A qualitative investigation of healthcare workers' strategies in response to readmissions.
A qualitative investigation of healthcare workers' strategies in response to readmissions.
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DOI：
10.1186/s12913-018-2945-9
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发表时间：
2018-02-27
影响因子：
2.8
通讯作者：
Ayres BS
中科院分区：
文献类型：
--
作者：
Pennathur PR;Ayres BS
患者再次入院通常与患者病情的显著临床变化相关，但尚不清楚医疗保健工作者在考虑这些变化时如何修改其护理提供。本研究的目的是确定医护人员如何改变他们的护理策略时，再入院的病人。采用扎根理论方法对医护人员进行典型个案抽样研究。研究环境包括学术中心和三级护理医院的几个患者护理单位。我们有目的地抽样34名医护人员（19名女性，15名男性）参加个别访谈，无论是面对面还是通过电话。我们向参与者询问了关于他们对再入院的想法以及他们如何改变再入院患者的过程和行为的半结构化问题。对访谈进行了录音和转录。我们使用了定性数据分析的基础上归纳的方法，以产生关于医护人员如何改变他们的策略，再入院患者的主题。医护人员在再入院策略上的转变反映在三个主要主题上：临床评估、信息的使用和管理以及沟通模式。参与者报告说，他们在评估再次入院患者的临床状况时变得更加保守。参与者还表示，根据护理要求，再入院患者将以与正常入院相似的方式接受治疗;然而，有些矛盾的是，他们还表示，获得先前的患者信息改变了他们治疗再入院患者的方式。虽然医护人员可能会表现出一种倾向，变得更加保守的再入院，现成的病人信息，从以前的入院发挥了很大的一部分，在指导他们的想法。对再次入院的患者采取更保守的方法本身并不一定会改善记录或改善患者护理。本文的在线版本（10.1186/s12913-018-2945-9）包含补充材料，可供授权用户使用。
Readmission of a patient to a hospital is typically associated with significant clinical changes in the patient’s condition, but it is unknown how healthcare workers modify their provision of care when considering these changes. The purpose of the present study was to determine how healthcare workers shift their care strategies when treating readmitted patients. A typical case sampling study of healthcare workers was conducted using the grounded theory approach. The study setting comprised several patient care units at an academic center and tertiary-care hospital. We purposively sampled 34 healthcare workers (19 women, 15 men) to participate in individual interviews, either face-to-face or by telephone. We asked the participants semi structured questions regarding their thoughts on readmissions and how they altered their process and behavior for readmitted patients. Interviews were audio-recorded and transcribed. We used a qualitative data analyses based on an inductive approach to generate themes about how healthcare workers shift their strategies for readmitted patients. Healthcare workers’ shifts in strategy for readmissions were reflected in three major themes: clinical assessment, use and management of information, and communication patterns. Participants reported that they became more conservative in their assessment of the clinical condition of a readmitted patient. The participants also indicated that readmitted patients would be treated in a similar way to normal admission based on care requirements; however, somewhat paradoxically, they also expressed that having access to prior patient information changed the way they treated a readmitted patient. Although healthcare workers may exhibit a tendency to become more conservative with readmissions, readily available patient information from the previous admission played a large part in guiding their thinking. A more conservative approach with a readmitted patient, on its own, does not necessarily lead to improved documentation or better patient care. The online version of this article (10.1186/s12913-018-2945-9) contains supplementary material, which is available to authorized users.
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