Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
BMJ Open. 2017 Feb 22;7(2):e014842. doi: 10.1136/bmjopen-2016-014842.
We examined the role of discharge instructions in postoperative recovery for patients undergoing colorectal surgery and report themes related to patient perceptions of discharge instructions and postdischarge experience.
Semistructured interviews were conducted as part of a formative evaluation of a Project Re-Engineered Discharge intervention adapted for surgical patients.
Michael E. DeBakey VA Medical Center, a tertiary referral centre in Houston, Texas.
Twelve patients undergoing elective colorectal surgery. Interviews were conducted at the two-week postoperative appointment.
Participants demonstrated understanding of the content in the discharge instructions. During the interviews, participants reported several positive roles for discharge instructions in their postdischarge care: a sense of security, a reminder of inhospital education, a living document and a source of empowerment. Despite these positive associations, participants reported that the instructions provided insufficient information to promote access to care that effectively addressed acute issues following discharge. Participants noted difficulty reaching providers after discharge, which resulted in the adoption of workarounds to overcome system barriers.
Despite concerted efforts to provide patient-centred instructions, the discharge instructions did not provide enough context to effectively guide postdischarge interactions with the healthcare system. Insufficient information on how to access and communicate with the most appropriate personnel in the healthcare system is an important barrier to patients receiving high-quality postdischarge care. Tools and strategies from team training programmes, such as team strategies and tools to enhance performance and patient safety, could be adapted to include patients and provide them with structured methods for communicating with healthcare providers post discharge.
我们研究了出院指导在结直肠手术后患者康复中的作用，并报告了与患者对出院指导的看法和出院后体验相关的主题。
作为对适应于外科患者的 Project Re-Engineered Discharge 干预措施的形成性评估的一部分，进行了半结构式访谈。
德克萨斯州休斯顿的 Michael E. DeBakey VA 医疗中心，这是一家三级转诊中心。
12 名接受择期结直肠手术的患者。在术后两周的预约时进行了访谈。
参与者对出院指导中的内容表现出理解。在访谈过程中，参与者报告了出院指导在其出院后护理中的几个积极作用：一种安全感、对住院教育的提醒、一份活的文件和一种赋权来源。尽管有这些积极的关联，但参与者报告说，这些指示提供的信息不足以促进获得以下出院后急性问题的有效护理。参与者表示，在出院后很难联系到提供者，这导致他们采用了权宜之计来克服系统障碍。
尽管为提供以患者为中心的指导做出了一致努力，但出院指导并未提供足够的背景信息来有效地指导与医疗保健系统的出院后互动。关于如何与医疗保健系统中最合适的人员联系和沟通的信息不足，是患者获得高质量出院后护理的一个重要障碍。团队培训计划中的工具和策略，如团队策略和工具以提高绩效和患者安全，可以进行调整，包括患者，并为他们提供与医疗保健提供者沟通的结构化方法。
