In attempt to improve continuity of patient care and reduce length of stay, hospitals have placed an increased focus on reducing delayed discharges through discharge planning. Several benefits and challenges to team-based approaches for discharge planning have been identified. Despite this, professional hierarchies and power dynamics are common challenges experienced by healthcare providers who are trying to work as a team when dealing with delayed discharges. The objective of this study was to explore what was working well with formal care team-based discharge processes, as well as challenges experienced, in order to outline how teams can function to better support transitions for patients experiencing a delayed discharge. METHODS: We conducted a descriptive qualitative study with hospital-based healthcare providers, managers and organizational leaders who had experience with delayed discharges. Participants were recruited from two diverse health regions in Ontario, Canada. In-depth, semi-structured interviews were conducted in-person, by telephone or teleconference between December 2019 and October 2020. All interviews were recorded and transcribed. A codebook was developed by the research team and applied to all transcripts. Data were analyzed inductively, as well as deductively through directed content analysis.We organized our findings into three main categories - (1) collaboration with physicians makes a difference; (2) leadership should meaningfully engage with frontline providers and (3) partnerships across sectors are critical. Regular physician engagement, as equal members of the team, was recommended to improve consistent communication, relationship building between providers, accessibility, and in-person communication. Participants highlighted the need for a dedicated senior leader who ensured members of the team were treated as equals and advocated for the team. Improved partnerships across sectors included the enhanced integration of community-based providers into discharge planning by placing more focus on collaborative practice, combined discharge planning meetings, and having embedded and physically accessible care coordinators in the hospital.Team-based approaches for delayed discharge can offer benefits. However, to optimize how teams function in supporting these processes, it is important to consistently collaborate with physicians, ensure senior leadership engage with and seek feedback from frontline providers through co-design, and actively integrate the community sector in discharge planning.
Introduction: Delayed discharge is a key challenge for health systems globally. Pandemic-related capacity pressures on hospitals have increasingly led to patients being moved to unique spaces (overflow units, hotels) while they wait to transition to their next point of care. However, it is unclear how patient care is managed and coordinated in these spaces or how patients and caregivers experience care in these environments.
Rationale/Objective: Our study aimed to understand how to optimize care experiences and outcomes for patients with a delayed discharge, their families and care providers. The purpose of our study was to learn about people’s experiences in unique spaces, including what works well and what needs to improve.
Methods: Using a qualitative descriptive design, we conducted in-depth, semi-structured interviews with patients/caregivers (n=9) and care providers (n=20; e.g., nurses, rehabilitation therapists, physicians, discharge planners) who had experience with receiving or providing care in a unique space. We interviewed participants from three different unique spaces associated with a hospital across rural and urban health regions in Ontario, Canada: a hotel previously used for patient and caregiver accommodations while receiving care away from home (beside hospital), a structured, heated tent (hospital parking lot) and a clinical building (1 hour away from hospital). Interviews were transcribed and a codebook was developed and applied to all transcripts. Thematic analysis was used to analyze the transcripts, specifically focusing on key challenges and opportunities.
Results: Patient, caregiver and care provider experiences in these unique spaces included positive aspects, such as care teams focused on facilitating integrated care transitions, the opportunity to develop a collaborative team culture from the ground up and having increased interdisciplinary patient assessments. Areas of improvement were also described across interviews, such as the need for adequate space and infrastructure for optimal patient care and safety, more integration of information sharing about patient care and journeys between and across providers, patients and caregivers, more resources and support from the associated hospital and clear patient eligibility criteria for care provider referrals.
Lessons learned: Unique spaces have the potential to be alternate care settings when hospitals are managing capacity pressures now and in the future; however, hospitals considering moving patients with delayed discharge to these spaces should consider both the opportunities and benefits of providing care within these environments compared to traditional hospital units. It is also important for hospitals to understand the challenges associated with providing care in these settings and develop plans to mitigate these challenges.
Next steps: These findings provide learnings to inform a co-design initiative with patients, caregivers and care providers to identify best practices and resources for providing or receiving care in unique spaces that responds to patient needs as the health system continues to look to alternate care settings to ease pressures. This work will have implications on how integrated health care services are implemented in unique spaces so that patients experience a continuum of care both while they wait and as they transition to new points of care.
The purpose of this paper was to understand the nature of delayed hospital discharge through the lens of a policy framework (ideas, institutions and interests; 3-I framework).One-to-one in-depth interviews were conducted with 57 participants, including 18 patients, 18 caregivers, 11 providers and 10 organizational leaders across two hospital networks in urban and rural regions of Ontario, Canada.Delayed discharge was a product of spill-over effects (due to rules and eligibility in other health sectors) and variable implementation of policies and guidelines (institutions); competing priorities and tensions among patients, caregivers, providers and organizational leaders (interests); as well as a number of perceived root causes including patient complexity, caregiver burnout, lack of system infrastructure, and an imbalance of system and personal responsibility to support aging adults (ideas).The 3-I framework allowed us to examine the contributing factors to delayed discharge in a comprehensive way. Based on our findings we suggest that cross-sectoral collaboration and strengthening of relationships among stakeholders is required to address this complex policy problem.
