2859例出院患者电话随访中反映的问题及分析

目的：通过电话随访了解2859例出院患者反映的住院期间问题并加以分析,以达到持续改进服务质量的目的。方法：于2011年9月至2012年2月,采用电话随访的方式对2859例出院患者进行调查,采用开放性的交流方法,了解患者住院期间在病房设施、医院管理、护理服务和医疗服务中发现的问题。结果：2859例出院患者共反映住院期间发现的问题494件,其中病房设施203件,医院管理112件,护理服务95件,医疗服务84件。结论：电话随访出院患者能客观了解其在住院期间发现的问题,医院应针对患者反映的问题制定相应的整改措施,营造良好的住院环境,不断改进护理服务质量,满足患者多方面的需求。     

Geriatric versus general medical wards: comparison of patients'' behaviours following discharge from an acute care hospital

The objective of this study was to explore, from a nursing perspective, the effectiveness of geriatric wards in preparing elderly patients for discharge from an acute care hospital. A convenience sample of 40 patients aged 70 years or older was obtained from three geriatric medical wards and two general medical wards of a large British teaching hospital. Data were collected immediately prior to discharge, and after 6 and 13 weeks following discharge. No meaningful differences were found between the two patient-groups in their ability to cope with activities of daily living following discharge. The majority of deaths and/or hospital readmissions occurred within 6 weeks of discharge. A major concern identified in both groups was patients' lack of knowledge about medications and their side-effects. A need for more effective teaching programmes for elderly patients was identified.     

老年患者对急诊就医体验的满意度现状调查与分析

目的调查老年患者对急诊就医体验的满意度,结合临床实际分析原因,为提高老年患者就医体验满意度,改进医院的服务质量提供参考依据。方法选取2018年6月至2019年3月我院急诊就诊的老年患者900例,调查患者就医满意度现状。结果老年患者对医护人员提供及时帮助、医师技术、院内标识醒目清楚、科室布局合理、医护人员对您隐私尊重保护、急诊就诊分级、医护人员耐心介绍用药方法及注意事项、本次就医费用明白合理、我感觉到了医护人员给予我的尊重和安慰、候诊时间可以接受、挂号等待时间可以接受满意度较高。结论提高老年患者急诊就医体验满意度需进一步推进医疗服务的人性化建设,在简化就诊流程的同时照顾老年患者这一特殊群体,持续完善医疗费用的公开透明。     

Subjective perception of additional support requirements of elderly patients discharged from accident and emergency departments.

Fifty per cent of elderly patients discharged from accident and emergency (A&E) departments experience functional deterioration and increased dependence; 5.6% require readmission within 14 days. Discharge is often to inadequate community support. Functional assessment by A&E department staff may identify patients at greatest risk. The predictive ability of 25 patients aged 75 years or over to identify their additional support requirements following discharge from the A&E department was evaluated retrospectively using interview questionnaires 10-20 days after discharge. A total of 23 patients, of mean age 79.3 years, were interviewed. Six patients expressed concern both about coping at home and about needing extra support; four of the nine patients who recruited additional help were in this group (P = 0.239; n.s.). There was no correlation between additional support needed and patients living alone (P = 0.302; n.s.), dependent relative (P = 0.325; n.s.) or existing domiciliary support (P = 0.197; n.s.). All patients were satisfied with their management, and of the six who expressed concern about being able to cope at home, none informed A&E staff. Patients' perception is an unreliable indicator of their need for additional help and their ability to manage at home after discharge from A&E departments. Additional support requirements appear to be unrelated to domestic circumstances.     

An audit of current discharge planning arrangements and their effectiveness on elderly care wards and community nursing services together with aspects of client satisfaction

This paper is a review of a clinical audit conducted on the elderly care wards of a National Health Service (NHS) Trust hospital in the East Midlands. The audit examined current discharge planning arrangements and their effectiveness on elderly care wards, community nursing services and client satisfaction. Sixty sets of nursing notes were examined, 27 community nurses received a questionnaire and 60 patients and 26 carers or significant others were interviewed in the patient's place of residence. The audit findings revealed that, of the 60 sets of notes examined, only 10% of patient discharge plans commenced on admission. Liaison between ward and community nursing staff to discuss the needs of patients being discharged was minimal. Only 50% of community nurses believed they were adequately informed about, and 40% adequately involved in, patient discharge. Little consultation between ward staff, patients and their carers occurred during the discharge planning phase. The majority of patients (63%) and carers (81%) interviewed said that the patient's needs were not discussed prior to discharge home. The report ended by formulating a list of 11 recommendations which includes a thorough review of current policies, procedures and standards. A multidisciplinary steering group has been formed to assist in the implementation of the recommendations.     

