“Just another fish in the pond”: the transitional care experience of a hip fracture patient

Abstract

IntroductionMiscommunication and lack of coordination can compromise care quality and patient safety during transitions in care, especially for medically complex older adults. Little research has been done to investigate care transitions from the perspective of those receiving and providing care.MethodsThis study explored multiple care transitions for an elderly hip fracture patient, post-surgery. Interviews and observations were conducted with the patient, their family caregivers, and health care providers, at each point of transition between four different care settings.ResultsFour key themes were identified over the patients care trajectory: ‘Missing Crucial Coversations’—Patient and family caregivers did not feel involved or informed about decisions in care; ‘Who’s Who’—Confusion about the role of health care providers; ‘Ready or Not’—Not knowing what to expect or what is expected; and, ‘Playing by the Rules’—Health system policies and procedures hinder individualized care.ConclusionStudy findings point to the need for the health care system to engage patients and family caregivers more fully and consistently in the process of care transitions as well as the importance of understanding these processes from multiple perspectives. Recommendations for system integration are proposed with a focus on transitional care.

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

“…During the last phase of the experience, named as 'getting on with it', carers strove for predictability and focused on facilitating social participation for themselves and their relatives. According to Byrne et al [31] i) Wanting to be involved Carers expected to participate and be engaged in the decision-making process [40][41][42][43]48,49]. Most of the carers did not feel incorporated in this process: "No, I actually wasn't (involved).…”

“…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].…”

“…Limited time in hospital and care resources [38] and a heavy reliance on their care [40], often left carers living with a sense of "not knowing what to expect or what is expected" from them [48] despite being the only ones providing continuity of care [41]. Carers have important information about the patient background (i.e.…”

“…iii) Being proactive Carers proactively sought knowledge but felt that the healthcare system placed them in a passive role, waiting for information; they struggled with their new role, with uncertainty and with feeling guilty for requesting information from busy staff [36,44,40,48]: "Every time I would ask the nurse she would have to go and look it up to come and give it to me but if I'm talking to somebody I can ask them about medication… but nobody has time to do that" [40 p.5]. Obtaining information was a struggle: "I mean it's extremely frustrating to try and find somebody who actually knows what the situation is" [44 p.7].…”

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

“…The mid-level practitioner can provide a comprehensive discharge summary for the nursing facility or home care agency that will assume patient care beyond the hospital. 239 Beyond direct patient care and coordination of care, the mid-level practitioner can participate in monitoring and assessing program performance data. A quality management dashboard serves as an integral method to improve patient care and outcomes.…”