Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E. 17th Avenue Mailstop F-782, Aurora, CO, 80045, USA.
Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Gen Intern Med. 2022 May;37(7):1729-1736. doi: 10.1007/s11606-021-07276-5. Epub 2022 Jan 6.
The transfer of patients between hospitals (inter-hospital transfer, or IHT) is a common occurrence for patients, but guidelines to ensure safe and effective IHTs are lacking. Poor IHTs result in higher rates of mortality, longer lengths of stay, and higher hospitalization costs compared to admissions from the emergency department. Nurses are often the first point of contact for IHT patients and can provide valuable insights on key challenges to IHT processes.
To characterize the experiences of inpatient floor-level bedside nurses caring for IHT patients and identify care coordination challenges and solutions.
DESIGN/PARTICIPANTS/APPROACH: Qualitative study using semi-structured focus groups and interviews conducted from October 2019 to July 2020 with 21 inpatient floor-level nurses caring for adult medicine patients at an academic hospital. Nurses were recruited using a purposive convenience sampling approach. A combined inductive and deductive coding approach guided by thematic analysis was used for data analysis.
Results from this study are mapped to the Agency for Healthcare Research and Quality Care Coordination Measurement Framework domains of communication, assessing needs and goals, and negotiating accountability. The following key themes characterize nurses' experiences with IHT related to these domains: (1) challenges with information exchange and team communication during IHT, (2) environmental and information preparation needed to anticipate transfers, and (3) determining responsibility and care plans after the IHT patient has arrived at the accepting facility.
Nurses described the absence of standardized processes to coordinate care before or at the time of patient arrival. Challenges to communication and coordination during IHTs negatively impacted patient care and nursing professional satisfaction. To streamline care for IHT patients and reduce nursing stress, future IHT interventions should include standardized handoff reports, timely identification and easy access to admitting clinicians, and timely clinician evaluation and orders.
医院间患者转院（院内转院，或 IHT）对患者来说很常见，但缺乏确保安全有效的 IHT 的指南。与从急诊科入院相比，较差的 IHT 会导致更高的死亡率、更长的住院时间和更高的住院费用。护士通常是 IHT 患者的第一接触点，可以就 IHT 流程的关键挑战提供宝贵的见解。
描述照顾 IHT 患者的住院楼层床边护士的经验，并确定护理协调挑战和解决方案。
设计/参与者/方法：使用半结构式焦点小组和访谈的定性研究，于 2019 年 10 月至 2020 年 7 月在一家学术医院对 21 名照顾成人内科患者的住院楼层护士进行，采用目的便利抽样方法招募护士。采用主题分析指导的综合归纳和演绎编码方法进行数据分析。
本研究的结果映射到医疗保健研究和质量协调测量框架的沟通、评估需求和目标以及协商问责制领域。以下关键主题描述了护士在与这些领域相关的 IHT 方面的经验：（1）IHT 期间信息交换和团队沟通的挑战，（2）需要环境和信息准备以预测转院，以及（3）在 IHT 患者到达接收机构后确定责任和护理计划。
护士描述了在患者到达之前或到达时没有标准化的流程来协调护理。IHT 期间沟通和协调方面的挑战对患者护理和护理人员的满意度产生了负面影响。为了简化 IHT 患者的护理并减轻护理人员的压力，未来的 IHT 干预措施应包括标准化的交接报告、及时识别和方便访问接收临床医生，以及及时的临床医生评估和医嘱。