Elderly patients discharged from an accident and emergency department--their dependency and support.

One hundred elderly patients who had attended an accident and emergency department and had been discharged were visited at home shortly afterwards. Compared to their previous level of function, 52 showed a minor or major increase in dependency, usually related to trauma. Scrutiny of accident and emergency records showed only scanty documentation of dependency, function and support arrangements. Available statutory services for dependent elderly in the community were under-utilized by these patients. In 39 of the 52 cases with increased dependency relatives had provided additional support.     

The efficiency of inpatient medical care in a hospital secure unit

A method was developed and tested to analyze the efficiency of medical care using each patient's length of hospital stay (LOS) and comparing these LOS with patients with similar diagnoses, ages, and operative conditions. The method assigns a percentile score to each discharged patient's LOS in comparison with the group of patients in the referent population with the same medical condition. A percentile score calculated in this way removes the effect of case mix and intensity of service from each patient's LOS, and allows the efficiency of medical care to be analyzed. This method was applied to patients who were discharged from a secure unit of a general hospital that serves the tertiary medical needs of patients from the state's correctional system. The LOS for our patients on average corresponded to the 60th percentile for the LOS in other patients with comparable ages and medical conditions. This difference was significantly greater than an expected value of 50.0 (P less than 0.01). The LOS of patients discharged from each specialty service were examined. Two services were identified, in which an increased LOS represented a difference in the practice patterns of physicians in these specialties, in comparison with those of other physicians in this area. An application of the method described in this report should enable hospitals to identify units or services where patients are managed inefficiently and to guide the need for managerial intervention.     

社区“以医助养”模式对老年人营养健康和生活质量的影响

目的探讨社区“以医助养”模式对老年人营养健康和生活质量的影响。方法选取2019年1月—2020年2月王母社区和大鹏社区的90例伴有高血压、糖尿病的老年人作为研究对象,予以社区“以医助养”干预,对比干预前后社区卫生服务利用率、老年人健康知识掌握程度、营养健康状态、老年人自我效能感、幸福度、家庭功能、社会支持得分的差异。结果干预6个月后,老年人健康评估与规划、建立社区健康档案、参与健康教育活动、领取教育资料、接受社区养老服务均优于干预前(P<0.05)。干预6个月后,老年人常见疾病防治知识、生活及心理卫生、保健知识及健康知识掌握程度总分均高于干预前(P<0.05)。干预6个月后,血清白蛋白(ALB)、血红蛋白(HB)、转铁蛋白(TRF)、前白蛋白(PAB)等营养健康指标均明显高于干预前(P<0.05)。干预6个月后,老年患者自我效能感、幸福度、家庭功能、社会支持得分均高于干预前(P<0.05)。结论“以医助养”模式应用于伴有慢性病老年人的社区养老管理,能提高老年人健康知识掌埋度,改善老年慢性病患者对社区卫生服务的利用率,进而提升老年人的营养健康状态、幸福度和生活质量。     

Barriers to accessing health care: the perspective of elderly people within a village community

Many initiatives which emphasise the consumerist stance of patients make the apparent assumption that patients have the knowledge and desire to exercise their consumer rights. This study explores the extent to which there is a consumerist ethos among elderly people in a village community, and the factors which influence the accessing of health care in the community. Using a mini-ethnographic approach, nine key informants were observed and interviewed. Cultural factors were found to influence coping in health and illness, and in legitimising access to primary health care. No informant saw the need to exercise their rights as consumers of health care, suggesting that despite initiatives to involve patients as partners in health care, the hierarchical position of the elderly people in the village is unchanged from the days of the medical model in health care, and is a significant barrier to their use of health services.     

Use of formal community services by elders and their family caregivers 2 weeks following hospital discharge*

Early identification of elders who need care following hospitalization might enhance their health and the health of family members who help them with managing their care. The purpose of this study was to: (a) identify pre-discharge predictors of resource use following hospitalization; (b) describe the formal community services used by elders and their family caregivers during the 2 weeks following hospitalization; and (c) determine whether there is a difference in hospital re-admissions between elders who receive community nursing services compared with those who do not receive any services. The sample consisted of 185 elder/caregiver dyads in which the elders were hospitalized for an acute episode of a chronic condition. Both patients and family caregivers were interviewed before discharge and 2 weeks post-discharge. The findings indicate that pre-discharge functional ability and age are statistically significant predictors of home care services used 2 weeks post-discharge. The findings also suggest that elders who receive visiting nurse services are less likely to be re-admitted to the hospital.     

