Rohatgi Nidhi, Kane Marlena, Winget Marcy, Haji-Sheikhi Farnoosh, Ahuja Neera
J Healthc Qual. 2018 Nov/Dec;40(6):329-335. doi: 10.1097/JHQ.0000000000000126.
Lack of collaboration between care teams and patients/families has been associated with delayed discharge from the hospital. In this study, we determine whether patients' awareness of the estimated date of discharge (EDD) was associated with a decrease in delayed discharge, and determine the factors associated with a delayed discharge. A total of 221 patients admitted to the General Medicine service between July and September 2014 were included in the study. Estimated date of discharge was identified within 36 hours of admission. The bedside nurse communicated this EDD to the patient/family. Patients were interviewed to identify whether they were aware of their EDD. Bedside nurses were interviewed to identify barriers to discharge. In our study, 49.8% of the patients had a delayed discharge. Patients who were aware of their EDD were less likely to have a delayed discharge (odds ratio [OR], 0.3 [95% confidence interval (CI), 0.1-0.6], p < .001). Patients who were discharged on Saturday or Sunday (OR, 4.8 [95% CI, 1.7-14.6], p < .001) and patients who were waiting for physicians' consult (OR, 4.5 [95% CI, 1.6-14.4], p = .007) were more likely to have a delayed discharge. Early identification of the EDD and communicating it with the care team and the patient/family, mobilizing resources for safe weekend discharges, and creating efficient process for consultations might decrease delayed discharges.
护理团队与患者/家属之间缺乏协作与出院延迟有关。在本研究中,我们确定患者对预计出院日期(EDD)的知晓是否与出院延迟的减少有关,并确定与出院延迟相关的因素。2014年7月至9月期间入住普通内科的221名患者纳入了本研究。预计出院日期在入院后36小时内确定。床边护士将此预计出院日期告知患者/家属。对患者进行访谈以确定他们是否知晓自己的预计出院日期。对床边护士进行访谈以确定出院的障碍。在我们的研究中,49.8%的患者出院延迟。知晓自己预计出院日期的患者出院延迟的可能性较小(优势比[OR],0.3[95%置信区间(CI),0.1 - 0.6],p <.001)。在周六或周日出院的患者(OR,4.8[95%CI,1.7 - 14.6],p <.001)以及等待医生会诊的患者(OR,4.5[95%CI,1.6 - 14.4],p =.007)出院延迟的可能性更大。尽早确定预计出院日期并与护理团队及患者/家属沟通,为安全的周末出院调动资源,以及建立高效的会诊流程可能会减少出院延迟。