Department of Surgery, Division of Vascular Surgery, University of Missouri System, Columbia, MI, USA.
Sinclair School of Nursing, University of Missouri System, Columbia, MO, USA.
Vascular. 2024 Apr;32(2):395-406. doi: 10.1177/17085381221135267. Epub 2022 Oct 26.
Transition from the hospital to an outpatient setting is a multifaceted process requiring coordination among a variety of services and providers to ensure a high-quality discharge. Vascular surgery patients comprise a complex population that experiences high unplanned readmission rates. We performed a qualitative study to identify themes for process improvement for vascular surgery patients. A validated discharge process, RED (Re-Engineered Discharge), was used to identify additional actionable themes to create a more efficient discharge process tailored specifically to the vascular surgery population.
A prospective, qualitative analysis at a tertiary center using a semi-structured focus group interview guide was performed to evaluate the current discharge process and identify opportunities for improvement. Focus groups were Zoom recorded, transcribed into electronic text files, and were loaded into Dedoose qualitative software for analysis using a directed content analysis approach. Two researchers independently thematically coded each transcript, starting with accepted discharge components to identify new thematic categories. Prior to analysis, all redundancy of codes was resolved, and all team members agreed on text categorization and coding.
Eight focus groups with a total of 38 participants were conducted. Participants included physicians ( = 13), nursing/ancillary staff ( = 14), advanced nurse practitioners ( = 2), social worker/dietitian/pharmacist ( = 3), and patients ( = 6). Transcript analyses revealed facilitators and barriers to the discharge process. In addition to traditional RED components, unique concepts pertinent to vascular surgery patients included patient complexity, social determinants of health, technology literacy, complexity of ancillary services, discharge appropriateness, and use of advanced nurse practitioners for continuity.
Specific themes were identified to target and enhance the future vRED (vascular Re-Engineered Discharge) bundle. Thematic targets for improvement include increased planning, organization, and communication prior to discharge to address vascular surgery patients' multiple comorbidities, extensive medication lists, and need for complex ancillary services at the time of discharge. Other thematic barriers discovered to improve include provider awareness of patient health literacy, patient understanding of complex discharge instructions, patient technology barriers, and intrinsic social determinants of health in this population. To address these discovered barriers, organizational targets to improve include enhanced social support, the use of advanced nurse practitioners for education reinforcement, and increased coordination. These results provide a framework for future quality improvement targeting the vascular surgery discharge process.
从医院过渡到门诊是一个多方面的过程，需要协调各种服务和提供者，以确保高质量的出院。血管外科患者是一个复杂的群体，他们经历高计划外再入院率。我们进行了一项定性研究，以确定血管外科患者改进流程的主题。采用经过验证的出院流程 RED（重新设计的出院）来确定其他可操作的主题，以创建更高效的专门针对血管外科患者的出院流程。
在一家三级中心进行前瞻性定性分析，使用半结构化焦点小组访谈指南，评估当前的出院流程并确定改进机会。焦点小组通过 Zoom 进行录制，转录为电子文本文件，并加载到 Dedoose 定性软件中，使用定向内容分析方法进行分析。两名研究人员独立对每个转录本进行主题编码，从接受的出院内容开始，以确定新的主题类别。在分析之前，解决了所有代码的冗余问题，并且所有团队成员都同意文本分类和编码。
共进行了 8 个焦点小组，共有 38 名参与者。参与者包括医生（=13）、护理/辅助人员（=14）、高级执业护士（=2）、社工/营养师/药剂师（=3）和患者（=6）。转录本分析揭示了出院流程的促进因素和障碍。除了传统的 RED 组件外，与血管外科患者相关的独特概念还包括患者的复杂性、健康的社会决定因素、技术素养、辅助服务的复杂性、出院的适当性以及高级执业护士在连续性方面的使用。
确定了特定的主题，以针对和增强未来的 vRED（血管重新设计的出院）捆绑包。改进的主题目标包括在出院前增加计划、组织和沟通，以解决血管外科患者的多种合并症、广泛的药物清单以及出院时对复杂辅助服务的需求。为了提高发现的其他主题障碍，包括提高提供者对患者健康素养的认识、患者对复杂出院说明的理解、患者的技术障碍以及该人群内在的社会决定因素。为了解决这些发现的障碍，组织目标包括增强社会支持、使用高级执业护士加强教育以及增加协调。这些结果为针对血管外科出院流程的未来质量改进提供了框架。
