Wray Charlie M, Farnan Jeanne M, Arora Vineet M, Meltzer David O
Section of Hospital Medicine, University of Chicago Medical Center, Chicago, Illinois.
Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
J Hosp Med. 2016 Oct;11(10):675-681. doi: 10.1002/jhm.2608. Epub 2016 May 11.
Inpatient service handoffs occur when physicians who care for hospitalized patients end a period of clinical service and handover a panel of patients to an oncoming physician. Despite the large amount of research on handoffs, none has described the patient perspective when cared for by a hospitalist physician during a service handoff.
To describe hospitalized patients' experiences regarding inpatient service changes, and develop a conceptual framework to inform future efforts to improve service-level handoffs.
Interview-based qualitative analysis using in-depth, semistructured interviews of hospitalized patients on a nonteaching hospitalist service. Patients were interviewed between October 2014 and December 2014 at an academic medical center whose inpatient stay spanned a weekly service change. We utilized an inductive approach with no a priori hypotheses and used a constant comparative method to generate emerging themes to develop a conceptual model that captured the patient experience during the transition.
Of patients who agreed to participate (40/43), most (85%) were unaware that a transition had occurred between their hospitalists. Six major themes emerged related to patients' experiences with hospitalist service handoffs: (1) importance of physician-patient communication, (2) desire for transparency in transitions, (3) an indifference toward transitions, (4) importance of hospitalist-specialist communication, (5) formation of new opportunities from a transition, and (6) effects of bedside manner.
Hospitalized patients desire improved communication and a more formalized transition process between hospitalists during service handoffs. Hospitalists should recognize that this transition may represent an opportunity to improve the hospitalized patient's experience and satisfaction. Journal of Hospital Medicine 2016;11:675-681. © 2016 Society of Hospital Medicine.
当负责住院患者的医生结束一段临床服务并将一组患者交接给即将接手的医生时，就会发生住院服务交接。尽管对交接进行了大量研究，但尚无研究描述在服务交接期间由住院医生护理时患者的观点。
描述住院患者对住院服务变更的体验，并制定一个概念框架，为未来改善服务层面交接的努力提供参考。
采用基于访谈的定性分析方法，对一家非教学医院住院医生服务的住院患者进行深入的半结构化访谈。2014年10月至2014年12月期间，在一家学术医疗中心对住院时间跨越每周服务变更的患者进行了访谈。我们采用归纳法，没有先验假设，并使用持续比较法生成新出现的主题，以开发一个概念模型，捕捉过渡期间的患者体验。
在同意参与的患者中（40/43），大多数（85%）没有意识到他们的住院医生之间发生了交接。出现了与患者住院医生服务交接体验相关的六个主要主题：（1）医患沟通的重要性，（2）交接过程中对透明度的渴望，（3）对交接的冷漠，（4）住院医生与专科医生沟通的重要性，（5）交接带来的新机会的形成，以及（6）床边态度的影响。
住院患者希望在服务交接期间改善住院医生之间的沟通，并建立更规范的交接流程。住院医生应认识到，这种交接可能是改善住院患者体验和满意度的一个机会。《医院医学杂志》2016年；11:675 - 681。©2016医院医学协会。
