Hip-Fracture Care in Rural Southwestern Ontario: An Ethnographic Study of Patient Transitions and Physiotherapy Handoffs

Abstract

Purpose: To examine information exchange by physiotherapists during care handoffs of patients with hip fracture in a rural health care setting. Methods: This qualitative ethnographic study used observation and interviews of 11 networks of patients with hip fracture (n ¼ 11), family caregivers (n ¼ 8), and health care providers (n ¼ 24). Patients were followed from acute care through each subsequent care setting. Data were supplemented by health care records and policy documents. Results: Findings revealed that handoffs were less successful when information transfer was untimely or incomplete. Family caregivers experienced challenges in obtaining information required to facilitate the handoff, especially when direct contact with physiotherapists was not possible as a result of distance or other factors. Physiotherapists had to navigate multiple data sources to retrieve important information, and managed information gaps in various ways. Information flow was often unidirectional and suggested no further clinical accountability for the discharging physiotherapist. Conclusions: Providing information in a structured and timely fashion facilitated physiotherapy handoffs. Inadequate handoffs compromised continuity of care, delayed progress in rehabilitation, and resulted in families' missing information of vital importance to their caregiving role. A multi-directional exchange of information is needed between patients, families, and health care providers across care settings.Key Words: continuity of patient care; hip fractures; qualitative research; rural health services. RÉ SUMÉObjectif : Examiner l'é change d'information assuré par les physiothé rapeutes au cours des transferts du soin de patients qui ont subi une fracture de la hanche en contexte de soins de santé ruraux. Mé thodes : Cette é tude ethnographique qualitative reposait sur l'observation et des entrevues de 11 ré seaux de patients ayant subi une fracture de la hanche (n ¼ 11), d'aidants naturels (n ¼ 8) et de fournisseurs de soins de santé (n ¼ 24). Les patients ont é té suivis du service de soins actifs jusqu'à chaque contexte de soins subsé quent. Les dossiers de santé et des documents straté giques ont complé té les donné es. Ré sultats : Les constatations ont ré vé lé que les transferts é taient moins ré ussis lorsque le transfert de l'information é tait en retard ou incomplet. Les aidants naturels ont eu de la difficulté à obtenir l'information né cessaire pour faciliter le transfert, surtout lorsque la distance ou d'autres facteurs empê chaient de communiquer directement avec les physiothé rapeutes. Les physiothé rapeutes ont dû consulter de multiples sources de donné es pour extraire des renseignements importants et ont gé ré le manque d'information de diverses fac¸ons. L'information a souvent circulé de fac¸on unidirectionnelle, ce qui indique qu'un physiothé rapeute qui donne son congé au patient n'a plus d'autre obligation clinique. Conclusions : L'information fournie d'une fac¸on structuré e et à temps a facilité les transferts en phys...

Qualitative Insights from the Osteoporosis Research: A Narrative Review of the Literature

“…An ethnography of physiotherapy hand-offs in Ontario revealed the importance of inter-professional handoffs between physicians and physiotherapists. Similar to other studies (e.g., [53]), the importance of family caregivers also emerged [58]. Clinician-patient hand-offs were characterized by unidirectional transmission of knowledge, little post-discharge provider responsibility for patients, and difficulties scheduling patient education, which often resulted in frustration and anxiety.…”

“…Physiotherapists often relied on contacting patients' surgeons rather than previous physiotherapists to clarify patient information. Caregivers and clinicians often had to navigate multiple sources of data, including paper notes concerning their patients [58]. Communication issues were also highlighted in a strength-based exploration of hip fracture transitions in British Columbia [59].…”

Information sharing with rural family caregivers during care transitions of hip fracture patients

“…This study was conducted as part of a larger, multi-site Canadian study of care transitions for hip fracture patients (www.inforehab.uwaterloo.ca); other findings have been reported elsewhere [5, 10, 13–15]. In all study sites, hip fracture patients were recruited in acute care post-surgery and followed through resulting transitions throughout their care trajectory until their arrival in their long-term destination (e.g.…”

Understanding informal carers’ experiences of caring for older people with a hip fracture: a systematic review of qualitative studies

“…You know, work, making sure things were taken care of with his household, my household, visiting him every day…so, trying to juggle everything was probably the most difficult thing" [36 p.5]. Additional stress and complication were sorting out and co-ordinating the roles of other family members involved in providing care [32,40,41,[43][44][45]; or living a significant distance away [41,45].…”

“…Providing carers with opportunities to express preferences and expectations in healthcare and strengthen information sharing could ensure that the needs of everyone involved in care are met [41,46]. This was described as being part of a patient's circle of care [40,41,[43][44][45]48].…”