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Mixed-methods study examining family carers’ perceptions of the relationship between intrahospital transitions and patient readiness for discharge
  1. Alycia A Bristol1,
  2. Catherine E Elmore1,
  3. Marianne E Weiss2,
  4. Lisa A. Barry1,
  5. Eli Iacob1,
  6. Erin P Johnson1,
  7. Andrea S Wallace1
  1. 1College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
  2. 2College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
  1. Correspondence to Dr Alycia A Bristol, College of Nursing, University of Utah Health, Salt Lake City, UT 84112, USA; alycia.bristol{at}nurs.utah.edu

Abstract

Introduction Intrahospital transitions (IHTs) represent movements of patients during hospitalisation. While transitions are often clinically necessary, such as a transfer from the emergency department to an intensive care unit, transitions may disrupt care coordination, such as discharge planning. Family carers often serve as liaisons between the patient and healthcare professionals. However, carers frequently experience exclusion from care planning during IHTs, potentially decreasing their awareness of patients’ clinical status, postdischarge needs and carer preparation. The purpose of this study was to explore family carers’ perceptions about IHTs, patient and carer ratings of patient discharge readiness and carer self-perception of preparation to engage in at home care.

Methods Sequential, explanatory mixed-methods study involving retrospective analysis of hospital inpatients from a parent study (1R01HS026248; PI Wallace) for whom patient and family carer Readiness for Hospital Discharge Scale (RHDS) score frequency of IHTs and patient and caregiver characteristics were available. Maximum variation sampling was used to recruit a subsample of carers with diverse backgrounds and experiences for the participation in semistructured interviews to understand their views of how IHTs influenced preparation for discharge.

Results Of discharged patients from July 2020 to April 2021, a total of 268 had completed the RHDS and 23 completed the semistructured interviews. Most patients experienced 0–2 IHTs and reported high levels of discharge readiness. During quantitative analysis, no association was found between IHTs and patients’ RHDS scores. However, carers’ perceptions of patient discharge readiness were negatively associated with increased IHTs. Moreover, non-spouse carers reported lower RHDS scores than spousal carers. During interviews, carers shared barriers experienced during IHTs and discussed the importance of inclusion during discharge care planning.

Conclusions IHTs often represent disruptive events that may influence carers’ understanding of patient readiness for discharge to home and, thus, their own preparation for discharge. Further consideration is needed regarding how to support carers during IHT to facilitate high-quality discharge planning.

  • Health services research
  • Patient-centred care
  • Transitions in care

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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Footnotes

  • Contributors All authors contributed to the conduct of the study and/or manuscript development, writing and editing.

  • Funding This study was funded by an Emma Eccles Jones Nursing Research Center Pilot Grant from the University of Utah, College of Nursing, and the Agency for Healthcare Research and Quality (1R01HS026248). CEE is funded by an NIH NINR T32 Post-doctoral Training Fellowship (T32NR013456) and ASW has received funding from NINR-NIMHD-NIAAA (R01NR019944), AHRQ (1R01HS026248), AHRQ (R21) HS026505 and AHRQ Care Transitions Challenge Award. AAB was a Family Caregiver Collaborative Caregiving Scholar, University of Utah (funded by K07AG068185).

  • Competing interests ASW has received travel funding from PCORI and NIH to attend grant review panels. ASW is a consultant for the American Association of Medical Colleges for SDOH content. ASW is a member of the United Way of Utah 211 Steering Committee. MEW serves as a consultant for the University of Utah on an AHRQ-funded grant.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.