Limes Julia, Callister Catherine, Young Eric, Burke Robert E, Albert Tyler, Cornia Paul B, Sehgal Raj, Jones Christine D
Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Am Med Dir Assoc. 2021 Nov;22(11):2344-2349. doi: 10.1016/j.jamda.2021.02.011. Epub 2021 Mar 19.
Prior studies have found suboptimal knowledge about post-acute care (PAC) among inpatient providers and poor communication at discharge that can lead to unsafe discharge transitions, but little is known about residents and the PAC transition. The aim of this study is to assess internal medicine residents' knowledge, attitudes, and current practice regarding patient transitions to PAC.
A multisite, cross-sectional 36-question survey.
Internal Medicine and Medicine-Pediatrics residents at 3 university-based Internal Medicine training programs in the United States.
Survey delivered electronically to residents in 2018 and 2019. Survey responses were described by collapsing 4-point Likert responses into dichotomous variables, and thematic content analysis was used to evaluate free text responses.
Of 482 residents surveyed, 236 responded (49%). Despite high reported confidence in their ability to transition patients to PAC, only 31% of residents knew how often patients received skilled therapies at skilled nursing facilities (SNFs) and 23% knew how frequently nursing services are provided. The majority of residents (79%) identified the discharge summary as the main way they communicated care instructions to the SNF, but only 55% reported always completing it prior to discharge. Upper-level residents were more likely to know how much therapy patients received at a SNF, but resident knowledge about PAC did not vary by residency year in other domains. Residents who experienced a clinical rotation at a SNF had higher levels of knowledge compared to residents who did not.
This national survey of internal medicine residents identified common knowledge gaps regarding PAC. These knowledge gaps did not improve throughout residency without deliberate exposure to PAC environments. This suggests a need for dedicated curriculum development as discharges to PAC continue to rise exponentially.
先前的研究发现住院医疗服务提供者对急性后护理（PAC）的了解不够理想，且出院时沟通不畅，这可能导致不安全的出院过渡，但对于住院医师和PAC过渡情况知之甚少。本研究的目的是评估内科住院医师关于患者向PAC过渡的知识、态度和当前实践。
一项多地点、横断面的36题调查问卷。
美国3个大学附属医院内科培训项目中的内科及内儿科住院医师。
于2018年和2019年以电子方式向住院医师发放调查问卷。通过将4级李克特量表回答合并为二分变量来描述调查结果，并使用主题内容分析法评估自由文本回答。
在482名接受调查的住院医师中，236人做出了回应（49%）。尽管报告称对自己将患者过渡到PAC的能力信心很高，但只有31%的住院医师知道患者在专业护理机构（SNF）接受熟练治疗的频率，23%的住院医师知道护理服务的提供频率。大多数住院医师（79%）将出院小结视为他们向SNF传达护理指示的主要方式，但只有55%的人报告总是在出院前完成。高年资住院医师更有可能知道患者在SNF接受的治疗量，但住院医师在其他领域关于PAC的知识并没有因住院年限而有所不同。与未在SNF进行临床轮转的住院医师相比，在SNF进行过临床轮转的住院医师知识水平更高。
这项针对内科住院医师的全国性调查发现了关于PAC的常见知识差距。如果没有刻意接触PAC环境，这些知识差距在整个住院医师培训期间都没有得到改善。这表明随着向PAC的出院人数继续呈指数级增长，需要专门制定课程。
