Stuck Amy, Crowley Christopher, Martinez Tracy, Wittgrove Alan, Brennan Jesse J, Chan Theodore C, Castillo Edward M
West Health Institute, Health Services, Successful Aging, La Jolla, California.
University of California, San Diego, Department of Emergency Medicine, San Diego, California.
West J Emerg Med. 2017 Jun;18(4):761-769. doi: 10.5811/westjem.2017.3.32348. Epub 2017 May 15.
The study objective was to explore emergency physicians' (EP) awareness, willingness, and prior experience regarding transitioning patients to home-based healthcare following emergency department (ED) evaluation and treatment; and to explore patient selection criteria, processes, and services that would facilitate use of home-based healthcare as an alternative to hospitalization.
We provided a five-question survey to 52 EPs, gauging previous experience referring patients to home-based healthcare, patient selection, and motivators and challenges when considering home-based options as an alternative to admission. In addition, we conducted three focus groups and four interviews.
Of participating EPs, 92% completed the survey, 38% reported ordering home-based healthcare from the ED as an alternative to admission, 90% ranked cellulitis among the top three medical conditions for home-based healthcare, 90% ranked "reduce unnecessary hospitalizations and observation stays" among their top three perceived motivators for using home-based care, and 77% ranked "no existing process in place to refer to home-based care" among their top three perceived barriers. Focus group and interview themes included the need for alternatives to admission; the longer-term benefits of home-based healthcare; the need for streamlined transition processes; and the need for highly qualified home-care staff capable of responding the same day or within 24 hours.
The study found that EPs are receptive to referring patients for home-based healthcare following ED treatment and believe people with certain diagnoses are likely to benefit, with the dominant barrier being the absence of an efficient referral process.
本研究的目的是探讨急诊医生（EP）在急诊科（ED）评估和治疗后，对于将患者转诊至居家医疗服务的认知、意愿和既往经验；并探讨有助于将居家医疗服务作为住院替代方案使用的患者选择标准、流程和服务。
我们向52名急诊医生提供了一份包含五个问题的调查问卷，以评估他们之前将患者转诊至居家医疗服务的经验、患者选择情况，以及在考虑将居家医疗选项作为住院替代方案时的动机和挑战。此外，我们还开展了三个焦点小组讨论和四次访谈。
参与调查的急诊医生中，92%完成了调查问卷，38%报告曾从急诊科安排居家医疗服务作为住院替代方案，90%将蜂窝织炎列为居家医疗服务的前三大适用病症，90%将“减少不必要的住院和观察期”列为使用居家医疗服务的前三大动机，77%将“没有现成的转诊至居家医疗服务的流程”列为前三大感知障碍。焦点小组讨论和访谈的主题包括需要住院替代方案；居家医疗服务的长期益处；需要简化的转诊流程；以及需要有能力在当天或24小时内做出响应的高素质居家护理人员。
研究发现急诊医生愿意在急诊科治疗后将患者转诊至居家医疗服务，并认为某些诊断的患者可能会从中受益，主要障碍是缺乏有效的转诊流程。