The COVID-19 pandemic has had a devastating impact on healthcare systems and care delivery, changing the context for patient and family engagement activities. Given the critical contribution of such activities in achieving health system quality goals, we undertook to address the question: What is known about work that has been done on patient engagement activities during the pandemic?
This study reports findings from an evaluation of a 3-year collaborative care pilot project implemented in a Canadian primary care setting to assess and treat seniors (age ≥ 65) living at home with a chronic physical illness and co-morbid depressed mood or anxiety. Data were collected using semi-structured interviews with seniors and family caregivers who had participated in the project (n = 14). Descriptive qualitative analysis revealed the significance of the care manager’s role in offering social and emotional connection and non-stigmatizing support to seniors living at home and self-managing their physical and mental health.
Purpose: To explore the role of breakfast cereal consumption on the relationships among BMI, percent fat mass (%FM), and body esteem in young adults. Methods: Weight, height, and %FM (by air displacement plethysmography) were measured in 29 males (aged 25.1 ± 4.0 years) and 28 females (aged 24.6 ± 4.0 years). Body esteem was measured using the Body Esteem Scale for Adolescents and Adults (BESAA). Three-day food records classified participants as breakfast cereal consumers (n = 27, any amount of ready-to-eat or cooked cereal consumed at breakfast) versus nonconsumers (n = 30, no cereal consumed at breakfast). Results: The %FM was significantly (P ≤ 0.05) inversely correlated with weight esteem (r = −0.769), appearance esteem (r = −0.723), and external attribution (r = −0.620) in female noncereal consumers. BMI was similarly correlated with BESAA scores. These relationships were not significant in female cereal consumers (all r < 0.426), despite no difference in confounding variables between female cereal consumers and nonconsumers. Neither BMI nor %FM were correlated with measures of body esteem (all r < 0.466, NS) in either male cereal consumers or nonconsumers. Conclusions: Breakfast cereal consumption may moderate the relationship among BMI, %FM, and body esteem in young adult women and may be useful for improving body esteem without focusing on weight loss.
Background Given growing hospital capacity pressures, persistent delayed discharges, and ongoing efforts to improve patient flow, the use of unconventional environments (newly created or repurposed areas for patient care) is becoming increasingly common. Despite this, little is known about individuals’ experiences in providing or receiving care in these environments. Objectives The objectives of this study were to: (1) describe the characteristics of three unconventional environments used to care for patients experiencing a delayed discharge, and (2) explore individuals’ experiences with the three unconventional environments. Methods This was a multi-method qualitative study of three unconventional environments in Ontario, Canada. Data were collected through semi-structured interviews and observations. Participants included patients, caregivers, healthcare providers, and clinical managers who had experience with delayed discharges. In-person observations of two environments were conducted. Interviews were transcribed and notes from the observations were recorded. Data were coded and analyzed thematically. Results Twenty-nine individuals participated. Three themes were identified for unconventional environments: (1) implications on the physical safety of patients; (2) implications on staffing models and continuity of care; and, (3) implications on team interactions and patient care. Participants discussed how the physical set-up of some unconventional spaces was not conducive to patient needs, especially those with cognitive impairment. Limited space made it difficult to maintain privacy and develop social relationships. However, the close proximity of team members allowed for more focused collaborations regarding patient care and contributed to staff fulfilment. A smaller, consistent care team and access to onsite physicians seemed to foster improved continuity of care. Conclusions There is potential to learn from multi-stakeholder perspectives in unconventional environments to improve experiences and optimize patient care. Key considerations include keeping hallways and patient rooms clear, having communal spaces for activities and socialization, co-locating team members to improve interactions and access to resources, and ensuring a consistent care team.
This analysis of people's accounts of establishing their need and experiences of healthcare for long Covid (LC) symptoms draws on interview data from five countries (UK, US, Netherlands, Canada, Australia) during the first ∼18 months of the Covid-19 pandemic when LC was an emerging, sometimes contested, condition with scant scientific or lay knowledge to guide patients and professionals in their sense-making of often bewildering constellations of symptoms. We extend the construct of candidacy to explore positive and (more often) negative experiences that patients reported in their quest to understand their symptoms and seek appropriate care. Candidacy usually considers how individuals negotiate healthcare access. We argue a crucial step preceding
