College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
BMJ Open. 2019 Sep 6;9(9):e029526. doi: 10.1136/bmjopen-2019-029526.
The burden of childhood mortality continues to be born largely by low-income and middle-income countries. The critical postdischarge period has been largely neglected despite evidence that mortality rates during this period can exceed inpatient mortality rates. However, there is a paucity of data on the paediatric discharge process from the perspective of the healthcare provider. Provider perspectives may be important in the development of an improved understanding of the barriers and facilitators to improving the transition from hospital to home.
To explore healthcare providers' and facility administrators' perspectives of the paediatric discharge process with respect to: (1) current procedures, (2) barriers and challenges, (3) ideas for change, (4) facilitators for change and (5) the importance of discharge planning.
A qualitative exploratory approach using focus groups (14) and in-depth interviews (7).
This study was conducted at seven hospitals providing paediatric care in Uganda.
Current discharge procedures are largely based on hospital-specific protocols or clinician opinion, as opposed to national guidelines. Some key barriers to an improved discharge process included caregiver resources and education, critical communication gaps, traditional practices, and a lack of human and physical resources. Teamwork and motivation to see improved paediatric transitions to home were identified as facilitators to implementing the ideas for change proposed by participants. The need for a standardised national policy guiding paediatric discharges, implemented through education at many levels and coupled with appropriate community referral and follow-up, was broadly perceived as essential to improving outcomes for children.
Although significant challenges and gaps were identified within the current health system, participants' ideas and the identified facilitators provide a significant basis from which change may occur. This work can facilitate the development of sustainable and effective interventions to improve postdischarge outcomes in Uganda and other similar settings.
儿童死亡率的负担主要仍由低收入和中等收入国家承担。尽管有证据表明在此期间的死亡率可能超过住院死亡率，但关键的出院后期间在很大程度上被忽视了。然而，从医疗保健提供者的角度来看，关于儿科出院过程的数据很少。提供者的观点对于更好地了解改善从医院到家庭的过渡的障碍和促进因素可能很重要。
从以下几个方面探讨医疗保健提供者和医疗机构管理人员对儿科出院过程的看法：（1）当前程序，（2）障碍和挑战，（3）变革思路，（4）变革促进因素，以及（5）出院计划的重要性。
使用焦点小组（14 个）和深入访谈（7 个）进行定性探索性方法。
本研究在乌干达的七家提供儿科护理的医院进行。
目前的出院程序主要基于医院特定的协议或临床医生的意见，而不是国家指南。改善出院流程的一些关键障碍包括照顾者资源和教育、关键沟通差距、传统做法以及人力和物力资源的缺乏。团队合作和改善儿科向家庭过渡的动机被确定为实施参与者提出的变革思路的促进因素。广泛认为需要制定一项指导儿科出院的标准化国家政策，通过各级教育实施，并结合适当的社区转诊和后续服务，这对于改善儿童的结局至关重要。
尽管在当前卫生系统中存在重大挑战和差距，但参与者的想法和确定的促进因素为可能发生的变革提供了重要基础。这项工作可以促进在乌干达和其他类似环境中开发可持续和有效的干预措施，以改善出院后的结果。
