Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
CJEM. 2024 Sep;26(9):633-641. doi: 10.1007/s43678-024-00697-1. Epub 2024 Jun 3.
Hospital and emergency department (ED) crowding is exacerbated on Mondays because fewer in-patients are discharged during the weekend. We evaluated the experiences and attitudes of in-patient ward nurses to better understand the challenges they face when considering the weekend discharge of their patients.
We conducted a qualitative study of in-patient ward nurses, using the theoretical domains framework (TDF), at two campuses of a major academic health sciences centre. The interview guides consisted of, first, a series of questions to explore the typical processes involved for safe patient discharges and, second, exploration of the influence of the 14 TDF domains. All interviews were audio-recorded, transcribed verbatim, and anonymized and then imported into NVivo qualitative software for data management and analysis. Analysis was conducted in three stages (coding, generation of specific beliefs, identification of relevant and nonrelevant domains).
The 28 interviewed nurses represented a variety of medical, surgical and other wards, and reported being acutely aware of the pressures to discharge patients on weekends (knowledge). They believed that increasing weekend discharges would improve hospital flow and aid in decanting the ED (beliefs about consequences). However, they also acknowledged that the weekend discharge pressures might result in patients being discharged prematurely and bouncing back to the hospital (beliefs about consequences). Overall, the nurses reported that as a hospital culture, discharging patients was not much of a priority (goals; environmental context and resources).
We know there are much fewer discharges on weekends, and this is associated with significant hospital and ED crowding on Mondays. This study has illuminated the many challenges faced by in-patient ward nurses when considering the discharge of admitted patients on weekends. In order to decrease ED and hospital crowding related to decreased weekend discharges, hospitals will need to effect a culture change amongst all staff.
由于周末住院患者出院人数减少，医院和急诊部（ED）的拥挤情况在周一加剧。我们评估了住院病房护士的经验和态度，以更好地了解他们在考虑周末出院患者时面临的挑战。
我们在一家主要学术健康科学中心的两个校区对住院病房护士进行了定性研究，使用理论领域框架（TDF）。访谈指南首先包括一系列问题，以探讨安全患者出院的典型过程，其次是探索 14 个 TDF 领域的影响。所有访谈均进行了录音、逐字记录和匿名处理，然后导入 NVivo 定性软件进行数据管理和分析。分析分三个阶段进行（编码、生成特定信念、识别相关和不相关领域）。
28 名接受采访的护士代表了各种内科、外科和其他病房，他们报告说对周末患者出院的压力非常敏感（知识）。他们认为增加周末出院人数将改善医院的流量，并有助于清空 ED（对后果的信念）。然而，他们也承认周末出院的压力可能导致患者过早出院并返回医院（对后果的信念）。总体而言，护士报告说，作为医院文化，出院并不是一个优先事项（目标；环境背景和资源）。
我们知道周末的出院人数要少得多，这与周一医院和 ED 拥挤的情况有关。这项研究阐明了住院病房护士在考虑周末出院住院患者时面临的许多挑战。为了减少与周末出院人数减少相关的 ED 和医院拥挤，医院将需要改变所有员工的文化。
