A qualitative exploration of discharge destination as an outcome or a driver of acute stroke care
A qualitative exploration of discharge destination as an outcome or a driver of acute stroke care
复制标题
DOI：
10.1186/1472-6963-14-193
复制
发表时间：
2014-04-29
影响因子：
2.8
通讯作者：
Edwards, Ian
中科院分区：
文献类型：
--
作者：
Luker, Julie A.;Bernhardt, Julie;Edwards, Ian
背景：许多急性中风患者没有在三级医院接受推荐的护理。专职医疗专业人员在多学科卒中团队中发挥着重要作用，并影响患者接受的护理质量。研究联合医疗专业人员在急性中风管理中的作用的研究很少，而且对这些中风临床医生的临床决策知之甚少。在这项研究中，我们的目的是描述影响这些专业人员复杂临床决策的因素，因为他们优先考虑急性中风患者的推荐护理。这项定性研究是更大的混合方法研究的一部分。方法：所采用的定性方法是建构主义扎根理论方法。我们有目的地对南澳大利亚三所大都市三级护理医院的 15 名与急性中风患者一起工作的专职医疗人员进行了抽样。使用问题指南和数字记录进行了面对面的半结构化访谈。两名研究人员使用严格的扎根理论流程对访谈进行转录和分析。结果：我们的分析强调“预测出院目的地”是该专业群体护理决策和临床优先顺序的强大驱动力。我们发现，预测出院目的地的复杂临床决策需要专业人员同时考虑患者的中风前状态、中风的性质和严重程度、康复过程以及医疗保健系统内的多个因素。这些决定的后果可能对患者产生深远的影响，有时会导致专业人员经历相当大的不确定性和压力。结论：我们的定性调查为专职医疗专业人员为急性中风患者做出重要临床决策的方式提供了新的见解。这是第一项已知的研究，证明联合医疗专业人员在急性入院早期对出院目的地的主观预测对中风患者提供的护理和康复以及最终结果具有强大的影响。
Background: Many patients with acute stroke do not receive recommended care in tertiary hospital settings. Allied health professionals have important roles within multidisciplinary stroke teams and influence the quality of care patients receive. Studies examining the role of allied health professionals in acute stroke management are scarce, and very little is known about the clinical decision making of these stroke clinicians. In this study we aimed to describe factors that influence the complex clinical decision making of these professionals as they prioritise acute stroke patients for recommended care. This qualitative study was part of a larger mixed methods study.Methods: The qualitative methodology applied was a constructivist grounded theory approach. Fifteen allied health professionals working with acute stroke patients at three metropolitan tertiary care hospitals in South Australia were purposively sampled.Semi-structured interviews were conducted face to face using a question guide, and digital recording. Interviews were transcribed and analysed by two researchers using rigorous grounded theory processes.Results: Our analysis highlighted 'predicted discharge destination' as a powerful driver of care decisions and clinical prioritisation for this professional group. We found that complex clinical decision making to predict discharge destination required professionals to concurrently consider patient's pre-stroke status, the nature and severity of their stroke, the course of their recovery and multiple factors from within the healthcare system. The consequences of these decisions had potentially profound consequences for patients and sometimes led to professionals experiencing considerable uncertainty and stress.Conclusions: Our qualitative enquiry provided new insights into the way allied health professionals make important clinical decisions for patients with acute stroke. This is the first known study to demonstrate that the subjective prediction of discharge destination made early in an acute admission by allied health professionals, has a powerful influence over the care and rehabilitation provided, and the ultimate outcomes for stroke patients.