Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study

Experiences with hospital-to-home transitions: perspectives from patients, family members and healthcare professionals. A systematic review and meta-synthesis of qualitative studies

PURPOSE

Multiple studies have explored the needs and experiences of patients, family members, and healthcare professionals regarding hospital-to-home transitions. Our study aimed to identify, critically appraise, and summarize these studies in a qualitative meta-synthesis.

MATERIALS AND METHODS

Medline, CINAHL and Embase were systematically searched to identify eligible articles from inception to June 2024. Qualitative studies were included and critically appraised using the Critical Appraisal Skills Program. Insufficient-quality papers were excluded. We performed a meta-synthesis following (1) open coding by two independent researchers and (2) discussing codes during reflexivity meetings.

RESULTS

Ninety-eight studies were appraised, of which 53 were included. We reached thematic saturation, four themes were constructed: (1) care coordination and continuity, (2) communication, (3) patient and family involvement, and (4) individualized support and information exchange. For patients and families, tailored information and support are prerequisites for a seamless transition and an optimal recovery trajectory after hospital discharge. It is imperative that healthcare professionals communicate effectively within and across care settings to ensure multidisciplinary collaboration and care continuity.

CONCLUSIONS

This study identifies essential elements of optimal transitional care. These findings could be supportive to researchers and healthcare professionals when (re)designing transitional care interventions to ensure care continuity after hospital discharge.

Patients' and staffs' experiences of clinical support after a lower limb reconstruction: An interview study

Objective: To explore patient and healthcare professional perspectives on post-lower limb reconstruction support. Design: A qualitative study. Setting: One-to-one semi-structured interviews undertaken via video conferencing software or over the telephone. Participants: Thirty-two patients (who had undergone reconstructive surgery due to trauma, malunion, non-union, infection or congenital issues treated by internal or external fixation) and 22 orthopaedic healthcare professionals (surgeons, nurses and physiotherapists) were interviewed between November 2020 and June 2021. Results: Thematic analysis was undertaken on data surrounding clinical support. Four themes were generated: being involved and feeling informed, physiotherapy as a motivator for recovery, the importance of timely access to physiotherapy, and mental health support. Patients valued being involved in decisions about their care and feeling informed. Supportive nurses played a key role, with patients appreciating clear communication and empathy. Trust in the clinical team eased anxiety, whilst a lack of information caused stress and dissatisfaction. Post-surgery, information on recovery, access to physiotherapy, and hospital contacts were crucial. Physiotherapy was vital for regaining mobility, providing motivation, and promoting confidence. Access to mental health support was limited, though patients appreciated emotional support from physiotherapists and hospital staff. Conclusion: By providing comprehensive support, healthcare professionals can optimise patient satisfaction with care, enhance psychological well-being, and facilitate the successful rehabilitation and reintegration of patients back into their daily lives.

Impact of a transition of care bundle on health-related quality of life after major emergency abdominal surgery: before-and-after study

INTRODUCTION

The transition from hospital to home can be challenging. This study investigated whether a standardized transition of care bundle could enhance health-related quality of life (HRQoL), reduce readmission rates, and increase days alive and out of hospital after major emergency abdominal surgery.

METHODS

A single-centre before-and-after study including consecutive patients undergoing major emergency abdominal surgery was conducted at Copenhagen University Hospital Herlev from 1 January 2022 to 31 December 2023. A transition of care bundle including standardized discharge coordination, written material, and multidisciplinary information meetings for patients and relatives was implemented on 1 January 2023. Patients were followed up by phone interviews and hospital records. HRQoL was assessed by the EQ-5D-5L questionnaire.

RESULTS

A total of 667 patients were included (before group 333 patients (median age 70.9), after group 335 patients (median age 72.2)). The predominant surgical procedure was emergency laparotomy for bowel obstruction (before group: n = 187, 56.2%, after group: n = 171, 51.5%). HRQoL was significantly higher in the after group compared with the before group at postoperative day (POD) 30 (0.846 versus 0.750, P < 0.001), postoperative day 90 (0.925 versus 0.847, P < 0.001), and at postoperative day 180 (0.907 versus 0.875, P = 0.039). No difference in days alive and out of hospital or readmission was found between the groups. A significant reduction in patients transitioning to a rehabilitation facility at discharge was found in the after group versus before group (12.5% versus 23.3%).

CONCLUSIONS

A transition of care bundle with coordination, written material, and multidisciplinary efforts increased HRQoL up to 180 days after major emergency abdominal surgery.

A Brief Intervention for Injury-Related Traumatic Stress: Results From a Feasibility Study

BACKGROUND

Post-traumatic stress disorder (PTSD) significantly impacts post-injury quality of life; however, many injured patients struggle to access necessary psychosocial care. A brief intervention, Talk, Listen, Communicate to Recover (TLC to Recover), may facilitate access to psychosocial care in low resource trauma centers.

OBJECTIVE

This study assessed staff and patient perceptions regarding the feasibility and acceptability of implementing TLC to Recover at a Level I trauma center.

METHODS

This study used a mixed methods approach to examine the implementation of a brief dyadic intervention intended to mitigate the effect of potential post-injury mental health sequelae. The study took place from April 2021 to April 2024. Participants included adult patients who received post-injury care and were at risk for post-injury PTSD and/or depression. Outpatient trauma clinic staff participated in formative and summative evaluations of the intervention. Recruitment, retention rates, and engagement were assessed. Symptom measurements were administered to patients at baseline, two week follow-up, and one month to measure the effectiveness of TLC to Recover. Semistructured interviews and focus groups explored the acceptability of TLC to Recover among staff and patients. Summative template analysis was utilized to analyze qualitative data and integrated with the theoretical framework of acceptability.

RESULTS

A total of N = 26 participants were included in the summative and formative evaluations, of which n = 15 were patients and n = 11 were clinic staff. The surgical clinic was an acceptable and feasible context to deliver a brief intervention to patients at risk for post-injury PTSD and/or depression.

CONCLUSION

This study offers insight into opportunities for implementation of brief post-injury psychosocial interventions in a surgical context.

Trauma Patient-Centered Discharge Plan Form: A Pilot Study

BACKGROUND

Comprehensive and multidisciplinary discharge planning can improve trauma patient throughput, decrease length of hospitalization, increase family and patient support, and expedite hospital discharge.

OBJECTIVE

This study aimed to assess the feasibility and acceptability of implementing a patient-centered discharge plan form for adult trauma patients.

METHODS

A single-center pilot study was conducted with adult trauma patients on a neurosurgical medical-surgical floor at a Level II trauma center in the Western United States from January to February 2023. The study had three phases: observation, pilot intervention, and follow-up. The key pilot intervention was the development of a standardized patient-centered discharge plan form, pilot tested by a trauma advanced practice provider and an inpatient discharge nurse. The primary outcome was the frequency of discharge orders being written before noon on the day of discharge. Qualitative and quantitative outcomes are reported.

RESULTS

The discharge form was used for eight patients during the pilot intervention phase; an advanced practice provider and an inpatient discharge nurse each completed the forms for four patients. Five of eight observed patients had discharge orders before noon; the incidence of orders before noon was slightly higher when the form was completed by the discharge nurse (three of four patients) than by the advanced practice provider (two of four patients).

CONCLUSIONS

The pilot study found that the patient-centered discharge plan form was feasible and acceptable to help improve the discharge process for trauma patients. Additional work to further refine the form's content and administration is warranted.