Patient Handoffs between Emergency Department and Inpatient Physicians

描述(由申请人提供)：对驻地工作时间的限制、大量不良事件中涉及的沟通问题以及联合委员会要求标准化移交做法的监管压力，这些都有助于了解和改进医院内的患者移交。然而，如果不能更好地了解社会因素和组织结构对信息传递、对病人的控制和责任的影响，或为了确保护理的连续性所必需的移交做法的变化，使这种过渡标准化的努力可能会受到限制。如果缺乏这样的理解，改善移交的努力有可能无意中给安全和护理质量带来新的挑战。此外，虽然关于患者移交实践的研究正在增长，但很少有人关注当患者从医院的急诊科(ED)被送往住院服务时发生的一种关键形式的移交。为了解决这些不足，本论文的研究将遵循扎根的理论方法，包括半结构访谈和人种志，以检查急诊科医生和美国一家大型三级教学医院的各种住院服务之间的入院移交。这项研究的目的是建立一个概念框架，了解接纳交接实践中多样性的来源和性质，以突出影响交接沟通和互动的复杂情景因素的重要性。这一框架将有助于更好地了解跨组织和专科边界协调护理的独特复杂性；证明患者、医生和更大的社会和组织因素的差异在塑造护理过渡中所起的作用；洞察移交的功能，超越患者信息的传达；以及确定富有成效的改进目标以及可能需要保护的重要差异来源的指南，从而有助于改进移交实践。

DESCRIPTION (provided by applicant): Limitations on resident work hours, the involvement of communication issues in a significant number of adverse events, and regulatory pressure from The Joint Commission to standardize handoff practices together contribute to a need to understand and improve patient handoffs in hospitals. Efforts to standardize such transitions, however, may be limited without a better understanding of the influence that social factors and organizational structures exert on transfers of information, control and responsibility for patients or of the variation in handoff practice that is necessary in order to ensure continuity of care. Lacking such an understanding, efforts to improve handoffs run the risk of inadvertently introducing new challenges to safety and quality of care. Furthermore, while research on patient handoff practices is growing, little attention has been directed toward a crucial form of handoff that occurs when patients are admitted from the emergency department (ED) of a hospital to an inpatient service. To begin addressing these deficiencies, this dissertation research will follow a grounded theory methodology, involving semi-structured interviews and ethnography to examine admission handoffs between physicians in the ED and various inpatient services of a large U.S. tertiary teaching hospital. The aim of the study is to develop a conceptual framework of the sources and nature of variety in admission handoff practice to highlight the importance of complex situational factors that affect handoff communication and interaction. This framework will contribute to handoff practice improvement by providing a better understanding of the unique complexities of coordinating care across organizational and specialization boundaries; evidence of the role that variations in patients, physicians, and larger social and organizational factors play in shaping care transitions; insight into the functions of handoffs beyond the conveying of patient information; and a guide for identifying fruitful targets for improvement, as well as, important sources of variation that may need to be protected.