Unplanned early hospital readmission among critical care survivors: a mixed methods study of patients and carers

Donaghy, Eddie; Salisbury, Lisa; Lone, Nazir; Lee, Robert; Ramsey, Pamela; Rattray, Janice; Walsh, Timothy

doi:10.1136/bmjqs-2017-007513

Cited by 35 publications

(62 citation statements)

References 44 publications

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“…We conducted our search only up to April 2017 and found there were repeating themes within the papers suggesting we had reached data saturation. Our assumption was confirmed by a recent study of contributory factors for readmission of ICU survivors reporting similar patient and system level themes [58].…”

Section: Discussionsupporting

confidence: 78%

“…We consider the use of House’s classification of needs with the addition of spiritual needs as highly relevant to this patient population. This view is supported by a recent study exploring contributory factors to early-unplanned hospital readmission of ICU survivors and recommending that interventions and service redesign include a strong focus on social support [58]. Contributory factors were inadequate informational (communication between secondary/primary care, hospital discharge planning, medication communication), emotional and spiritual (timing of psychological care, coming to terms with near-death experiences), instrumental (mobility issues and problems with specialist aids/equipment) and appraisal (fragile social support and goal setting) needs.…”

Section: Discussionmentioning

confidence: 97%

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Identifying patients’ support needs following critical illness: a scoping review of the qualitative literature

et al. 2019

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Background Intensive care survivors suffer chronic and potentially life-changing physical, psychosocial and cognitive sequelae, and supporting recovery is an international priority. As survivors’ transition from the intensive care unit to home, their support needs develop and change. Methods In this scoping review, we categorised patients’ support needs using House’s Social Support Needs framework (informational, emotional, instrumental, appraisal) and mapped these against the Timing it Right framework reflecting the patient’s transition from intensive care (event/diagnosis) to ward (stabilisation/preparation) and discharge home (implementation/adaptation). We searched electronic databases from 2000 to 2017 for qualitative research studies reporting adult critical care survivors’ experiences of care. Two reviewers independently screened, extracted and coded data. Data were analysed using a thematic framework approach. Results From 3035 references, we included 32 studies involving 702 patients. Studies were conducted in UK and Europe ( n = 17, 53%), Canada and the USA ( n = 6, 19%), Australasia ( n = 6, 19%), Hong Kong ( n = 1, 3%), Jordan ( n = 1, 3%) and multi-country ( n = 1, 3%). Across the recovery trajectory, informational, emotional, instrumental, appraisal and spiritual support needs were evident, and the nature and intensity of need differed when mapped against the Timing it Right framework. Informational needs changed from needing basic facts about admission, to detail about progress and treatments and coping with long-term sequelae. The nature of emotional needs changed from needing to cope with confusion, anxiety and comfort, to a need for security and family presence, coping with flashbacks, and needing counselling and community support. Early instrumental needs ranged from managing sleep, fatigue, pain and needing nursing care and transitioned to needing physical and cognitive ability support, strength training and personal hygiene; and at home, regaining independence, strength and return to work. Appraisal needs related to obtaining feedback on progress, and after discharge, needing reassurance from others who had been through the ICU experience. Conclusions This review is the first to identify the change in social support needs among intensive care survivors as they transition from intensive care to the home environment. An understanding of needs at different transition periods would help inform health service provision and support for survivors. Electronic supplementary material The online version of this article (10.1186/s13054-019-2441-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 97%

Identifying patients’ support needs following critical illness: a scoping review of the qualitative literature

et al. 2019

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“…4 10-15 The patient experience of unplanned hospital readmission is poorly understood and qualitative studies to date have focused on clinician perspectives 16 17 or specific patient groups such as older patients, 18 patients with heart failure 19 or survivors of critical illness. 20 A recent study where 36 medical patients who experienced unplanned hospital readmission within 30 days were interviewed showed that many patients attributed their readmission to underlying illness. 21 Although 63% did not identify factors they thought could have prevented hospital readmission, communication deficits between health professionals, and between health professionals and patients, was a dominant theme.…”

Section: Introductionmentioning

confidence: 99%

Understanding the patient experience of early unplanned hospital readmission following acute care discharge: a qualitative descriptive study

et al. 2020

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ObjectivesTo understand from a patient and carer perspective: (1) what features of the discharge process could be improved to avoid early unplanned hospital readmission (within 72 hours of acute care discharge) and (2) what elements of discharge planning could have enhanced the discharge experience.DesignA qualitative descriptive design was used. Study data were collected using semi-structured interviews that were transcribed verbatim and analysed using inductive thematic analysis. Data related to participant characteristic were collected by medical record audit and summarised using descriptive statistics.SettingThree acute care hospitals from one health service in Australia.ParticipantsPatients who had an early unplanned hospital readmission and/or their carers, if present during the interviews and willing to participate, with patient permission.FindingsThirty interviews were conducted (23 patients only; 6 patient and carer dyads; 1 carer only). Five themes were constructed: ‘experiences of care’, ‘hearing and being heard’, ‘what’s wrong with me’, ‘not just about me’ and ‘all about going home’. There was considerable variability in patients’ and carers’ experiences of hospital care, discharge processes and early unplanned hospital readmission. Features of the discharge process that could be improved to potentially avoid early unplanned hospital readmission were better communication, optimal clinical care including ensuring readiness for discharge and shared decision-making regarding discharge timing and goals on returning home. The discharge experience could have been enhanced by improved communication between patients (and carers) and the healthcare team, not rushing the discharge process and a more coordinated approach to patient transport home from hospital.ConclusionsThe study findings highlight the complexities of the discharge process and the importance of effective communication, shared decision-making and carer engagement in optimising hospital discharge and reducing early unplanned hospital readmissions.

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“…Various system‐ and patient‐related factors increase the risk of hospital readmission of frail older cardiac patients (Alyahya et al, 2016; Donaghy et al, 2018; Osnard, 2016; Riegel et al, 2009; Toles et al, 2016; Walsh et al, 2016). A conceptual framework was developed, based on these system‐ and patient‐related factors to explore CCB patients’ and (in)formal caregivers’ perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission, see Figure 1 and Appendix S1.…”

Section: Introductionmentioning

confidence: 99%

The course of readmission in frail older cardiac patients

Rijpkema

Verweij

Jepma

et al. 2021

Journal of Advanced Nursing

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Aim The aim of this study is to explore patients’ and (in)formal caregivers’ perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi‐structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients’ medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six‐step analysis of Strauss & Corbin have been used. Results Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients’ health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers’ perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients’ care needs and expectations should be prioritized to stimulate participation. Impact (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients’ care needs and expectations.

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Unplanned early hospital readmission among critical care survivors: a mixed methods study of patients and carers

Cited by 35 publications

References 44 publications

Identifying patients’ support needs following critical illness: a scoping review of the qualitative literature

Identifying patients’ support needs following critical illness: a scoping review of the qualitative literature

Understanding the patient experience of early unplanned hospital readmission following acute care discharge: a qualitative descriptive study

The course of readmission in frail older cardiac patients

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