Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspe
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(2020) 20:780
RESEARCH ARTICLE
Open Access
Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives Ruth Baxter1* , Rosemary Shannon1, Jenni Murray1, Jane K. O’Hara2, Laura Sheard3, Alison Cracknell4 and Rebecca Lawton1,5
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). Keywords: Patient safety, Transitions of care, Hospital discharge, Elderly care, Health care professionals, Qualitative, Focus groups, Positive deviance
* Correspondence: [email protected] 1 Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptatio
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