Information sharing between intensive care and primary care after an episode of critical illness; A mixed methods analysis\
Information sharing between intensive care and primary care after an episode of critical illness; A mixed methods analysis\
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DOI：
10.1371/journal.pone.0212438
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发表时间：
2019-02-28
期刊：
影响因子：
3.7
通讯作者：
O'Connor, Enda
中科院分区：
文献类型：
--
作者：
Zilahi, Gabor;O'Connor, Enda
前言：出院时医院医生和全科医生之间的沟通质量差与患者的不良结局有关。这可能是更显着的发作后，危重病，其并发症可以持续很长时间后出院。评估重症监护室工作人员和全科医生之间的信息共享2。以确定影响因素的流动和利用这一信息。MethodsParallel混合方法观察研究在爱尔兰设置，同等重视定量和定性数据。对来自GP和ICU顾问问卷的定量数据进行描述性分析。定性数据来自半结构化的采访与全科医生和顾问，并进行了分析，使用定向内容分析。混合的数据发生在阶段的interpretation.ResultsGP很少收到的信息直接从ICU工作人员的危重病发作，大多数来自患者和亲属。从医院收到的信息往往是简短和不完整的。咨询师报告的常见沟通障碍是时间不足，重要性低，难以建立GP联系。在提供信息时，全科医生很少采取具体的干预措施，理由是医院通信指导不足，对危重病并发症及其管理的了解不足。大多数受访者认为，改善信息共享将使患者受益。文化对实践的影响被定性数据。先验的定性主题是：（1）信息共享的感知效益，（2）影响当前做法的因素和（3）最佳信息共享的战略。紧急主题是：（4）GP在患者护理中的核心作用，（5）的概念，“整个病人的旅程”和（6）文化的期望周围的GP的知识的医院care.ConclusionsPractical和文化因素有助于次优的ICU和初级保健医生之间的信息共享在ICU的危重病发作。我们提出了一个三个里程碑的战略，以改善流动和利用信息时，病人入院，出院或死亡的ICU。
IntroductionPoor quality communication between hospital doctors and GPs at the time of hospital discharge is associated with adverse patient outcomes. This may be more marked after an episode of critical illness, the complications of which can persist long after hospital discharge.Aims1. to evaluate information sharing between ICU staff and GPs after a critical illness2. to identify factors influencing the flow and utilisation of this information.MethodsParallel mixed methods observational study in an Irish setting, with equal emphasis on quantitative and qualitative data. Descriptive analysis was performed on quantitative data derived from GP and ICU consultant questionnaires. Qualitative data came from semi-structured interviews with GPs and consultants, and were analysed using directed content analysis. Mixing of data occurred at the stage of interpretation.ResultsGPs rarely received information about an episode of critical illness directly from ICU staff, with most coming from patients and relatives. Information received from hospital sources was frequently brief and incomplete. Common communication barriers reported by consultants were insufficient time, low perceived importance and difficulty establishing GP contact. When provided information, GPs seldom actioned specific interventions, citing insufficient guidance in hospital correspondence and poor knowledge about critical illness complications and their management. A majority of all respondents thought that improved information sharing would benefit patients. Cultural influences on practice were identified in qualitative data. A priori qualitative themes were: (1) perceived benefits of information sharing, (2) factors influencing current practice and (3) strategies for optimal information sharing. Emergent themes were: (4) the central role of the GP in patient care, (5) the concept of the "whole patient journey" and (6) a culture of expectation around a GP's knowledge of hospital care.ConclusionsPractical and cultural factors contribute to suboptimal information sharing between ICU and primary care doctors around an episode of critical illness in ICU. We propose a three-milestone strategy to improve the flow and utilisation of information when patients are admitted, discharged or die within the ICU.