Department of Population Health, New York University School of Medicine, New York, NY, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, 550 Brookline Avenue, Boston, MA, 02215, USA.
J Gen Intern Med. 2021 Jun;36(6):1568-1575. doi: 10.1007/s11606-020-06508-4. Epub 2021 Feb 2.
Safely and effectively discharging a patient from the hospital requires working within a multidisciplinary team. However, little is known about how perceptions of responsibility among the team impact discharge communication practices.
Our study attempts to understand residents' perceptions of who is primarily responsible for discharge education, how these perceptions affect their own reported communication with patients, and how residents envision improving multidisciplinary communication around discharges.
A multi-institutional cross-sectional survey.
Internal medicine (IM) residents from seven US residency programs at academic medical centers were invited to participate between March and May 2019, via email of an electronic link to the survey.
Data collected included resident perception of who on the multidisciplinary team is primarily responsible for discharge communication, their own reported discharge communication practices, and open-ended comments on ways discharge multidisciplinary team communication could be improved.
Of the 613 resident responses (63% response rate), 35% reported they were unsure which member of the multidisciplinary team is primarily responsible for discharge education. Residents who believed it was either the intern's or the resident's primary responsibility had 4.28 (95% CI, 2.51-7.30) and 3.01 (95% CI, 1.66-5.71) times the odds, respectively, of reporting doing discharge communication practices frequently compared to those who were not sure who was primarily responsible. To improve multidisciplinary discharge communication, residents called for the following among team members: (1) clarifying roles and responsibilities for communication with patients, (2) setting expectations for communication among multidisciplinary team members, and (3) redefining culture around discharges.
Residents report a lack of understanding of who is responsible for discharge education. This diffusion of ownership impacts how much residents invest in patient education, with more perceived responsibility associated with more frequent discharge communication.
安全有效地将患者从医院出院需要多学科团队合作。然而，对于团队成员对责任的看法如何影响出院沟通实践，人们知之甚少。
我们的研究试图了解住院医师对谁主要负责出院教育的看法，这些看法如何影响他们自己与患者的沟通报告，以及住院医师如何设想改善多学科团队在出院方面的沟通。
多机构横断面调查。
来自美国 7 个学术医疗中心的内科住院医师被邀请参加 2019 年 3 月至 5 月期间的调查，通过电子邮件发送电子链接。
收集的数据包括住院医师对多学科团队中谁主要负责出院沟通的看法、他们自己报告的出院沟通实践，以及关于如何改进出院多学科团队沟通的开放式意见。
在 613 名住院医师的回复中（63%的回复率），35%的人表示他们不确定多学科团队中的哪个成员主要负责出院教育。认为这是实习医生或住院医师的主要责任的住院医师，报告经常进行出院沟通实践的可能性分别是不确定谁主要负责的住院医师的 4.28 倍（95%CI，2.51-7.30）和 3.01 倍（95%CI，1.66-5.71）。为了改善多学科团队的出院沟通，住院医师呼吁团队成员采取以下措施：（1）明确与患者沟通的角色和责任，（2）为多学科团队成员之间的沟通设定期望，（3）重新定义围绕出院的文化。
住院医师报告对谁负责出院教育缺乏了解。这种所有权的扩散影响了住院医师对患者教育的投入程度，更多的感知责任与更频繁的出院沟通相关。
