Baxter Ruth, O'Hara Jane, Murray Jenni, Sheard Laura, Cracknell Alison, Foy Robbie, Wright John, Lawton Rebecca
Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.
Leeds Institute of Medical Education, University of Leeds, Leeds, West Yorkshire, UK.
BMJ Open. 2018 Sep 19;8(9):e022468. doi: 10.1136/bmjopen-2018-022468.
Hospital admissions are shorter than they were 10 years ago. Notwithstanding the benefits of this, patients often leave hospital requiring ongoing care. The transition period can therefore be risky, particularly for older people with complex health and social care needs. Previous research has predominantly focused on the errors and harms that occur during transitions of care. In contrast, this study adopts an asset-based approach to learn from factors that facilitate safe outcomes. It seeks to explore how staff within high-performing ('positively deviant') teams successfully support transitions from hospital to home for older people.
Six high-performing general practices and six hospital specialties that demonstrate exceptionally low or reducing 30-day emergency hospital readmission rates will be invited to participate in the study. Healthcare staff from these clinical teams will be recruited to take part in focus groups, individual interviews and/or observations of staff meetings. Data collection will explore the ways in which teams successfully deliver exceptionally safe transitional care and how they overcome the challenges faced in their everyday clinical work. Data will be thematically analysed using a pen portrait approach to identify the manifest (explicit) and latent (abstract) factors that facilitate success.
Ethical approval was obtained from the University of Leeds. The study will help develop our understanding of how multidisciplinary staff within different healthcare settings successfully support care transitions for older people. Findings will be disseminated to academic and clinical audiences through peer-reviewed articles, conferences and workshops. Findings will also inform the development of an intervention to improve the safety and experience of older people during transitions from hospital to home.
如今的住院时间比10年前缩短了。尽管这有诸多益处，但患者出院后往往仍需持续护理。因此，过渡阶段可能存在风险，对于那些有复杂健康和社会护理需求的老年人而言尤其如此。以往的研究主要聚焦于护理过渡期间出现的错误和危害。相比之下，本研究采用基于资产的方法，从有助于实现安全结果的因素中汲取经验。它旨在探究高绩效（“积极偏差”）团队中的工作人员如何成功支持老年人从医院过渡到家庭。
将邀请六个高绩效的普通医疗诊所和六个医院专科科室参与研究，这些科室的30天急诊再入院率极低或呈下降趋势。将招募这些临床团队的医护人员参加焦点小组、个人访谈和/或员工会议观察。数据收集将探索各团队成功提供异常安全的过渡性护理的方式，以及他们如何克服日常临床工作中面临的挑战。将采用人物素描法对数据进行主题分析，以确定促成成功的显性（明确）和隐性（抽象）因素。
已获得利兹大学的伦理批准。本研究将有助于加深我们对不同医疗环境中的多学科工作人员如何成功支持老年人护理过渡的理解。研究结果将通过同行评审文章、会议和研讨会传播给学术和临床受众。研究结果还将为一项干预措施的制定提供参考，以改善老年人从医院过渡到家庭期间的安全性和体验。
