Handover is a complex system based on several sound socio-technical principles and the value of this nurse-to-nurse communication should be acknowledged. The multiple functions highlight the knowledge and expertise currently hidden within handover, which could be promoted in terms of nursing professionalism.

Objective: To investigate patients' and carers' experiences of Early Supported Discharge services and inform future Early Supported Discharge service development and provision. Design and subjects: Semi-structured interviews were completed with 27 stroke patients and 15 carers in the Nottinghamshire region who met evidence-based Early Supported Discharge service eligibility criteria. Participants were either receiving Early Supported Discharge or conventional services. Setting: Community stroke services in Nottinghamshire, UK. Results: A thematic analysis process was applied to identify similarities and differences across datasets. Themes specific to participants receiving Early Supported Discharge services were: the home-based form of rehabilitation; speed of response; intensity and duration of therapy; respite time for the carer; rehabilitation exercises and provision of technical equipment; disjointed transition between Early Supported Discharge and ongoing rehabilitation services. Participants receiving Early Supported Discharge or conventional community services experienced difficulties related to: limited support in dealing with carer strain; lack of education and training of carers; inadequate provision and delivery of stroke-related information; disjointed transition between Early Supported Discharge and ongoing rehabilitation services. Conclusions: Accelerated hospital discharge and home-based rehabilitation was perceived positively by service users. The study findings highlight the need for Early Supported Discharge teams to address information and support needs of patients and carers and to monitor their impact on carers in addition to patients, using robust outcome measures.

Objectives: To explore the perspectives of healthcare professionals and commissioners working with a stroke Early Supported Discharge service in relation to: (1) the factors that facilitate or impede the implementation of the service, and (2) the impact of the service. Design: Cross-sectional qualitative study using semi-structured interviews. Data were analysed by two researchers using a thematic analysis approach. Setting: Two Early Supported Discharge services in Nottinghamshire. Participants: Purposive sampling identified 35 key informants including practitioners, managers and commissioners. Results: The identified facilitators to the implementation of evidence-based services were: (1) the adaptability of the intervention to the healthcare context, (2) the role of rehabilitation assistants and (3) cross-service working arrangements. Perceived challenges included: (1) lack of clarity regarding the referral decision making process, (2) delays in securing social care input and (3) lack of appropriate followon services in the region. Most respondents perceived the impact of the services to be: (1) reducing inhospital stay, (2) aiding the seamless transfer of care from hospital to the community and (3) providing intensive stroke specific therapy. Commissioners called for greater evidence of service impact and clarity regarding where it fits into the stroke pathway. Conclusions: Early Supported Discharge services were perceived as successful in providing homebased, stroke specific rehabilitation. Teams would benefit from capitalising on identified facilitators and developing strategies to address the challenges. The remit and impact of the services should be clear and demonstrable, with teams strengthening links with other health and social care providers.

Background and Purpose-Research evidence supporting Early Supported Discharge (ESD) services has been summarized in a Cochrane Systematic Review. Trials have shown that ESD can reduce long-term dependency and admission to institutional care and reduce the length of hospital stay. No adverse impact on the mood or well-being of patients or carers has been reported. With the implementation of many national and international stroke initiatives, we felt it timely to reach consensus about ESD among trialists who contributed to the review. Methods-We used a modified Delphi approach with 10 ESD trialists. An agreed list of statements about ESD was generated from the Cochrane review and three rounds of consultation completed. ESD trialists rated statements regarding team composition, model of team work, intervention, and success. Results-Consensus of opinion (Ͼ75% agreement) was obtained on 47 of the 56 statements. Multidisciplinary, specialist stroke ESD teams should plan and co-ordinate both discharge from hospital and provide rehabilitation in the community. Specific eligibility criteria (safety, practicality, medical stability, and disability) need to be followed to ensure this service is provided for mild to moderate stroke patients who can benefit from ESD. Length of stay in hospital, patient and carer outcome measures and cost, need to be routinely audited. Conclusions-We have created a consensus document that can be used by commissioners and service providers in implementing ESD services. Our aim is to promote the use of recommendations derived from research findings to facilitate successful implementation of stroke services nationally and internationally. (Stroke. 2011;42:1392-1397.)

Purpose – The purpose of this research is to present the empirical findings from a case study in knowledge sharing with the aim of understanding knowledge sharing in a strategic context through a socio‐technical approach. Design/methodology/approach – Knowledge sharing facilitators and barriers were examined in a UK owned multinational engineering organisation. A total of 20 semi‐structured interviews were conducted and analysed using a combination of matrix and template analysis. Findings – The paper highlights leadership, organisational, and individual factors that are perceived to impact knowledge sharing. Furthermore, three sub‐factors: trust, individual motivation and geographical location, are discussed as double‐edged factors, i.e. their impact on knowledge sharing is complex in that they may act as both barriers and enablers. Research limitations/implications – The main limitation of this study is that it is conducted in a single organisational context. A second case study is currently being analysed to explore knowledge sharing in a different context within the same organisation. Practical implications – A balanced approach to knowledge management practices is emphasised where both technical and social aspects are taken into account. Originality/value – This paper provides important contributions. First, it emphasises the impact of strategic change on knowledge sharing as one aspect of the organisational knowledge management. Second, it frames knowledge sharing within a socio‐technical approach. Third, it provides us with empirical evidence through our use of case study in an organisational setting.

Informal workplace learning was identified as arising from both opportunistic encounters and more planned activities, which are both supported and restricted through a variety of mechanisms. Maximising informal learning opportunities and removing barriers to doing so should be a priority for primary care practitioners, managers and educators.

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