Verhaegh Kim J, Jepma Patricia, Geerlings Suzanne E, de Rooij Sophia E, Buurman Bianca M
Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, DD Amsterdam, The Netherlands.
ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, BD Amsterdam, The Netherlands.
Int J Qual Health Care. 2019 Mar 1;31(2):125-132. doi: 10.1093/intqhc/mzy139.
Unplanned hospital readmissions frequently occur and have profound implications for patients. This study explores chronically ill patients' experiences and perceptions of being discharged to home and then acutely readmitted to the hospital to identify the potential impact on future care transition interventions.
Twenty-three semistructured interviews were conducted with chronically ill patients who had an unplanned 30-day hospital readmission at a university teaching hospital in the Netherlands.
A constructive grounded theory approach was used for data analysis.
The core category identified was 'readiness for hospital discharge,' and the categories related to the core category are 'experiencing acute care settings' and 'outlook on the recovery period after hospital discharge.' Patients' readiness for hospital discharge was influenced by the organization of hospital care, patients' involvement in decision-making and preparation for discharge. The experienced difficulties during care transitions might have influenced patients' ability to cope with challenges of recovery and dependency on others.
The results demonstrated the importance of assessing patients' readiness for hospital discharge. Health care professionals are recommended to recognize patients and guide them through transitions of care. In addition, employing specifically designated strategies that encourage patient-centered communication and shared decision-making can be vital in improving care transitions and reduce hospital readmissions. We suggest that health care professionals pay attention to the role and capacity of informal caregivers during care transitions and the recovery period after hospital discharge to prevent possible postdischarge problems.
计划外的医院再入院情况频繁发生，对患者有着深远影响。本研究探讨慢性病患者出院回家后又急症再入院的经历和看法，以确定对未来护理过渡干预措施的潜在影响。
在荷兰一家大学教学医院，对23名有计划外30天医院再入院情况的慢性病患者进行了半结构化访谈。
采用建构性扎根理论方法进行数据分析。
确定的核心类别是“出院准备情况”，与核心类别相关的类别是“体验急症护理环境”和“出院后恢复期展望”。患者的出院准备情况受医院护理组织、患者参与决策和出院准备工作的影响。护理过渡期间经历的困难可能影响了患者应对康复挑战和依赖他人的能力。
结果表明评估患者出院准备情况的重要性。建议医护人员认识到患者的情况，并指导他们度过护理过渡阶段。此外，采用专门设计的策略鼓励以患者为中心的沟通和共同决策，对于改善护理过渡和减少医院再入院至关重要。我们建议医护人员关注非正式照护者在护理过渡期间及出院后恢复期的作用和能力，以预防可能出现的出院后问题。
