School of Medicine, University of Nottingham, Nottingham, United Kingdom.
NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham, United Kingdom.
PLoS One. 2024 Mar 8;19(3):e0298140. doi: 10.1371/journal.pone.0298140. eCollection 2024.
Stroke early supported discharge (ESD) involves the co-ordinated transfer of care from hospital to home. The quality of communication processes between professionals delivering ESD and external stakeholders may have a role to play in streamlining this process. We explored how communication and information exchange were achieved and influenced the hospital-to-home transition and the delivery quality of ESD, from healthcare professionals' perspectives.
Six ESD case study sites in England were purposively selected. Under a realist approach, we conducted interviews and focus groups with 117 staff members, including a cross-section of the multidisciplinary team, service managers and commissioners.
Great variation was observed between services in the type of communication processes they employed and how organised these efforts were. Effective communication between ESD team members and external stakeholders was identified as a key mechanism driving the development of collaborative and trusting relationships and promoting coordinated care transitions. Cross-boundary working arrangements with inpatient services helped clarify the role and remit of ESD, contributing to timely hospital discharge and response from ESD teams. Staff perceived honest and individualised information provision as key to effectively prepare stroke survivors and families for care transitions and promote rehabilitation engagement. In designing and implementing ESD, early stakeholder involvement ensured the services' fit in the local pathway and laid the foundations for communication and partnership working going forward.
Findings highlighted the interdependency between services delivering ESD and local stroke care pathways. Maintaining good communication and engagement with key stakeholders may help achieve a streamlined hospital discharge process and timely delivery of ESD. ESD services should actively manage communication processes with external partners. A shared cross-service communication strategy to guide the provision of information along to continuum of stroke care is required. Findings may inform efforts towards the delivery of better coordinated stroke care pathways.
脑卒中早期支持出院（ESD）涉及将医疗从医院转移到家庭的协作。为了简化这一过程，提供 ESD 的专业人员与外部利益相关者之间的沟通流程质量可能会起到一定作用。我们从医疗保健专业人员的角度探讨了沟通和信息交流是如何实现的，并影响了医院到家庭的过渡以及 ESD 的交付质量。
在现实主义方法的指导下，我们在英格兰的六个 ESD 案例研究地点进行了访谈和焦点小组讨论，参与者包括多学科团队、服务经理和专员的交叉部分。
在他们所采用的沟通流程类型以及这些努力的组织方式方面，服务之间存在很大差异。ESD 团队成员与外部利益相关者之间的有效沟通被确定为推动协作和信任关系发展以及促进协调护理过渡的关键机制。与住院服务之间的跨边界工作安排有助于明确 ESD 的角色和职权范围，有助于及时出院和 ESD 团队的响应。工作人员认为，提供诚实和个性化的信息是为护理过渡和促进康复参与有效地准备脑卒中幸存者及其家属的关键。在设计和实施 ESD 时，早期利益相关者的参与确保了服务符合当地途径，并为未来的沟通和伙伴关系奠定了基础。
研究结果强调了提供 ESD 和当地脑卒中护理途径的服务之间的相互依存关系。保持与关键利益相关者的良好沟通和参与，可能有助于实现简化的医院出院流程和及时提供 ESD。ESD 服务应积极管理与外部合作伙伴的沟通流程。需要制定一个跨服务的共享沟通策略，以指导脑卒中护理连续体信息的提供。研究结果可能为协调更好的脑卒中护理途径的努力提供信息。
