The first review of transitional care interventions between hospitals and care homes has been conducted by researchers at the GM PSTRC

Research has revealed that older people living in care homes who are allocated to interventions that support the move between a care home and a hospital or emergency department are almost two times less likely to be readmitted.

Here, the authors of the paper, ‘Transitional Care Interventions for Older Residents of Long-term Care Facilities: A Systematic Review and Meta-analysis’, along with a member of the centre’s public engagement group, share their thoughts on the study and its findings.

The transition between hospital and care home is a challenging time for many older people and previous research has shown that patient safety issues are more common at points of transition.

Therefore, we identified the need to carry out research to improve patient safety in this area. Our study involved a systematic review which gathered together data reported in previous research. We then used a type of analysis known as meta-analysis to understand the association between interventions that support transitions between care settings, and various outcomes for care home residents and care home staff. Some examples of these interventions include post-discharge support and outreach services.

Transitional care interventions associated with improved outcomes

We discovered that for care home residents who were allocated to a transitional care intervention, there were fewer readmissions and their length of stay in the emergency department was shorter.

However, we discovered that the content of these interventions varied. The studies didn’t always measure the same outcomes, making it difficult to directly compare the results across studies. Therefore, a standardised set of outcomes that are agreed by patients, staff and health and care systems would strengthen future research.

We also found that the quality of communication and referral processes between care providers, as well as engagement with primary care is likely to influence the effect of transitional care interventions.

Input from people with lived experience

The study was supported by three public contributors with experience of caring for family members, preparing for a move to or already living in care homes. The public contributors provided feedback on the design of the research and on the studies that were included in the review. They agreed with our finding that more clarity is needed regarding staff roles, training and ability, in order to support transitions to and from different care settings.

Public contributor Mr Manoj Mistry said: ”We were involved from the beginning of the study, we questioned everything that was presented to us by the researchers on the basis of our ‘lived experience’ of having family members in care homes etc, which then led to refinements, further discussions and consensus. This study has been a good example of genuine collaboration and co-production between an established team of researchers and public contributors, adding more validity to the findings”.

Implications of the research

Dr Maria Panagioti, lead of the GM PSTRC’s Safer Care Systems and Transitions theme and an author of this study, said: “As this is the first review of transitional interventions in care homes, we believe our findings have the potential to improve patient safety in this area, especially since the emergence of COVID-19.”

The research identified 15 studies of transitional care interventions, 10 of which were set in Australia, but none had been carried out in the UK.  

Dr Panagioti continued: “There is a striking lack of investment in transitional care interventions across most countries, and the high human and financial costs mean such investment is urgently needed.”

The research “Transitional Care Interventions for Older Residents of Long-term Care Facilities: A Systematic Review and Meta-analysis” was published in the journal JAMA Network Open and was funded by the National Institute for Health and Care Research School for Primary Care Research (NIHR SPCR), with support from staff within the National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC).