干预措施的关键方面包括设定沟通应当发生的预期、记录沟通发生的时间以及在多专业查房期间审查该记录。
