Introduction 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.
Methods and analysis 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.
Ethics and dissemination 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.
- primary care
- qualitative research
- geriatric medicine
- quality in health care
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Contributors RL, JoH, RF, LS, AC and JW were involved in the design of the overall PACT programme of research and the conception of studies within it. RB developed the protocol for the current study and JoH, JM, LS, AC, RF, JW and RL contributed to the study design. RB wrote a first draft of the manuscript and all authors have contributed to the drafting, reviewing of it. All authors have approved the final version of this manuscript for submission.
Funding This report is independent research funded by the National Institute for Health Research (National Institute for Health Research Programme Grants for Applied Health Research, Partners at Care Transitions (PACT): improving patient experience and safety at transitions in care, RP-PG-1214- 20017).
Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
Competing interests None declared.
Patient consent Not required.
Ethics approval The preparatory work did not require ethical or HRA approval but permissions to access the readmission data were granted by the relevant CCGs and the North East Commissioning Support Unit. Ethics and HRA approvals for the qualitative data collection were gained separately for primary and secondary care: (1) University of Leeds ethical approval: primary care reference—17-0202 , date 18 July 2017; secondary care reference—17-0234, date 30 August 2017; (2) HRA approval: primary care IRAS reference—230156, date 24 August 2017; secondary care IRAS reference 233797, date 22 September 17. Local NHS capability and capacity approvals were granted by all organisations involved; (3) The study was registered on the UK Clinical Research Network Study Portfolio: primary care reference—35272; secondary care reference—36174.
Provenance and peer review Not commissioned; externally peer reviewed.
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