Formal service utilization by the frail elderly at home during the last 6 months of life

Abstract The purpose of this study was to examine how the use of medical/social services by elderly persons changes over time as they approach death. This research was conducted at a public visiting nursing office in Tokyo. Nursing records of all elderly persons, those who died at home or died within 1 week of hospital admission between April 1993 and June 1997 were reviewed. The percent of patients using each type of medical or social service was calculated for three time periods before death: more than 6 months, 1–6 months and within 1 month. This retrospective examination clearly demonstrates a shift in specific service usage by elderly persons during the months prior to death. As terminal illness becomes more advanced, the use of medical services increases more remarkably than the use of social services. The increase in nurse visits is far greater than that of home aid visits. Visiting nurses should demonstrate their skills of care appropriate to the changeable conditions of the elderly and their families in the terminal stage.     

Predictors of early hospital readmissions of older adults who are functionally impaired

When older adults who are chronically ill are discharged home, they face a high risk of hospital readmission. The purpose of the study was to determine whether low social support, low satisfaction with social support, high depressive symptomatology of the caregiver, and minimal use of home health care predicted hospital readmissions of the older adult. Sixty family caregivers were interviewed in their homes soon after hospital discharge and 3 months later. Tangible forms of social support and helping others were negatively related to the number of hospital readmissions. Nurses need to encourage families to seek and use social support that is offered.     

The problems of elderly people at home one week after discharge from an acute care setting

The problems of elderly people following discharge from hospital is a worldwide focus of nursing attention. Actual and local insight into the nature worldwide focus of nursing attention. Actual and local insight into the nature and extent of post-discharge problems is needed as a base for improving and evaluating discharge planning. Problems following discharge were investigated as the first part of a larger study. Over a 3-month period, 251 elderly people who had been discharged after a hospital stay of more than 3 days. Were asked to participate in the study. Half received a postal questionnaire and half were interviewed at home, one week after discharge. There were 145 respondent. The need for information was mentioned by 80% of the patients. Housekeeping tasks also caused most patients some difficulty. Almost 40% of those discharged reported some kind of unmet need.     

Health and Social Service Utilization Among Elderly Immigrants from the Former Soviet Union

Purpose: To explore factors that affect health and social service use among elderly Russian immigrants from the perspectives of the elders, their adult caregiving children, and the health and social service professionals who serve them.
Methods: A qualitative, case-oriented study design was used and 17 elderly Russian immigrants, 8 adult caregiving children, and 15 health professionals were interviewed in the Boston area in 1998. Perceptions about the patterns of and reasons for Russian elders' health and social service use were summarized through content analysis of the interview data.
Findings: Participants across groups perceived extensive service use by elderly Russian immigrants. Life circumstances associated with immigration, cultural norms and beliefs, and structural characteristics of the local Russian immigrant community accounted for service use.
Conclusions: Findings indicate that providing support for depression and loneliness associated with immigration, educating immigrants about the role of primary care providers in the US as well as realistic expectations for American medicine, and managing care to decrease the use of unnecessary services would facilitate appropriate service use among elderly Russian immigrants.     

手术出院患者社区护理需求与实际利用状况

目的 调查手术患者出院时社区护理服务需求及出院1周内实际利用社区护理服务的状况.方法 采用整群抽样的方法选取某综合医院257例手术患者为研究对象,运用自制调查表,在患者出院当日调查社区护理服务需求情况,在患者出院1周时电话随访社区护理服务实际利用情况.结果 96.0%的手术患者出院时存在社区护理需求;需求的社区护理服务项目涉及疾病护理、健康指导及预防保健类服务;需求多种服务方式.出院1周内社区护理实际利用率为16.5%;分别有54.5%和63.6%的患者利用了伤口护理和给药护理服务,服务内容以疾病护理为主,服务方式以社区卫生服务中心(站)护理为主.结论 手术出院患者对社区护理服务的需求状况与实际利用情况两者存在矛盾.积极开展手术患者社区护理服务,拓展服务内容,完善服务模式,提高社区护理参与程度以满足患者的强烈需求,具有重要意义.     

