Thise Rasmussen Marie Louise, Lomborg Kirsten, Iversen Kasper Karmark, Konradsen Hanne
Department of Emergency Medicine, Copenhagen University Hospital-Herlev and Gentofte, Herlev 2730, Denmark.
Department of Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev 2730, Denmark.
Emerg Med Int. 2023 Jun 6;2023:4997401. doi: 10.1155/2023/4997401. eCollection 2023.
Unmet care needs and more than one reasonable discharge solution have been identified among patients in the emergency department. Less than half of the patients attending emergency care have reported being involved in decisions to the degree they have wanted. Having a person-centered approach, such as involving patients in decisions regarding their discharge, has been reported as being associated with beneficial outcomes for the patient.
The aim of the study was to explore the extent of patients' involvement in discharge planning in acute care and how patient involvement in decisions regarding discharge planning is managed in clinical practice.
A multimethod study, including both quantitative and qualitative data, was carried out. The quantitative part included a descriptive and comparative analysis of additional data from the patient's medical records and patient's responses to the CollaboRATE questionnaire. The qualitative part included a content analysis of notes from field studies of interactions between healthcare professionals and patients.
A total of 615 patients from an emergency department at a medium-sized hospital completed the questionnaire. Roughly, a third gave top-box scores (36%), indicating optimal involvement in decisions. Two factors, being discharged home and not readmitted, were significantly associated with the experience of being involved. In clinical practice, there was a focus on symptoms, and diagnostic tools and choice of treatment were decisive for the further care trajectory of the patients. Speed and low continuity left limited opportunities for dialogue to uncover patients' preferences. At the same time, the patients did not expect to be involved.
Two out of three patients did not experience being involved in decisions regarding emergency department discharge. The interactions reflected an organizational structure in which the conditions for patient involvement were limited. Uncovering opportunities and initiatives to increase the number of patients who experience being involved in decisions is important tasks for the future.
在急诊科患者中已发现存在未满足的护理需求以及不止一种合理的出院解决方案。不到一半的急诊患者表示参与了他们期望程度的决策。据报道，采用以患者为中心的方法，如让患者参与有关出院的决策，对患者有有益的结果。
本研究的目的是探讨急性护理中患者参与出院计划的程度，以及在临床实践中如何管理患者对出院计划决策的参与。
进行了一项多方法研究，包括定量和定性数据。定量部分包括对患者病历中的额外数据以及患者对CollaboRATE问卷的回答进行描述性和比较性分析。定性部分包括对医疗保健专业人员与患者互动的实地研究记录进行内容分析。
一家中型医院急诊科的615名患者完成了问卷。大致上，三分之一的患者给出了最高分（36%），表明在决策中得到了最佳参与。两个因素，即出院回家和不再入院，与参与体验显著相关。在临床实践中，重点关注症状，诊断工具和治疗选择对患者的进一步护理轨迹起决定性作用。速度快和连续性差使得进行对话以了解患者偏好的机会有限。与此同时，患者并不期望参与。
三分之二的患者没有体验到参与急诊科出院决策。这些互动反映了一种组织结构，其中患者参与的条件有限。发现增加参与决策体验的患者数量的机会和举措是未来的重要任务。
