Patient Experience in the Transition of Home Parenteral Nutrition Services Between Centers: Evaluation of a Transition Model

Abstract

Background: In 2014, Dudley Group of Hospitals (DGH) underwent an organizational change that necessitated closure of their Home Parenteral Nutrition (HPN) service. University Hospitals Birmingham NHS Foundation Trust (UHBFT) transitioned 50 patients from DGH into their HPN service. The transition model included communication with patients, communication between centers (development of an HPN Patient Passport), and rapid follow-up on transition ensuring clinical care continued uninterrupted. Aim: Evaluate patient experience and their level of satisfaction with our HPN transition model. Method: A 19-point, mixed mode paper-based questionnaire was developed. Questionnaires were posted to 42 surviving patients still receiving HPN. Results: Response rate: 67%. Communication with patients: The transition was discussed with them, and they had appropriate contact details during the process—94%. Patients informed of patient transition meetings—97%. Attendance at meetings: DGH 89%, UHBFT 55%. Ongoing care at UHBFT: 86% very satisfied and 11% satisfied. Overall rating of the transition process: 79% very satisfied and 14% satisfied. Friends and Family Test: 82% “extremely likely” and 18% “likely” to recommend our services. Conclusion: The transition model used was successful, with the majority of patients “very satisfied” with how the transition was managed and their ongoing care. Effective communication with patients and between the 2 centers was the key to success. To our knowledge, this is the first report of transition of care for HPN patients. It is proposed that this model may be used by other centers to plan for future HPN service transitions where necessary.

The effect of transitions intervention to ensure patient safety and satisfaction when transferred from hospital to home health care—A systematic review

“…While most of the interventions used in the studies, which have been included in this review, consisted of either follow‐up by nurses from the hospital or at home post‐discharge, three studies used a combination of improved patient education and establishment of contact with the locale health care services pre‐discharge (Fletcher et al, 2019; Mcinnes et al, 1999; Preen et al, 2005). Another study used improved patient education pre‐discharge (Cajanding, 2017).…”

“…Rayyan is a web and mobile application used for systematic reviews, which facilitates abstract and title screening and enables one to collaborate on the same review (Ouzzani et al, 2016). In total, 26 articles were included in the study, thereby resulting in a total of 5596 patients, and the number of patients varied from 536 (Boter, 2004) to 28 (Fletcher et al, 2019). Diagnoses of the patients varied; however, most patients had advanced and serious diseases (for example, stroke, cardiac disease, COPD and kidney transplant).…”

“…In total, 26 articles were included in the study, thereby resulting in a total of 5596 patients, and the number of patients varied from 536 (Boter, 2004) to 28 (Fletcher et al, 2019). Diagnoses of the patients varied; however, most patients had advanced and serious diseases (for example, stroke, cardiac disease, COPD and kidney transplant).…”

Navigating the Challenges of Home Parenteral Nutrition

“…An example of a discharge checklist is shown in Table . When presented with the need to transition the care of HPN patients from 1 tertiary center to another, 1 group developed a plan in which each patient was given an “HPN passport” to effectively share vital clinical data between providers . In the current healthcare environment, this type of standardized approach has not been fully realized, as different hospitals, pharmacies, and home health providers have unique systems for orders, formulas, and other documentation, and thus safe transitions of care must instead rest on close communication with providers.…”

“…15 clinical data between providers. 16 In the current healthcare environment, this type of standardized approach has not been fully realized, as different hospitals, pharmacies, and home health providers have unique systems for orders, formulas, and other documentation, and thus safe transitions of care must instead rest on close communication with providers.…”