School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Victoria, Australia.
BMJ Open. 2020 May 20;10(5):e034728. doi: 10.1136/bmjopen-2019-034728.
To understand from a patient and carer perspective: (1) what features of the discharge process could be improved to avoid early unplanned hospital readmission (within 72 hours of acute care discharge) and (2) what elements of discharge planning could have enhanced the discharge experience.
A qualitative descriptive design was used. Study data were collected using semi-structured interviews that were transcribed verbatim and analysed using inductive thematic analysis. Data related to participant characteristic were collected by medical record audit and summarised using descriptive statistics.
Three acute care hospitals from one health service in Australia.
Patients who had an early unplanned hospital readmission and/or their carers, if present during the interviews and willing to participate, with patient permission.
Thirty interviews were conducted (23 patients only; 6 patient and carer dyads; 1 carer only). Five themes were constructed: 'experiences of care', 'hearing and being heard', 'what's wrong with me', 'not just about me' and 'all about going home'. There was considerable variability in patients' and carers' experiences of hospital care, discharge processes and early unplanned hospital readmission. Features of the discharge process that could be improved to potentially avoid early unplanned hospital readmission were better communication, optimal clinical care including ensuring readiness for discharge and shared decision-making regarding discharge timing and goals on returning home. The discharge experience could have been enhanced by improved communication between patients (and carers) and the healthcare team, not rushing the discharge process and a more coordinated approach to patient transport home from hospital.
The study findings highlight the complexities of the discharge process and the importance of effective communication, shared decision-making and carer engagement in optimising hospital discharge and reducing early unplanned hospital readmissions.
从患者和照护者的角度了解：（1）出院流程中哪些方面可以改进以避免提前计划外的住院再入院（急性护理出院后 72 小时内）；（2）出院计划的哪些要素可以改善出院体验。
采用定性描述性设计。使用半结构式访谈收集研究数据，将访谈内容逐字转录，并进行归纳主题分析。通过病历审核收集与参与者特征相关的数据，并使用描述性统计进行总结。
澳大利亚一家医疗服务机构的三家急性护理医院。
提前计划外住院再入院的患者（仅 23 名患者）和/或其照护者，如果在访谈期间在场并愿意参与，且获得患者同意，以及 6 名患者和照护者二人组、1 名照护者。
共进行了 30 次访谈（仅 23 名患者；6 名患者和照护者二人组；1 名照护者）。构建了五个主题：“护理体验”、“倾听与被倾听”、“我怎么了”、“不仅仅是我”和“一切为了回家”。患者和照护者对医院护理、出院流程和提前计划外住院再入院的经历存在较大差异。可以改进出院流程以潜在避免提前计划外住院再入院的方面包括更好的沟通、最佳的临床护理，包括确保准备好出院，以及就出院时间和回家目标进行共同决策。通过改善患者（和照护者）与医疗团队之间的沟通、不急于出院流程以及更协调地安排患者从医院回家的交通，可以改善出院体验。
研究结果强调了出院流程的复杂性，以及有效沟通、共同决策和照护者参与对优化医院出院和减少提前计划外住院再入院的重要性。
