Partners at Care Transitions (PACT): Improving Patient Experience and Safety at Transitions of Care

Aims and Objectives: To investigate whether greater involvement of patients and their families can improve patient experience and safety at transitions of care. To achieve this aim we will: Develop a better understanding of the transitions process from the perspective of older people, their carers (WP1) and health and social care professionals (WP2). Use the knowledge generated above to develop a measure of the quality of care transitions (WP3) and the Partners at Care Transitions (PACT) intervention (WP4) and test acceptability. Test the intervention and measurement instruments and the trial methods (WP5). We will further refine the implementation strategy and conduct feasibility work to inform a full trial. Conduct a full RCT (WP6) with a parallel process and economic evaluation to evaluate the effectiveness and cost-effectiveness of the transitions intervention and establish how it is used in practice. Rationale: Improvements in patient experience and safety are at the centre of NHS Policy (NHS Outcomes Framework 2015/16), representing core outcomes against which NHS commissioners and providers will be held accountable. When a patient moves between different care organisations e.g. from hospital to home, they are particularly vulnerable to risk and they often report a poor experience of care. The NHS Future Forum reported that too often patients experience gaps in service provision, failures in communication, and poor transitions between services. The current research programme will directly address this issue by building on recent systematic reviews of transition interventions that suggests that greater involvement of patients and their families can improve patient safety and experience at the transitions of care. In this programme we will adopt a novel conceptual approach to safety, known as 'Safety II', which goes beyond a focus on past harm and explores what goes well and why, as well as more effective anticipation and response to signals (disruptions, gliches etc.) to prevent harm in the first place. This programme of work will build upon our existing expertise in patient involvement in safety, the measurement of patient experience and patient safety and elderly care to address the question of what resilience (the capacity to recover quickly from difficulties) looks like at transitions and whether resilience can be fostered through the greater involvement of patients and their families at transitions of care. Research plan: This research will be delivered through six work-packages. The existing research on transition interventions, experience of older patients at transitions and the measurement of quality at transitions has been, and will continue to be, reviewed prior to the commencement of the programme. Work-package 1 will employ different interviewing techniques, together with observations to help understand the patient/carer experience of care at transitions and generate ideas about how patients could be more actively involved. Thirty patients from two hospital Trusts will be interviewed at different points in their care transition. Work-package 2 will use a positive deviance approach to identify wards and community teams that manage, despite similar resource constraints, to have low rates of hospital readmissions compared to similar services. We will then explore how this is achieved through multi-disciplinary, multi-service focus groups. Work-package 3 will use findings from the literature reviews and work-packages 1 and 2 to develop a measure of quality of care at transitions, a secondary outcome measure for the trial. The reliability and validity of this measure will be assessed in two studies. Work-package 4 will use co-production to develop and assess the acceptability of the Partners at Care Transitions (PACT) intervention. Through collection of feedback from staff and patients, this work-package will also inform the implementation strategy.