How older people enact care involvement during transition from hospital to home: A systematic review and model

Murray, Jenni; Hardicre, Natasha; Birks, Yvonne; O’Hara, Jane; Lawton, Rebecca

doi:10.1111/hex.12930

Cited by 34 publications

(56 citation statements)

References 44 publications

(151 reference statements)

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“…A distinctive feature of this study was the inclusion of older people who had recently experienced acute health crises, including those living with cognitive impairment and who had experienced acute confusion. Older people’s and caregivers’ perspectives are rarely included in research on acute healthcare at home, or at the acute/chronic illness interface, and yet provide insights into service improvement [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting

et al. 2020

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Background There is limited understanding of the contribution made by older people and their caregivers to acute healthcare in the home and how this compares to hospital inpatient healthcare. Objectives To explore the work of older people and caregivers at the time of an acute health event, the interface with professionals in a hospital and hospital at home (HAH) and how their experiences relate to the principles underpinning comprehensive geriatric assessment (CGA). Design A qualitative interview study within a UK multi-site participant randomised trial of geriatrician-led admission avoidance HAH, compared with hospital inpatient care. Methods We conducted semi-structured interviews with 34 older people (15 had received HAH and 19 hospital care) alone or alongside caregivers (29 caregivers; 12 HAH, 17 hospital care), in three sites that recruited participants to a randomised trial, during 2017–2018. We used normalisation process theory to guide our analysis and interpretation of the data. Results Patients and caregivers described efforts to understand changes in health, interpret assessments and mitigate a lack of involvement in decisions. Practical work included managing risks, mobilising resources to meet health-related needs, and integrating the acute episode into longer-term strategies. Personal, relational and environmental factors facilitated or challenged adaptive capacity and ability to manage. Conclusions Patients and caregivers contributed to acute healthcare in both locations, often in parallel to healthcare providers. Our findings highlight an opportunity for CGA-guided services at the interface of acute and chronic condition management to facilitate personal, social and service strategies extending beyond an acute episode of healthcare.

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Section: Discussionmentioning

confidence: 99%

The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting

et al. 2020

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“…Without overburdening them, initiatives could effectively support patients and families to complete this 'work', for example, by educating them on the types of information that healthcare professionals value and/or need to know. Supporting patients to do this will be essential as they do not always feel comfortable or skilled in relaying information, especially when unwell and/or in busy hospital environments [55]. Structural changes, for example re-configuring staff rotas may also help enhance continuity and facilitate the development of trust and rapport between patients and staff.…”

Section: Building Relationships With Patients and Familiesmentioning

confidence: 99%

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

Baxter¹,

Shannon²,

Murray³

et al. 2020

BMC Health Serv Res

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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).

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“…In fact, the literature underlines that failure to involve patients in their discharge care could have negative consequences of varying proportions in the future (e.g. future distrust, security errors, readmissions) (Murray et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“The light at the end of the tunnel”. Discharge experience of older patients with chronic diseases: A multi‐centre qualitative study

Facchinetti

Albanesi

Piredda

et al. 2021

Journal of Advanced Nursing

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Aim To explore the experiences of being discharged from hospital of older patients with chronic diseases at time of discharge. Design Multi‐centre descriptive qualitative study. Methods Semi‐structured interviews were conducted with older patients with chronic diseases discharged from two Italian university hospitals, between March 2017 and October 2019. The interviews were audio‐recorded, transcribed verbatim and analysed using inductive content analysis. Several strategies were used to ensure the credibility, dependability, confirmability, authenticity and transferability of the findings. The study was reported in accordance with Standards for Reporting Qualitative Research and Consolidated criteria for reporting qualitative research. Results Sixty‐five patients participated in the study. Six main categories emerged: feelings, need for information, time of fragility, need for support, need for trusting relationships, and home as a caring place. Conclusion Older patients with chronic diseases are patients who require quality discharge planning with a patient‐centred care vision. Healthcare professionals should intervene more extensively and deeply in the discharge process, balancing the patients' perception of their needs against organizational priorities and the wish to return home with that of not being abandoned. Impact Discharge from hospital remains an area of concern as older people have varying degrees of met and unmet needs during and following hospital discharge. Discharge is characterized by conflicting feelings of patients, who need information and support of healthcare professionals through trusting and continuous relationships. Understanding the experience of discharge is essential to support older patients with chronic diseases, considering that discharge from hospital is not an end point of care but a stage of the process involving care transition. The reframing of discharge as another transition point is crucial for healthcare professionals, who will be responsible for making their patients fit for discharge by preparing them to manage their chronic condition at home.

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How older people enact care involvement during transition from hospital to home: A systematic review and model

Cited by 34 publications

References 44 publications

The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting

The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting

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

“The light at the end of the tunnel”. Discharge experience of older patients with chronic diseases: A multi‐centre qualitative study

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