ImportanceCare transition models are structured approaches used to ensure the smooth transfer of patients between health care settings or levels of care, but none currently are tailored to the surgical patient. Tailoring care transition models to the unique needs of surgical patients may lead to significant improvements in surgical outcomes and reduced care fragmentation. The first step to developing surgical care transition models is to understand the surgical discharge process.ObjectiveTo map the surgical discharge process in a sample of US hospitals and identify key components and potential challenges specific to a patient’s discharge after surgery.Design, Setting, and ParticipantsThis qualitative study followed a cognitive task analysis framework conducted between January 1, 2022, and April 1, 2023, in Veterans Health Administration (VHA) hospitals. Observations (n = 16) of discharge from inpatient care after a surgical procedure were conducted in 2 separate VHA surgical units. Interviews (n = 13) were conducted among VHA health care professionals nationwide.ExposurePostoperative hospital discharge.Main Outcomes and MeasuresData were coded according to the principles of thematic analysis, and a swim lane process map was developed to represent the study findings.ResultsAt the hospitals in this study, the discharge process observed for a surgical patient involved multidisciplinary coordination across the surgery team, nursing team, case managers, dieticians, social services, occupational and physical therapy, and pharmacy. Important components for a surgical discharge that were not incorporated in the current care transition models included wound care education and supplies; pain control; approvals for nonhome postdischarge locations; and follow-up plans for wounds, ostomies, tubes, and drains at discharge. Potential challenges to the surgical discharge process included social situations (eg, home environment and caregiver availability), team communication issues, and postdischarge care coordination.Conclusions and RelevanceThese findings suggest that current and ongoing studies of discharge care transitions for a patient after surgery should consider pain control; wounds, ostomies, tubes, and drains; and the impact of challenging social situations and interdisciplinary team coordination on discharge success.

中文翻译：

---

绘制手术后出院过程图

ImportanceCare 过渡模型是一种结构化方法，用于确保患者在医疗机构或护理级别之间顺利转移，但目前还没有一种模型是针对手术患者量身定制的。根据手术患者的独特需求定制护理过渡模型可能会显着改善手术结果并减少护理碎片化。开发手术护理过渡模型的第一步是了解手术出院流程。目的绘制美国医院样本中的手术出院流程，并确定患者术后出院的关键组成部分和潜在挑战。设计、设置和参与者这定性研究遵循 2022 年 1 月 1 日至 2023 年 4 月 1 日在退伍军人健康管理局 (VHA) 医院进行的认知任务分析框架。在 2 个独立的 VHA 手术室中对手术后住院护理的出院情况进行了观察（n = 16）。对全国 VHA 医疗保健专业人员进行了访谈（n = 13）。暴露术后出院情况。主要结果和措施根据主题分析原则对数据进行编码，并开发了泳道流程图来代表研究结果。结果在医院在这项研究中，观察到的手术患者的出院过程涉及手术团队、护理团队、病例管理者、营养师、社会服务、职业和物理治疗以及药房的多学科协调。当前护理过渡模式中未纳入手术出院的重要组成部分包括伤口护理教育和用品；疼痛控制；非家庭出院后地点的批准；出院时伤口、造口、插管和引流的后续计划。手术出院过程的潜在挑战包括社会情况（例如，家庭环境和护理人员的可用性）、团队沟通问题和出院后护理协调。结论和相关性这些发现表明，当前和正在进行的关于手术后患者出院护理过渡的研究应考虑疼痛控制；伤口、造口、插管和引流管；以及具有挑战性的社交环境和跨学科团队协调对出院成功的影响。