Gallaher Charles, Herrmann Simone, Hunter Laura, Wilkins Alex
Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.
BMJ Open Qual. 2020 Feb;9(1). doi: 10.1136/bmjoq-2019-000820.
We carried out a quality improvement (QI) project (QIP), aiming to improve the quality, safety and equity of healthcare provided for homeless patients attending the emergency department (ED). We used QI methodology to identify areas for improvement, and introduced and modified interventions over four Plan, Do, Study, Act cycles. We launched a departmental 'Homeless Health Initiative' (HHI), the chief intervention being the provision of 'Homeless Health Boxes' in the ED, which contained a 'Safe Discharge Checklist for Homeless Patients', maps to specialist homeless general practitioner surgeries and homeless day centres, information on other inclusion health services, copies of a local rough sleepers' magazine and oral hygiene supplies. Voluntary Homeless Link Nurses and a number of informal 'Homeless Health Champions' were appointed. The HHI was embedded in departmental awareness through regular presentations to staff and incorporation into the induction programme for new doctors. Staff satisfaction, in terms of how satisfied staff members were with the care they were able to provide for homeless patients in the ED on a 0-10 scale, improved modestly over the course of the QIP from median 6/10 to median 7/10. The number of staff who were severely dissatisfied with the care they were able to provide for homeless patients improved more markedly: first quartile staff satisfaction improved from 3.875/10 to 6.125/10. Staff compliance with the checklist was poor, with full compliance observed in only 15% of cases by the end of the QIP. An HHI is a cheap and worthwhile QI project, with the potential to significantly improve the quality, safety and equity of healthcare provided for homeless patients, while improving staff satisfaction concurrently. Similar initiatives should be considered in any ED which sees a significant number of homeless patients.
我们开展了一项质量改进（QI）项目（QIP），旨在提高为前往急诊科（ED）就诊的无家可归患者提供的医疗服务的质量、安全性和公平性。我们运用QI方法来确定改进领域，并在四个“计划、执行、研究、行动”循环中引入并调整干预措施。我们发起了一项部门“无家可归者健康倡议”（HHI），主要干预措施是在急诊科提供“无家可归者健康包”，其中包含“无家可归患者安全出院检查表”、到专科无家可归者全科医生诊所和无家可归者日间中心的地图、其他包容性健康服务信息、当地露宿者杂志副本以及口腔卫生用品。任命了志愿的无家可归者联络护士和一些非正式的“无家可归者健康倡导者”。通过定期向工作人员进行介绍并将其纳入新医生的入职培训计划，HHI融入了部门意识之中。就工作人员对他们在急诊科为无家可归患者提供护理的满意度而言（以0至10分衡量），在QIP过程中，工作人员满意度从中位数6/10略有提高至中位数7/10。对他们为无家可归患者提供护理严重不满的工作人员数量改善更为明显：第一四分位数的工作人员满意度从3.875/10提高到6.125/10。工作人员对检查表的依从性较差，到QIP结束时，仅15%的病例完全依从。HHI是一个成本低廉且值得开展的QI项目，有可能显著提高为无家可归患者提供的医疗服务的质量、安全性和公平性，同时提高工作人员满意度。任何接待大量无家可归患者的急诊科都应考虑开展类似举措。
