How To Hospital: barriers to developing a patient ‘Hospital Survival Guide’ to support information transfer during ward-rounds on the patient journey from admission to hospital to discharge

BMJ Open Quality

article

Swyn Lewis¹  Gwenlli Mai Jones¹  Paul Barach²  Hawys Tomos⁵  Mari Davies⁶  Buddug Eckley⁶  Hannah Rebecca Dowell⁶  Christian Peter Subbe¹ 

[1] Medicine;Pediatrics , Wayne State University;Thomas Jefferson University;College of Population Health;Royal College of Art: School of Design;Cardiff University;School of Medicine;Medicine , Bangor University School of Medical Sciences

关键词: clinical microsystem;    hospital medicine;    patient-centred care;    patient participation;    quality improvement;   

DOI  :  10.1136/bmjoq-2021-001556

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Clinicians can enable patients to actively participate in their care but communication with patients is often poor and highly variable. The aim of this study was to explore patients’ understanding of their current illness while in hospital and using a codesign process to create prototype tools to facilitate better communication during ward rounds.A mixed-methods, multistep design with step 1: Application of a questionnaire addressing domains of care in the acute medical unit; step 2: Development of communication aids that were codesigned with active help of patients, students and a specialist in user centric design to address patient needs and step 3: Evaluation of tools with patients in four Plan–Do–Study–Act cycles.In the initial survey of 30 patients 12 (40%) patients did not know what their diagnosis was and 5 (17%) did not know the results of recent key tests. 20 (67%) patients felt that staff communication and coordination could be improved.An intervention was prototyped with four variations: (1) An A6 ward-round summary sheet completed by doctors during ward rounds. The system worked well but was highly person dependent. (2) An A4 patient-owned diary (‘How to Hospital’) that contained information about key processes in hospital and space to document conversations from rounds and prompts for questions. 10 patients read the diary and commented favourably but did not complete any pages. (3) ‘Diary-cards’: a basic set of information cards was given to patients on admission to hospital. (4) Patient specific ‘diary-cards’ were completed by clinicians—10 forms were piloted during rounds and improved subsequent day information retention of diagnosis to 80%.Our study identified interventions that were feasible but remained person-dependent. The patients’ ownership of information in relation to their care might facilitate retention and satisfaction but the optimal format for these interventions for enhancing communication remains unclear.clinical microsystemhospital medicinepatient-centred carepatient participationquality improvementData availability statementAll data relevant to the study are included in the article or uploaded as supplementary information.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND