Senior Research Fellow in Ethnography, Bristol Medical School - Population Health Sciences, University of Bristol, UK.
Deputy Director, National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West, University of Bristol NHS Foundation Trust, UK.
J Health Serv Res Policy. 2020 Oct;25(4):213-219. doi: 10.1177/1355819619898229. Epub 2020 Feb 3.
Older people living with frailty (OPLWF) are often unable to leave hospital even if they no longer need acute care. The aim of this study was to elicit the views of health care professionals in England on the barriers to effective discharge of OPLWF.
We conducted semi-structured interviews with hospital-based doctors and nurses with responsibility for discharging OPLWF from one large urban acute care hospital in England. The data were analysed using the constant comparative method.
We conducted interviews with 17 doctors (12 senior doctors or consultants and 5 doctors in training) and six senior nurses. Some of our findings reflect well-known barriers to hospital discharge including service fragmentation, requiring skilled coordination that was often not available due to high volumes of work, and poor communication between staff from different organizations. Participants' accounts also referred to less frequently documented factors that affect decision making and the organization of patient discharges. These raised uncomfortable emotions and tensions that were often ignored or avoided. One participant referred to 'conversations not had', or failures in communication, because difficult topics about resuscitation, escalation of treatment and end-of-life care for OPLWF were not addressed.
The consequences of not initiating important conversations about decisions relating to the end of life are potentially far reaching not only regarding reduced efficiency due to delayed discharges but also for patients' quality of life and care. As the population of older people is rising, this becomes a key priority for all practitioners in health and social care. Evidence to support practitioners, OPLWF and their families is needed to ensure that these vital conversations take place so that care at the end of life is humane and compassionate.
患有衰弱症的老年人（OPLWF）即使不再需要急性护理，也常常无法出院。本研究旨在了解英国医疗保健专业人员在有效出院 OPLWF 方面面临的障碍的看法。
我们对英格兰一家大型城市急性护理医院负责出院 OPLWF 的医院医生和护士进行了半结构化访谈。使用恒定性比较方法对数据进行分析。
我们采访了 17 名医生（12 名高级医生或顾问和 5 名受训医生）和 6 名高级护士。我们的一些发现反映了众所周知的出院障碍，包括服务碎片化、需要熟练的协调，由于工作量大，协调往往无法提供，以及不同组织之间的员工沟通不畅。参与者的描述还提到了影响决策和患者出院安排的记录较少的因素。这些因素引发了不舒服的情绪和紧张，这些情绪往往被忽视或避免。一位参与者提到了“未进行的对话”或沟通失败，因为没有讨论有关 OPLWF 的复苏、治疗升级和临终关怀的困难话题。
由于延迟出院导致效率降低，以及对患者的生活质量和护理产生潜在影响，不开始就与生命末期相关决策进行重要对话的后果可能是深远的。随着老年人口的增加，这成为所有医疗保健和社会护理从业者的一个关键优先事项。需要为从业者、OPLWF 及其家属提供证据，以确保进行这些重要的对话，以便在生命末期提供人道和富有同情心的护理。
