Parent and Physician Qualitative Perspectives on Reasons for Pediatric Hospital Readmissions.
Parent and Physician Qualitative Perspectives on Reasons for Pediatric Hospital Readmissions.
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DOI：
10.1542/hpeds.2020-004499
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发表时间：
2021-10
影响因子：
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通讯作者：
Rosenthal JL
中科院分区：
文献类型：
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作者：
Hamline MY;Sauers-Ford H;Kair LR;Vadlaputi P;Rosenthal JL
五分之一的父母报告说，他们的孩子在从医院到家庭的过渡过程中存在问题，导致不良事件、不满和再次入院。虽然有几项研究探讨了父母对出院需求的看法，但很少有人探讨儿科再入院的原因。我们试图从父母和医生的角度调查导致儿科再入院的因素。我们进行了一项定性研究，采用半结构化的采访与家长，出院和再入院的医生，并在30天内从儿科病房在城市非独立儿童医院首次出院的儿童再入院的专科顾问。参与者在再入院期间接受采访，询问最初入院期间的护理过渡经验以及再入院的潜在原因和可预防性。使用恒定比较方法迭代分析数据。我们确定了主要主题，征求反馈，并推断主题之间的关系，以开发一个概念模型，防止再入院。我们进行了53次访谈，从20名患者再入院，包括20名家长，20名再入院医生，11名出院医生，和3个咨询专科医生。主要专题包括：1）角色不明确导致患者护理任务缺乏所有权，2）缺乏协作沟通导致对护理计划的理解不一致，3）不完整的医院到家庭过渡导致对医院的持续依赖。明确定义团队成员的角色，改善护理团队成员之间的沟通和护理团队和家庭之间，并加强护理协调，以促进医院到家庭的过渡被认为是潜在的干预措施，可能有助于防止再入院。
One in five parents report a problem in their child’s hospital-to-home transition, leading to adverse events, dissatisfaction, and readmissions. While several studies have explored parent insights into discharge needs, few have explored perceptions of causes for pediatric readmissions. We sought to investigate factors contributing to pediatric readmissions, from both parent and physician perspectives. We conducted a qualitative study using semi-structured interviews with parents, discharging and readmitting physicians, and subspecialist consultants of children readmitted within 30 days of initial discharge from the pediatric ward at an urban non-freestanding children’s hospital. Participants were interviewed during the readmission, asking about care transition experiences during the initial admission and potential causes and preventability of readmission. Data were analyzed iteratively using a constant-comparative approach. We identified major themes, solicited feedback, and inferred relationships between themes to develop a conceptual model for preventing readmissions. We conducted 53 interviews from 20 patient readmissions, including 20 parents, 20 readmitting physicians, 11 discharging physicians, and 3 consulting subspecialists. Major themes included: 1) Unclear roles cause lack of ownership in patient care tasks, 2) Lack of collaborative communication leads to discordant understanding of care plans, and 3) Incomplete hospital-to-home transitions result in ongoing reliance on the hospital. Clear definition of team member roles, improved communication among care team members and between care teams and families, and enhanced care coordination to facilitate the hospital-to-home transition were perceived as potential interventions that may help prevent readmissions.