Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Jens Chr. Skous Vej 4, Building 1483, 3rd Floor, 8000, Aarhus, Denmark; Department of Research, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark.
Department of Research, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark.
Soc Sci Med. 2022 Nov;312:115388. doi: 10.1016/j.socscimed.2022.115388. Epub 2022 Sep 22.
The discharge from hospital is an essential care transition for elderly people with chronic illness, specifically because the responsibility for treatment and care is transferred between locations and healthcare staff. To optimise the use of healthcare resources in a time of progressively shorter hospital admissions and increasingly streamlined hospital care, discharges are highlighted as important moments to be handled with caution. Yet, discharges are expected to be "early" and "quick" procedures to maintain a flow of patients through the hospital. In this qualitative article, we use ethnographic methods to investigate how this apparent contradiction unfolds in everyday discharge situations through the work of establishing discharge readiness in three medical wards in a middle-sized Danish hospital. We use the lens of infrastructure to help us see how elements like patient screens, screen meetings, clinical (and embodied) signs and community health care criteria are interrelated in the work of establishing discharge readiness of patients. By looking closely into specific discharge situations, we analyse the way care needs are defined and how care work is transferred, and we identify the inherent uncertainties for health care professionals, patients and relatives. We show how clinical signs take precedence over embodied experience, and how complex situations are reduced to workable problems to enable discharge.
出院是慢性病老年患者的重要医疗过渡期，特别是因为治疗和护理的责任在不同地点和医护人员之间转移。为了在住院时间逐渐缩短和医院护理日益简化的情况下优化医疗资源的利用，出院被强调为需要谨慎处理的重要时刻。然而，出院预计是“早期”和“快速”的程序，以保持患者在医院中的流动。在这篇定性文章中，我们使用民族志方法通过在丹麦一家中等规模医院的三个医疗病房中建立出院准备情况的工作，调查这种明显的矛盾如何在日常出院情况中展开。我们使用基础设施的视角来帮助我们看到患者屏幕、屏幕会议、临床（和体现）迹象和社区医疗保健标准等要素如何相互关联，以建立患者的出院准备情况。通过仔细观察特定的出院情况，我们分析了护理需求的定义方式以及护理工作的转移方式，并确定了医疗保健专业人员、患者和亲属所面临的固有不确定性。我们展示了临床迹象如何优先于体现经验，以及复杂情况如何简化为可行的问题以实现出院。
