Evaluating the implementation of an early supported discharge (ESD) program for stroke survivors: A mixed methods longitudinal case study

Hitch, Danielle; Leech, Kathleen; Neale, Sharon; Malcolm, Avetta

doi:10.1371/journal.pone.0235055

Cited by 12 publications

(25 citation statements)

References 32 publications

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“…However, for other clinicians the perceived elasticity of such settings was relatively diminished, leading to concerns over the plasticity of the intervention itself. This variability in perception has been noted previously across a range of different contexts [28][29][30][31][32] demonstrating its salience in explaining some of the complexity associated with embedding interventions across all healthcare settings.…”

Section: Discussionsupporting

confidence: 66%

“…Hitch et al's [31] recent study on staff perceptions of an early stroke discharge system highlighted similar problems regarding its perceived compatibility. Restructuring interventions alongside the staff intended to implement them is valuable in both developing intervention plasticity and engagement [28][29][30][31][32].…”

Section: Discussionmentioning

confidence: 98%

“…This has transcended health care specialism to include intervention in areas such as palliative care [3], obstetrics [4], cardiovascular health promotion [28], medication safety [29], and pharmacy auditing [30]. Hitch et al's [31] recent study on staff perceptions of an early stroke discharge system highlighted similar problems regarding its perceived compatibility. Restructuring interventions alongside the staff intended to implement them is valuable in both developing intervention plasticity and engagement [28][29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

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Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists

et al. 2021

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Background Normalisation process theory reports the importance of contextual integration in successfully embedding novel interventions, with recent propositions detailing the role that ‘plasticity’ of intervention components and ‘elasticity’ of an intended setting contribute. We report on the introduction of a clinical pathway assessing patient non-responsiveness to treatment for glaucoma and ocular hypertension. The aim of this study was to assess the feasibility of implementing the Cardiff Model of Glaucoma Care into hospital eye services, identifying any issues of acceptability for staff through the filter of normalisation process theory. Methods A prospective observational study was undertaken in four hospital eye services. This incorporated detailed qualitative semi-structured interviews with staff (n = 8) to gather their perceptions on the intervention’s usefulness and practicality. In addition, observational field notes of patient and staff consultations (n = 88) were collected, as well as broader organisational observations from within the research sites (n = 52). Data collection and analysis was informed by the normalisation process theory framework. Results Staff reported the pathway led to beneficial knowledge on managing patient treatment, but the model was sometimes perceived as overly prescriptive. This perception varied significantly based on the composition of clinics in relation to staff experience, staff availability and pre-existing clinical structures. The most commonly recounted barrier came in contextually integrating into sites where wider administrative systems were inflexible to intervention components. Conclusions Flexibility will be the key determinant of whether the clinical pathway can progress to wider implementation. Addressing the complexity and variation associated with practice between clinics required a remodelling of the pathway to maintain its central benefits but enhance its plasticity. Our study therefore helps to confirm propositions developed in relation to normalisation process theory, contextual integration, intervention plasticity, and setting elasticity. This enables the transferability of findings to healthcare settings other than ophthalmology, where any novel intervention is implemented.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists

et al. 2021

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“…People after stroke found it meaningful to practise and recover in their everyday surroundings [ 50 ] and described ESD as personalised or tailored to their individual needs [ 40 , 44 , 45 , 51 ] in contrast to hospital services. HCPs also described rehabilitation at home as more meaningful [ 47 , 53 ]. The home environment also aided rehabilitation by providing a greater number of and a wider range of task practice opportunities in the home and local area than hospital [ 41 , 42 , 44 , 47 ] for example, “carpet-bowls and exercising the dog” [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals’ experiences of early supported discharge (ESD) after stroke

Connor

Horgan²,

Galvin³

et al. 2023

PLoS ONE

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Objective Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals. Method A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden’s three step approach for thematic synthesis. Results Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD. Conclusion The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.

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“…The domains of the framework take a holistic, systems-thinking approach to understand the implementation of an intervention [ 12 – 14 ].…”

Section: Methodsmentioning

confidence: 99%

A study to investigate the implementation process and fidelity of a hospital to community pharmacy transfer of care intervention

Khayyat

Nazar

2021

PLoS ONE

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Background Hospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention. Methods The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach. Results Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity. Conclusions This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.

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Evaluating the implementation of an early supported discharge (ESD) program for stroke survivors: A mixed methods longitudinal case study

Cited by 12 publications

References 32 publications

Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists

Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists

A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals’ experiences of early supported discharge (ESD) after stroke

A study to investigate the implementation process and fidelity of a hospital to community pharmacy transfer of care intervention

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