A Perfect Storm: Care Transitions for Vulnerable Older Adults Discharged Home From the Emergency Department Without a Hospital Admission
A Perfect Storm: Care Transitions for Vulnerable Older Adults Discharged Home From the Emergency Department Without a Hospital Admission
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DOI：
10.1093/geront/gnu017
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发表时间：
2016-04-01
期刊：
影响因子：
5.7
通讯作者：
Ziminski, Carolyn E.
中科院分区：
文献类型：
--
作者：
Cadogan, Mary P.;Phillips, Linda R.;Ziminski, Carolyn E.
研究目的：本研究的目的是描述，从急诊科（艾德）供应商的角度来看，影响脆弱老年人从艾德过渡到家的质量和安全的因素。设计和方法：采用扎根理论方法分析来自9个焦点小组的数据，这些小组与艾德工作人员一起进行，其中包括来自护理、医学、药学、社会工作和呼吸治疗的代表。从这些护理提供者的角度来看，5个先行概念有助于从艾德到家的过渡的感知质量和安全性。这5个概念包括老年医学介绍的性质、提供者知识、消费者知识、艾德资源基础和卫生保健系统断裂。共发生和相互作用之间的5个确定的前因成立的条件，一个焦点小组的参与者描述为一个完美的storm.Implications：老年人出院回家的艾德没有入院治疗是一个越来越重要的，但研究不足的过渡期护理文献组。虽然他们与那些经历不同健康转变的人有一些相似之处，但他们独特的需求和艾德护理的具体特点需要一种新的方法。在这项研究中出现的模型为理解他们的过渡性护理需求的复杂和相互关联的方面提供了方向。
Purpose of the Study: The purpose of the study was to describe, from the perspectives of emergency department (ED) providers, factors that influence quality and safety of transitions home from the ED for vulnerable older adults.Design and Methods: A grounded theory approach was used to analyze data from 9 focus groups conducted with ED staff that included representatives from nursing, medicine, pharmacy, social work, and respiratory therapy.Results: From the perspectives of these care providers, 5 antecedent concepts contribute to the perceived quality and safety of transitions from the ED to home. These 5 concepts include the nature of geriatric presentations, provider knowledge, consumer knowledge, the ED resource base, and health care system fractures. Co-occurrence and interaction among the 5 identified antecedents set up conditions for what one focus group participant described as a perfect storm.Implications: Older adults discharged home from the ED without a hospital admission are an increasingly important but understudied group within the transitional care literature. Although they share some similarities with those undergoing different health transitions, their unique needs and the specific characteristics of ED care require a novel approach. The model that emerged in this study provides direction for understanding the complex and interrelated aspects of their transitional care needs.