Processing discharge summaries in general practice: a qualitative interview study with GPs and practice managers.
Processing discharge summaries in general practice: a qualitative interview study with GPs and practice managers.
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DOI：
10.3399/bjgpopen18x101625
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发表时间：
2019-04-01
期刊：
影响因子：
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通讯作者：
Avery, Anthony J
中科院分区：
文献类型：
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作者：
Spencer, Rachel A;Rodgers, Sarah;Avery, Anthony J
背景：出院摘要对于将患者信息从二级护理传递到关于医院出院的全科医学是必不可少的。目的：探讨全科医生对出院总结中未能对要求的行动作出反应的相关因素，以及采取什么措施来缓解这种情况。设计与背景：对英格兰三个地理区域的初级保健人员进行了半结构化访谈。方法：对10名执业经理和10名全科医生(10家诊所各一名)进行访谈，以探讨出院总结的管理。结果：从访谈中得出五个主题。“次级护理因素”主题描述了参与者对摘要设计的看法，这些观点是不一致的，经常需要改进。“处理系统的安全特征”主题侧重于初级保健中的文件处理。随后举行了一个主题为“药品对账”的会议。“错误处理造成的错误和危害”是一个描述“人为错误”和其他因素的主题，参与者认为这些因素导致未能对请求的操作做出响应。最后，“安全改进策略”主题描述了预防更安全的护理过渡失败的举措。结论：正确处理出院总结对于确保患者经历安全的护理过渡至关重要，而不仅仅是出院。根据访谈结果，建议减少出院总结处理过程中的错误的策略，以加强更安全的护理过渡。
BACKGROUND: Discharge summaries are essential for communicating patient information from secondary care to general practice on hospital discharge. Although there has been extensive research into their design and completion in secondary care, very little is known about primary care processing of these documents.AIM: To explore what general practice staff think are the factors associated with failure to respond to actions requested in discharge summaries and what practices do to mitigate this.DESIGN & SETTING: Semi-structured interviews were undertaken with primary care staff in three geographical regions of England.METHOD: Interviews with 10 practice managers and 10 GPs (one of each at each of the 10 practices) were undertaken to explore management of discharge summaries.RESULTS: Five themes emerged from the interviews. The 'secondary care factors' theme describes participants' perspectives on the design of summaries, which are inconsistent and often require improvement. The 'safety features of processing systems' theme focuses on document handling in primary care. A theme devoted to 'medicines reconciliation' followed. 'Error and harm as a result of faulty processing' is a theme describing 'human error' and other factors that participants believed contributed to failure to respond to requested actions. Finally, the 'strategies for safety improvement' theme describes initiatives to prevent failures of safer transitions of care.CONCLUSION: Correct processing of discharge summaries is essential to ensure patients experience a safe transition of care and not just a hospital discharge. Based on the interview findings, strategies to mitigate against faults in the processing of discharge summaries have been suggested to enhance safer transitions of care.