Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark.
Center for Clinical Research in Nursing, Regional Hospital Viborg, Viborg, Denmark.
Nurs Inq. 2019 Oct;26(4):e12310. doi: 10.1111/nin.12310. Epub 2019 Jul 8.
Several studies describe intersectoral collaboration in Western healthcare as hampered by lack of coordination of care and treatment and incoherent patient pathways. We performed an ethnographic study following elderly patients from admission to an emergency unit (EMU) to discharge and further treatment and care at other facilities in the healthcare system. The aim was to explore how health professionals work together across sectors in the Danish healthcare system and how they create patient pathways for elderly patients (+65) with multiple chronic illnesses. Intersectoral collaboration was identified as distant relations between large numbers of health professionals, where communication was conveyed by electronic health record (EHR) formats which promoted information delivery that focused on patients' immediate symptoms. Other significant 'mediators' of communication were the telephone that seemed to resemble face-to-face communication and the patient who delivered information from one professional to another. We suggest that the communication among professionals at various facilities interacts with the format and functionalities of the EHRs, which typically fall short in delivery of information across sectors, because the often complex needs of patients with multimorbidity do not fit in with the available functionalities of the EHR.
多项研究表明，西方医疗保健领域的跨部门协作受到医疗和治疗协调不足以及患者路径不连贯的阻碍。我们对从急诊部（EMU）入院到其他医疗机构接受进一步治疗和护理的老年患者进行了一项民族志研究。目的是探讨丹麦医疗保健系统中的卫生专业人员如何跨部门合作，以及他们如何为患有多种慢性疾病的老年患者（+65 岁）创建患者路径。跨部门协作被确定为大量卫生专业人员之间的远程关系，其中沟通是通过电子健康记录（EHR）格式进行的，这促进了侧重于患者即时症状的信息传递。其他重要的沟通“中介”是电话，它似乎类似于面对面的沟通，患者将信息从一个专业人员传递给另一个专业人员。我们认为，各个医疗机构之间的专业人员之间的沟通与 EHR 的格式和功能相互作用，由于患有多种疾病的患者的需求通常很复杂，不符合 EHR 现有功能的要求，因此 EHR 在跨部门传递信息方面往往存在不足。
