Dataset Information

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 semi-structured 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 ).

SUBMITTER: Baxter R

PROVIDER: S-EPMC7444052 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Baxter Ruth R Shannon Rosemary R Murray Jenni J O'Hara Jane K JK Sheard Laura L Cracknell Alison A Lawton Rebecca R

BMC health services research 20200824 1

<h4>Background</h4>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.<h4>Metho ...[more]

PMID: 32831038

Similar Datasets

Project description:BackgroundA wide range of initiatives on early detection and intervention have been developed to proactively identify problems related to health and wellbeing in (frail) older people, with the aim of supporting them to live independently for as long as possible. Nevertheless, it remains unclear what the best way is to design such initiatives and how older people's needs and preferences can be best addressed. This study aimed to address this gap in the literature by exploring: 1) older people's perspectives on health and living environment in relation to living independently at home; 2) older people's needs and preferences in relation to initiating and receiving care and support; and 3) professionals' views on what would be necessary to enable the alignment of early detection initiatives with older people's own needs and preferences.MethodsIn this qualitative study, we conducted semi-structured interviews with 36 older people and 19 professionals in proactive elderly care. Data were analysed using the framework analysis method.ResultsFrom the interviews with older people important themes in relation to health and living environment emerged, such as maintaining independence, appropriate housing, social relationships, a supporting network and a sense of purpose and autonomy. Older people preferred to remain self-sufficient, and they would rather not ask for help for psychological or social problems. However, the interviews also highlighted that they were not always able or willing to anticipate future needs, which can hinder early detection or early intervention. At the same time, professionals indicated that older people tend to over-estimate their self-reliance and therefore advocated for early detection and intervention, including social and psychological issues.ConclusionOlder people have a broad range of needs in different domains of life. Discrepancies exist between older people and professionals with regard to their views on timing and scope of early detection initiatives. This study aimed to reveal starting-points for better alignment between initiatives and older people's needs and preferences. Such starting points may support policy makers and care professionals involved in early detection initiatives to make more informed decisions.

Project description:BACKGROUND:Organisational change in health systems is common. Success is often tied to the actors involved, including their awareness of the change, personal engagement and ownership of it. In many health systems, one of the most common changes we are witnessing is the redevelopment of long-standing hospitals. However, we know little about how hospital staff understand and experience such potentially far-reaching organisational change. The purpose of this study is to explore the understanding and experiences of hospital staff in the early stages of organisational change, using a hospital redevelopment in Sydney, Australia as a case study. METHODS:Semi-structured interviews were conducted with 46 clinical and non-clinical staff working at a large metropolitan hospital. Hospital staff were moving into a new building, not moving, or had moved into a different building two years prior. Questions asked staff about their level of awareness of the upcoming redevelopment and their experiences in the early stage of this change. Qualitative data were analysed using thematic analysis. RESULTS:Some staff expressed apprehension and held negative expectations regarding the organisational change. Concerns included inadequate staffing and potential for collaboration breakdown due to new layout of workspaces. These fears were compounded by current experiences of feeling uninformed about the change, as well as feelings of being fatigued and under-staffed in the constantly changing hospital environment. Nevertheless, balancing this, many staff reported positive expectations regarding the benefits to patients of the change and the potential for staff to adapt in the face of this change. CONCLUSIONS:The results of this study suggest that it is important to understand prospectively how actors involved make sense of organisational change, in order to potentially assuage concerns and alleviate negative expectations. Throughout the processes of organisational change, such as a hospital redevelopment, staff need to be engaged, adequately informed, trained, and to feel supported by management. The use of champions of varying professions and lead departments, may be useful to address concerns, adequately inform, and promote a sense of engagement among staff.

Project description:ObjectiveDespite consistent evidence for the positive impact of contingency planning for falls in older people, implementation of plans often fail. This is likely due to lack of recognition and knowledge about perspectives of older people about contingency planning. The objective of this research was to explore the perspectives of older people living in the community about use of contingency planning for getting help quickly after a fall.MethodA systematic literature search seeking qualitative research was conducted in April 2014, with no limit placed on date of publication. Medline, EMBASE, Ageline, CINAHL, HealthSource- Nursing/Academic Edition, AMED and Psych INFO databases were searched. Three main concepts were explored and linked using Boolean operators; older people, falls and contingency planning. The search was updated until February 2016 with no new articles found. After removal of duplicates, 562 articles were assessed against inclusion and exclusion criteria resulting in six studies for the meta-synthesis. These studies were critically appraised using the McMaster critical appraisal tool. Bespoke data extraction sheets were developed and a meta-synthesis approach was adopted to extract and synthesise findings.FindingsThree themes of 'a mix of attitudes', 'careful deliberations' and 'a source of anxiety' were established. Perspectives of older people were on a continuum between regarding contingency plans as necessary and not necessary. Levels of engagement with the contingency planning process seemed associated with acceptance of their risk of falling and their familiarity with available contingency planning strategies.ConclusionAvoiding a long lie on the floor following a fall is imperative for older people in the community but there is a lack of knowledge about contingency planning for falls. This meta-synthesis provides new insights into this area of health service delivery and highlights that implementation of plans needs to be directed by the older people rather than the health professionals.

Project description:BackgroundFalls are the most common reason for ambulance callouts resulting in non-conveyance. Even in the absence of injury, only half of those who fall can get themselves up off the floor, often remaining there over an hour, increasing risk of complications. There are recognized techniques for older people to learn how to get up after a fall, but these are rarely taught. The aim of this study was to develop an understanding of attitudes of older people, carers and health professionals on getting up following a fall.MethodsA qualitative focus group and semi-structured interviews were conducted with 28 participants, including community-dwelling older people with experience of a non-injurious fall, carers, physiotherapists, occupational therapists, paramedics and first responders. Data were transcribed and analysed systematically using the Framework approach. A stakeholder group of falls experts and service users advised during analysis.ResultsThe data highlighted three areas contributing to an individual's capability to get-up following a fall: the environment (physical and social); physical ability; and degree of self-efficacy (attitude and beliefs about their own ability). These factors fell within the wider context of making a decision about needing help, which included what training and knowledge each person already had to manage their fall response. Staff described how they balance their responsibilities, prioritising the individual's immediate needs; this leaves limited time to address capability in the aforementioned three areas. Paramedics, routinely responding to falls, only receive training on getting-up techniques from within their peer-group. Therapists are aware of the skillset to breakdown the getting-up process, but, with limited time, select who to teach these techniques to.ConclusionNeither therapists nor ambulance service staff routinely teach strategies on how to get up, meaning that healthcare professionals largely have a reactive role in managing falls. Interventions that address the environment, physical ability and self-efficacy could positively impact on peoples' capability to get up following a fall. Therefore, a more proactive approach would be to teach people techniques to manage these aspects of future falls and to provide them easily accessible information.

Dataset Information

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

Publications

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

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure