Measuring patient safety at hospital transitions of care
File(s)
Author(s)
Molloy, Aoife
Type
Thesis
Abstract
Transitions of care are high-risk for patient safety. A transition of care refers to patient movement and transfer of responsibility for care across settings. There is lack of consensus regarding critical areas of patient safety measurement during transitions. Certain factors put patients at increased risk of patient safety incidents at transitions of care, including care-setting, race, age, and multimorbidity. It remains unclear how to identify those at risk. Can published literature identify what is important for patient safety during transitions and can high-risk patients be identified using routine healthcare data?
I conducted a scoping review outlining gaps in literature and identifying important components of transitions: transition planning and follow-up care; information transfer, communication, and coordination between healthcare professionals; patient involvement, engagement, and education; and multi-disciplinary, social, and psychological support. I generated themes of patient safety measurement at transitions through metasynthesis of literature and qualitative analysis of people’s experiences. The themes were grouped into domains and underpinned with international standards to create domains and measurement approaches. Expert validation through a modified Delphi process resulted in domains of patient safety at transitions of care. The panel noted patient characteristics that increase risk may be measurable in routine administrative data.
I analysed over seven million transitions of care in the NHS in England and found that discharge to a destination that differed from the admission source had two-fold-higher odds of delay and four-fold-higher odds of readmission. Ethnicity, older age, frailty, multimorbidity and deprivation significantly increased adverse outcomes. I have shown that transitions of care can be analysed using routine administrative data. My findings are highly relevant to healthcare practice and mean that patients at increased risk of patient safety incidents at transitions of care can be identified. This work could form the basis of a patient safety risk score at transitions of care.
I conducted a scoping review outlining gaps in literature and identifying important components of transitions: transition planning and follow-up care; information transfer, communication, and coordination between healthcare professionals; patient involvement, engagement, and education; and multi-disciplinary, social, and psychological support. I generated themes of patient safety measurement at transitions through metasynthesis of literature and qualitative analysis of people’s experiences. The themes were grouped into domains and underpinned with international standards to create domains and measurement approaches. Expert validation through a modified Delphi process resulted in domains of patient safety at transitions of care. The panel noted patient characteristics that increase risk may be measurable in routine administrative data.
I analysed over seven million transitions of care in the NHS in England and found that discharge to a destination that differed from the admission source had two-fold-higher odds of delay and four-fold-higher odds of readmission. Ethnicity, older age, frailty, multimorbidity and deprivation significantly increased adverse outcomes. I have shown that transitions of care can be analysed using routine administrative data. My findings are highly relevant to healthcare practice and mean that patients at increased risk of patient safety incidents at transitions of care can be identified. This work could form the basis of a patient safety risk score at transitions of care.
Version
Open Access
Date Issued
2024-02-01
Date Awarded
01/04/2025
License URL
Advisor
Mossialos, Elias
Søren Rud, Kristensen
Sponsor
National Institute for Health Research (Great Britain)
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)