Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives

Abstract

Background: Transitions of care are often risky, particularly for older people, and shorter hospital stays mean that patients can go home with ongoing care needs. Most previous research has focused on fundamental system flaws, however, care generally goes right far more often than it goes wrong. We explored staff perceptions of how high performing general practice and hospital specialty teams deliver safe transitional care to older people as they transition from hospital to home. Methods: We conducted a qualitative study in six general practices and four hospital specialties that demonstrated exceptionally low or reducing readmission rates over time. Data were also collected across four community teams that worked into or with these high-performing teams. In total, 157 multidisciplinary staff participated in semistructured focus groups or interviews and 9 meetings relating to discharge were observed. A pen portrait approach was used to explore how teams across a variety of different contexts support successful transitions and overcome challenges faced in their daily roles. Results: Across healthcare contexts, staff perceived three key themes to facilitate safe transitions of care: knowing the patient, knowing each other, and bridging gaps in the system. Transitions appeared to be safest when all three themes were in place. However, staff faced various challenges in doing these three things particularly when crossing boundaries between settings. Due to pressures and constraints, staff generally felt they were only able to attempt to overcome these challenges when delivering care to patients with particularly complex transitional care needs. Conclusions: It is hypothesised that exceptionally safe transitions of care may be delivered to patients who have particularly complex health and/or social care needs. In these situations, staff attempt to know the patient, they exploit existing relationships across care settings, and act to bridge gaps in the system. Systematically reinforcing such enablers may improve the delivery of safe transitional care to a wider range of patients. Trial registration: The study was registered on the UK Clinical Research Network Study Portfolio (references 35272 and 36174).

Recommendations made by patients, caregivers, providers, and decision-makers to improve transitions in care for older adults with hip fracture: a qualitative study in Ontario, Canada

“…Patients and caregivers described the importance of being treated as a unique person, rather than another patient with a hip fracture. Similarly, Baxter and colleagues identified ‘knowing the patient’ as a key recommendation in their qualitative research on safe transitions in care for older adults [ 30 ]. Specifically, participants in Baxter and colleagues’ study expressed the importance of getting to know patients beyond their medical condition to understand goals and expectations, living and psychosocial situations, as well as any potential fears about transitioning out of hospital [ 30 ].…”

“…Similarly, Baxter and colleagues identified ‘knowing the patient’ as a key recommendation in their qualitative research on safe transitions in care for older adults [ 30 ]. Specifically, participants in Baxter and colleagues’ study expressed the importance of getting to know patients beyond their medical condition to understand goals and expectations, living and psychosocial situations, as well as any potential fears about transitioning out of hospital [ 30 ]. In order to develop this understanding, it was important for staff to build trust and rapport with their patients.…”

Key Care Provision Aspects That Affect Care Transition in the Long-Term Care Systems: Preliminary Review Findings

“…This will help to ensure comprehensive knowledge about the patient moving from one setting to another. Good communication and transfer of information regarding health status and the needs of the patient may help the receiving setting to better accommodate patient’s needs and address preferences [ 7 , 25 , 26 ]. This is expected to have an overall positive impact on the patient’s experience of the transition process, and can also reduce poly-pharmacy and ultimately improve patient outcomes [ 27 ].…”

The STS case study: an analysis method for longitudinal qualitative research for implementation science

“…A pen portrait organizes data from different sources, at different time points, together in one document; it is like a collage describing one site where an innovation is being implemented [4]. Both periodic reflections [26][27][28][29] and pen portraits [30,31] have been used in the field to help develop study protocols; pen portraits have also been used as a method of data analysis [32,33]. As a novel form of LQR, the STS case study method introduces the opportunity to engage with material culture, and thus contributes a way to focus and re-focus, or calibrate, the analytic lens, or to look for how local use and understanding of the material elements of an intervention changes over time, and what that could mean for the normalization [34][35][36] of the implementation as a whole.…”