Safer Care Systems and Transitions
This is a new theme for the 2017-2022 NIHR Greater Manchester PSTRC that responds to the growing need to understand how safety is assured as patient care is transferred between different care providers, specialists and organisations.
The Safer Care Systems and Transitions theme builds on research carried out between 2012 and 2017. That research showed how patients with more than one health condition (multimorbidity) often face challenges to their safety when being cared for or treated by more than one organisation or care provider.
A patient pathway is the route that a patient will take from their first contact with an NHS member of staff (usually their GP), through referral, to the end of their treatment. It may also cover a stay in hospital. The centre’s previous research revealed how care pathways often involve care being transferred between different organisations, teams or departments.
During transitions, patients have reported feeling vulnerable. There is a risk to patient safety because of the difficulties of coordinating the transfer of care between different carers. While researchers know more about what increases safety within care settings, we know less about what makes care safer between settings.
Safer Care Systems and Transitions theme looks at the safety of care transitions. This includes:
- The ways in which patients move across their care pathway.
- The flow of information between all the professionals involved across care pathways.
- The role played by making organisational improvements.
- The different technologies used to support the coordination of all the specialists and carers involved in a particular care pathway.
The theme is looking at these transitional issues across:
- Primary (for example general practice) and secondary care (hospitals).
- In-mental health services.
- Nursing homes/elderly residential care homes.
- Cancer care pathways and end of life care, to ensure learning and innovations are shared across the health and social care sectors.
The research and impact
An example of one of the research projects underway is the ADAPT programme which researchers from both the Safer Care Systems and Transitions and Safety Informatics themes are working on, along with The Christie NHS Foundation Trust and Cancer Vanguard. It aims to improve outcomes for long term survivors of lymphoma. Once this has been completed, researchers will use what they’ve learnt to look at other types of cancer.
The following work is also underway:
SAFER Patient Flow Bundle for patient discharge
Developing ways to refine SAFER and make it safer for patients when they are discharged from mental health hospitals into the care of general practice in the community.
Transitions between care homes and hospitals
Developing a handover intervention scheme to improve the transfer of information to and from hospitals and nursing homes/elderly residential care homes within Salford Clinical Commissioning Group (CCG).
Prison healthcare transitions
Understanding the safety issues when managing medications for people going into prisons, moving between prisons or leaving prison. As a result opportunities for improvements to interventions will be identified.
Transitions between hospital and the community
Interventions to support the coordination of specialists before, during and after patients are discharged from hospital.
Patient-held care record
The co-design and feasibility testing of a paper version of a patients medical record held by them or their carer known as a 'patient-held care records'.
Inpatient to community transitions in mental health and offender healthcare
Understanding and testing solutions to the threats to safety in the 'inpatient to community' circuit of care in mental health services and offender healthcare.
NHS improvement intervention for making healthcare transitions safer
Researchers will evaluate this pilot and develop and test new ways of routine data collection and analysis for safety along with other research themes at the GM PSTRC.
Within the remit of the NIHR PSTRCs there’s a responsibility to develop and test ideas that improve patient safety with a focus on behavioural and digital interventions.
Digital interventions are developed and tested through our Safety Informatics theme, and many of the interventions across all themes to improve safety are behavioural. For example, the following patient safety projects are underway at the GM PSTRC and include a strong emphasis on behavioural science:
- The adaptation of a theory-based behaviour change intervention that reduces suicidal ideation and behaviour to meet the needs of marginalised groups.
- The application of control theory to improve safety in medication prescribing (REVISIT).
- Ensuring that national guidelines are implemented to enhance patient safety.
Introducing a Behavioural Science sub theme will align to our existing work but allow the centre also to explore this area further in relation to patient safety.
Behavioural Science involves the application of theory and evidence to understand aspects of healthcare and illness including:
- Making recommendations for improving health service delivery by observing current practice.
- Designing and testing innovative behaviour change interventions.
- Evaluating new and existing interventions to examine their effectiveness and acceptability both to patients and healthcare professionals.
- Ensuring that behaviour change interventions are embedded in practice.
The Behavioural Science sub theme is hosted by the Safer Care Systems and Transitions theme. It will be led by Prof Chris Armitage who is a world-renowned research leader in behavioural science, to:
- Formalise and draw attention to the behavioural science research that is currently undertaken within the GM PSTRC.
- Provide a resource for the main GM PSTRC themes to embed behavioural science within their programmes of research.
- Provide a roadmap for future novel behavioural science projects to promote and enhance patient safety.
- Address key patient safety problems that are currently under-researched including psychological safety for staff, and patient safety in intensive care settings.
Behavioural Science Subtheme Lead
- Dr Thomas Blakeman
- Professor Stephen Campbell
- Dr Gavin Daker-White
- Dr Chris Keyworth
- Dr Claire Planner
- Dr Natasha Tyler
- Dr Isabel Adeyemi (Patient and Public Involvement)
- Dr Sally Giles (also Marginalised Groups: Patients and Carers)
- Dr Andrew Grundy
- Dr Richard Keers (also Medication Safety)
- Professor Catherine Robinson
PSTRC PhD Fellow
- Victoria Moore