Gotlib Conn Lesley, Zwaiman Ashley, DasGupta Tracey, Hales Brigette, Watamaniuk Aaron, Nathens Avery B
Evaluative Clinical Sciences, Trauma, Emergency and Critical Care Research Program, Sunnybrook Research Institute, Toronto ON Canada.
Sunnybrook Health Sciences Centre, Toronto ON Canada.
Injury. 2018 Jan;49(1):97-103. doi: 10.1016/j.injury.2017.09.028. Epub 2017 Sep 28.
Challenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences.
A qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach.
Twenty-four interviews included 19 patients and 7 family members. Participants' experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities' ability to care for injured patients.
The quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients encounter complex barriers to quality discharge that likely require a comprehensive, multimodal intervention.
在医院出院和护理过渡期间，提供优质护理面临的挑战尤为突出。从创伤中心出院的重伤患者将回家、前往康复机构或另一家有复杂管理需求的急症医院。本研究的目的是探索在地区学术创伤中心接受治疗的创伤患者及其家属的经历，以更好地理解并改善他们的出院和护理过渡体验。
2016年3月至10月进行了一项采用归纳主题分析的定性研究。在创伤中心出院后，对创伤患者和/或一名家庭成员进行了电话访谈。数据收集和分析按照定性方法以归纳和迭代的方式完成。
24次访谈包括19名患者和7名家庭成员。参与者的经历凸显了出院和转诊过程中要么（1）促进了优质出院，要么（2）阻碍了优质出院的情况。促进优质出院的因素有病房工作人员的准备工作、建立有效的护理连续性以及充分的情感支持。阻碍出院质量的因素有离开医院的感知压力、强加的转诊决定以及出院时沟通和协调欠佳。患者与提供者之间的沟通被认为是由系统驱动的，而非患者需求。机构间的信息差距引发了对接收机构照顾受伤患者能力的担忧。
创伤患者出院和过渡体验的质量受到系统和病房层面流程的损害，这些流程在产生以患者为中心的高质量出院方面相互竞争而非协同一致。侧重于创伤中心内可改变因素的局部改进方案包括以患者为导向的出院教育和患者导航；然而，仅靠这些方法可能不足以提升患者体验。创伤患者在获得优质出院方面面临复杂障碍，可能需要全面的多模式干预。
