通过出院后家庭访视和熟练护理设施访视的实习护理过渡课程。
Intern Transitions of Care Curriculum Through Posthospital Home and Skilled Nursing Facility Visits.
作者信息
Miller Rachel K, Keddem Shimrit, Katz Samuel, Smith Zachary, Whitehouse Christina R, Goldstein Karen, Hirschman Karen B, Johnson Jerry C
出版信息
J Grad Med Educ. 2018 Aug;10(4):442-448. doi: 10.4300/JGME-17-00499.1.
BACKGROUND
Transitions of care pose significant risks for patients with complex medical histories. There are few experiential medical education curricula targeting this important aspect of care.
OBJECTIVE
We designed and tested an internal medicine transitions of care experience integrated into interns' ambulatory curriculum.
METHODS
The program included 1-hour group didactics, a posthospitalization discharge visit in pairs with a home care nurse (cohort 1: 2011-2012; cohort 2: 2012-2013), and a half-day small-group visit to a skilled nursing facility led by a faculty member in geriatrics (cohort 2 only). Both visits had structured debriefings by faculty in geriatrics. For cohort 1, a quantitative follow-up survey was administered 18 to 20 months after the experience. For cohort 2, reflections were analyzed.
RESULTS
Thirty-three of 42 second-year residents (79%) in cohort 1 who participated in didactics and a home visit completed the survey. Seventy-six percent (25 of 33) reported increased knowledge of interprofessional team members' roles and the discharge process for patients with complex medical histories. Seventy-nine percent (26 of 33) reported continued use of medication reconciliation at discharge, and 64% (21 of 33) reported the experience enhanced their ability to identify threats to transitions. Of cohort 2 interns, 88% (42 of 48) participated in the home visit and 69% (33 of 48) in the skilled nursing facility visit. Intern reflections revealed insights gained, incomprehensive discharge plans, posthospital health care teams, and patients' postdischarge experience.
CONCLUSIONS
An experiential transitions of care curriculum is feasible and acceptable. Residents reported using the curriculum 18 to 20 months after exposure.
背景
对于有复杂病史的患者而言，医疗护理的过渡存在重大风险。针对这一重要护理环节的体验式医学教育课程寥寥无几。
目的
我们设计并测试了一种融入实习医生门诊课程的内科医疗护理过渡体验。
方法
该项目包括1小时的小组教学、与家庭护理护士结对进行的出院后家访（队列1：2011 - 2012年；队列2：2012 - 2013年），以及由老年医学教员带领的对一家专业护理机构进行的半天小组参观（仅队列2）。两次参观后均由老年医学教员进行结构化的汇报总结。对于队列1，在体验结束18至20个月后进行了定量随访调查。对于队列2，对反馈意见进行了分析。
结果
队列1中参与教学和家访的42名二年级住院医生中有33名（79%）完成了调查。76%（33名中的25名）报告称对跨专业团队成员的角色以及有复杂病史患者的出院流程的了解有所增加。79%（33名中的26名）报告在出院时持续进行用药核对，64%（33名中的21名）报告该体验增强了他们识别护理过渡威胁的能力。队列2的实习医生中，88%（48名中的42名）参与了家访，69%（48名中的33名）参与了专业护理机构参观。实习医生的反馈揭示了他们所获得的见解、不全面的出院计划、出院后医疗团队以及患者出院后的经历。
结论
一种体验式护理过渡课程是可行且可接受的。住院医生报告在接触该课程18至20个月后仍在使用。
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