Elderly patients' use of hospital-based emergency services

Past studies have shown in many instances that elderly people are represented in the hospital emergency room in proportion to their distribution in the population. It is possible, though, that elderly patients in the emergency room are using different types of resources than individuals of a younger age. Samples of two hospital emergency room users were selected in 1981 and in 1986. Patients aged 25 years or older were included in the study. The dependent variable was the extent to which patients used resources available at the hospital emergency room only or at alternative emergency medical services in the community. The effect of age on the use of resources in the hospital emergency rooms was estimated separately for those who were transported to the emergency room by ambulance and for those who were not. Age had an effect on use of resources under both conditions, regardless of the patients' gender, time of the visits, availability of alternative sources of emergency care, and diagnostic categories. The role of the hospital emergency room is to address medical care needs of specific segments of the population in special circumstances. Elderly emergency room patients are indeed one of these specific segments with very special needs.     

The process of hospital discharge for medical patients: a model

BACKGROUND: The 1990 NHS Community Care Act established a requirement for hospital discharge policies and procedures in the United Kingdom to be developed in collaboration with local government authorities in order to ensure supported discharge for those in need. AIMS: The aim of the study reported in this paper was to track decisions about hospital discharge in relation to outcomes for a sample of medical patients and their carers, identified as at risk of experiencing unsuccessful discharge processes. METHODS: Themed unstructured interviews were conducted in three different hospitals with 30 patients identified as at risk of unsuccessful discharge and their carers pre- and postdischarge. Hospital, community and social care staff involved in the care of the patient were also interviewed. FINDINGS: Patients and carers were constantly negotiating their social roles, seeking to juggle appropriate identities and limited resources to maintain their own and each others' dignity and quality of life. When the negotiation process was destabilized (for example, by exacerbation of chronic disease, withdrawal of some resource, or the experience of additional stressors - not necessarily health-related), then either or both parties sought a way out. In all the cases examined the result was admission to hospital - usually, but not always, mediated by community professionals. CONCLUSIONS: The effective discharge of patients from hospital needs to move from a functional focus on symptom management to a negotiation of quality of life that seeks to promote health for all parties involved.     

Elderly patients' perceptions of their spiritual needs and care: a pilot study

This paper describes a pilot study, in a small sample of elderly patients, designed to ascertain their perceptions of their spiritual needs and care. According to the nursing literature, spiritual care is part of the nurse's role. But it is not clear what spiritual needs are or how nurses are expected to give spiritual care. Ten patients from a care of the elderly assessment unit located in a hospital in Edinburgh, Scotland were interviewed about their spiritual needs in the summer of 1995. Eight patients admitted to having experienced spiritual needs at some time in their lives, six while in hospital. The types of needs experienced related to religion, meaning, love and belonging, morality, and death and dying. Their spiritual needs could have been better met if, for example, a quiet room for reflection/prayer had been available and if they had been told about hospital church services and provided with transport to attend. Although limited, the findings contribute to our understanding of spiritual need and spiritual care from the elderly in-patients' view point. Further research, however, is needed to explore the type of spiritual help other elderly patients and other patient groups in different geographical locations feel they would like.     

Nonemergent ED patients referred to community resources after medical screening examination: characteristics, medical condition after 72 hours, and use of follow-up services.

INTRODUCTION: Limited access to medical care has resulted in large numbers of patients seeking primary care for non-emergent emergency conditions in emergency departments. This influx of patients is contributing to overcrowding and delays in care for patients with emergencies. In response, a system was implemented in which persons with non-emergent medical conditions, following a medical screening examination, did not receive further ED assessment or treatment and instead were referred to community resources. The purpose of this study was to describe the characteristics of individuals who were referred to community-based services, their condition after 72 hours, and their use of follow-up health care services. METHODS: All referred cases (n=225) were reviewed for chief complaint and demographics. Phone contact was attempted after 72 hours to determine the person's condition and if community resources were utilized. RESULTS: Of the 225 cases, 52% were female, with a mean age of 33 years. Their most common chief complaints were extremity problems (16%), toothache (9%), and medication refill (8%). Follow-up phone contact was successful with 82 people (37%) an average of 14 days after their ED visit. The majority (55%) reported their condition had improved; 39%were unchanged, and 6% were worse. Thirty-one people(40%) accessed community resources and 8 (26%) returned to another emergency department. No clinically significant associations were found between patient demographics and use of community resources. DISCUSSION: Most people who were successfully contacted for follow-up and who had come to the emergency department with non-emergent chief complaints did not access community resources and their condition frequently improved. Additional studies, with improved follow-up, are needed before suggesting that referring individuals to community resources is an acceptable practice.