Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study
Objectives Trauma and acute care surgery (TACS) patients face complex barriers associated with hospitalization discharge that hinder successful recovery. We sought to better understand the challenges in the discharge transition of care, which might suggest interventions that would optimize it.Method...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/7/1/e000800.full |
| _version_ | 1826956388846272512 |
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| author | Gregory J Jurkovich Nikia R McFadden Melissa M Gosdin Garth H Utter |
| author_facet | Gregory J Jurkovich Nikia R McFadden Melissa M Gosdin Garth H Utter |
| author_sort | Gregory J Jurkovich |
| collection | DOAJ |
| description | Objectives Trauma and acute care surgery (TACS) patients face complex barriers associated with hospitalization discharge that hinder successful recovery. We sought to better understand the challenges in the discharge transition of care, which might suggest interventions that would optimize it.Methods We conducted a qualitative study of patient and clinician perceptions about the hospital discharge process at an urban level 1 trauma center. We performed semi-structured interviews that we recorded, transcribed, coded both deductively and inductively, and analyzed thematically. We enrolled patients and clinicians until we achieved data saturation.Results We interviewed 10 patients and 10 clinicians. Most patients (70%) were male, and the mean age was 57±16 years. Clinicians included attending surgeons, residents, nurse practitioners, nurses, and case managers. Three themes emerged. (1) Communication (patient-clinician and clinician-clinician): clinicians understood that the discharge process malfunctions when communication with patients is not clear. Many patients discussed confusion about their discharge plan. Clinicians lamented that poorly written discharge summaries are an inadequate means of communication between inpatient and outpatient clinicians. (2) Discharge teaching and written instructions: patients appreciated discharge teaching but found written discharge instructions to be overwhelming and unhelpful. Clinicians preferred spending more time teaching patients and understood that written instructions contain too much jargon. (3) Outpatient care coordination: patients and clinicians identified difficulties with coordinating ongoing outpatient care. Both identified the patient’s primary care physician and insurance coverage as important determinants of the outpatient experience.Conclusion TACS patients face numerous challenges at hospitalization discharge. Clinicians struggle to effectively help their patients with this stressful transition. Future interventions should focus on improving communication with patients, active communication with a patient’s primary care physician, repurposing, and standardizing the discharge summary to serve primarily as a means of care coordination, and assisting the patient with navigating the transition.Level of evidence III—descriptive, exploratory study. |
| first_indexed | 2024-04-11T18:27:47Z |
| format | Article |
| id | doaj.art-83446aad07a74f58ad4a5f6f6fbe8bbe |
| institution | Directory Open Access Journal |
| issn | 2397-5776 |
| language | English |
| last_indexed | 2025-02-18T00:05:54Z |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj.art-83446aad07a74f58ad4a5f6f6fbe8bbe2024-11-30T12:15:13ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762022-10-017110.1136/tsaco-2021-000800Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative studyGregory J Jurkovich0Nikia R McFadden1Melissa M Gosdin2Garth H Utter3Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of California Davis, Davis, California, USADepartment of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of California Davis, Davis, California, USA1 Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USADepartment of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of California Davis, Davis, California, USAObjectives Trauma and acute care surgery (TACS) patients face complex barriers associated with hospitalization discharge that hinder successful recovery. We sought to better understand the challenges in the discharge transition of care, which might suggest interventions that would optimize it.Methods We conducted a qualitative study of patient and clinician perceptions about the hospital discharge process at an urban level 1 trauma center. We performed semi-structured interviews that we recorded, transcribed, coded both deductively and inductively, and analyzed thematically. We enrolled patients and clinicians until we achieved data saturation.Results We interviewed 10 patients and 10 clinicians. Most patients (70%) were male, and the mean age was 57±16 years. Clinicians included attending surgeons, residents, nurse practitioners, nurses, and case managers. Three themes emerged. (1) Communication (patient-clinician and clinician-clinician): clinicians understood that the discharge process malfunctions when communication with patients is not clear. Many patients discussed confusion about their discharge plan. Clinicians lamented that poorly written discharge summaries are an inadequate means of communication between inpatient and outpatient clinicians. (2) Discharge teaching and written instructions: patients appreciated discharge teaching but found written discharge instructions to be overwhelming and unhelpful. Clinicians preferred spending more time teaching patients and understood that written instructions contain too much jargon. (3) Outpatient care coordination: patients and clinicians identified difficulties with coordinating ongoing outpatient care. Both identified the patient’s primary care physician and insurance coverage as important determinants of the outpatient experience.Conclusion TACS patients face numerous challenges at hospitalization discharge. Clinicians struggle to effectively help their patients with this stressful transition. Future interventions should focus on improving communication with patients, active communication with a patient’s primary care physician, repurposing, and standardizing the discharge summary to serve primarily as a means of care coordination, and assisting the patient with navigating the transition.Level of evidence III—descriptive, exploratory study.https://tsaco.bmj.com/content/7/1/e000800.full |
| spellingShingle | Gregory J Jurkovich Nikia R McFadden Melissa M Gosdin Garth H Utter Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study Trauma Surgery & Acute Care Open |
| title | Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study |
| title_full | Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study |
| title_fullStr | Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study |
| title_full_unstemmed | Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study |
| title_short | Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study |
| title_sort | patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care a qualitative study |
| url | https://tsaco.bmj.com/content/7/1/e000800.full |
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