How Hospital Clinicians Select Patients for Skilled Nursing Facilities
How Hospital Clinicians Select Patients for Skilled Nursing Facilities
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DOI：
10.1111/jgs.14954
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发表时间：
2017-11-01
影响因子：
6.3
通讯作者：
Jones, Jacqueline
中科院分区：
文献类型：
--
作者：
Burke, Robert E.;Lawrence, Emily;Jones, Jacqueline
目的：了解医院临床医生如何评估住院的老年人，并决定哪些人将被转至专业护理机构（SNF）进行急性后期护理。
设计：半结构化访谈，并结合社会建构主义理论指导的定性分析方法。
地点：三家医院的住院病房。采用有目的的抽样方法，以最大限度地增加医院、医院内科室以及这些科室工作人员的差异性。
参与者：参与急性后期护理评估和决策的临床医生（内科医生、护士、治疗师、社会工作者、病例管理人员）（N = 25）。
测量指标：与临床医生评估和出院决策相关的核心主题。
结果：临床医生描述了加快评估和出院决策的压力，这导致将SNF作为从医院出院的老年人的“安全网”。医院临床医生对SNF护理实践、质量或患者预后缺乏了解，导致缺乏标准化的评估流程或明确的主要决策者。
结论：医院临床医生对SNF急性后期护理的评估和决策可能具有仓促的特点，没有明确的决策系统或框架，并且对SNF或转至SNF患者的预后缺乏了解。这导致SNF被用作许多老年人的“安全网”。随着医院和SNF越来越多地对在医院和SNF之间转诊的个体的预后共同负责，迫切需要改进评估和决策的新解决方案。
OBJECTIVE: To understand how hospital-based clinicians evaluate older adults in the hospital and decide who will be transferred to a skilled nursing facility (SNF) for postacute care.DESIGN: Semistructured interviews paired with a qualitative analytical approach informed by Social Constructivist theory.SETTING: Inpatient care units in three hospitals. Purposive sampling was used to maximize variability in hospitals, units within hospitals, and staff on those units.PARTICIPANTS: Clinicians (hospitalists, nurses, therapists, social workers, case managers) involved in evaluation and decision-making regarding postacute care (N = 25).MEASUREMENTS: Central themes related to clinician evaluation and discharge decision-making.RESULTS: Clinicians described pressure to expedite evaluation and discharge decisions, resulting in the use of SNFs as a "safety net" for older adults being discharged from the hospital. The lack of hospital-based clinician knowledge of SNF care practices, quality, or patient outcomes resulted in lack of a standardized evaluation process or a clear primary decision-maker.CONCLUSION: Hospital clinician evaluation and decision-making about postacute care in SNFs may be characterized as rushed, without a clear system or framework for making decisions and uninformed by knowledge of SNF or patient outcomes in those discharged to SNFs. This leads to SNFs being used as a " safety net" for many older adults. As hospitals and SNFs are increasingly held jointly accountable for outcomes of individuals transitioning between hospitals and SNFs, novel solutions for improving evaluation and decision-making are urgently needed.