BMJ quality & safety
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BMJ quality & safety · Dec 2012
Multicenter StudyStakeholder perspectives on handovers between hospital staff and general practitioners: an evaluation through the microsystems lens.
Much of the research on improving patient handovers has focused on enhancing communication within the hospital system, but there have been relatively few efforts aimed at addressing the challenges at the interface between the hospital and the primary care setting. ⋯ The microsystem approach offers an innovative organisational construct and approach to assess the gaps in 'hospital to community' patient handovers, by viewing the hospital to the community interface as a clinical microsystem continuum. Our application of the microsystem approach confirms and extends earlier findings about the impact of barriers on the continuity and safety of patient transitions and their impact on the quality of patient care.
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BMJ quality & safety · Dec 2012
Multicenter StudySearching for the missing pieces between the hospital and primary care: mapping the patient process during care transitions.
Safe patient transitions depend on effective communication and a functioning care coordination process. Evidence suggests that primary care physicians are not satisfied with communication at transition points between inpatient and ambulatory care, and that communication often is not provided in a timely manner, omits essential information, or contains ambiguities that put patients at risk. ⋯ Process mapping is effective in bringing together key stakeholders and makes explicit the mental models that frame their understanding of the clinical process. Exploring the barriers and facilitators to safe and reliable patient transitions highlights opportunities for further improvement work and illustrates ideas for best practices that might be transferrable to other settings.
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BMJ quality & safety · Dec 2012
Multicenter StudyAre patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers.
Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients. ⋯ Our findings suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients' and families' capabilities, needs and preferences. Future interventions should be directed at healthcare providers' attitudes and their organisation's leadership, with a focus on improving communication among care providers, patients and families, and between hospital and community care providers.