Developing a co-designed systems-level response to safety issues for residents transitioning from hospital to care homes

Background: Transition from hospital to care home is high in risk, with a third of transitions resulting in adverse events (Kapoor et al., 2019).

Common problems include communication failures, (Richardson et al., 2019) medication errors, (Weir et al., 2019) and incorrect documentation (Hellesø et al., 2004).

Identifying incidents is difficult; reports do not accurately reflect level of harm (Scott et al., 2019a), care home and hospital organisations have different priorities (Sutton et al., 2016), and health and social care sectors use different definitions of safety (Scott et al., 2017).

Consequently integrated care is lacking, and opportunities for organisational, cross-sector learning can be missed (Scott et al., 2017). Moreover, there is a knowledge gap around how care homes collect incident reports.

Aims: Develop a better understanding of incident reporting in care homes and co-design a systems-level response to safety issues for patients transitioning from hospital to care home. Methods: Two Workstreams (W) will run in parallel.

W1 will consist of a scoping review of types of existing systems for reporting incidents, including policies, technology and types of data captured.

Representative stakeholders representing medium to large care home organisations will be involved, leading to the development of a taxonomy of incident reporting in care homes. The taxonomy will be developed using a standardised approach to taxonomy development (Nickerson et al., 2013). W2 will be structured in three Phases (P) with care home organisations.

P1 will consist of ≤40 interviews with care home staff to develop a better understanding of their specific internal systems for reporting incidents.

P2 will consist of a retrospective documentary analysis of care home data relating to resident transitions, using the knowledge of the systems gained in P1. Data size and sampling will be determined based on potential data size. A validated data extraction form (Scott et al., 2019) will be adapted and revalidated before use.

Content analysis (Elo and Kyngäs, 2008) informed by the heuristic of systemic risk factors will be the primary mode of analysis, supported by thematic analysis for emerging themes (Braun and Clarke, 2006).

P3 will consist of four validation and co-design workshops to develop a service specification using NHS Improvement's (2018) framework. This will then be mapped against existing systems and recommendations produced.

Discussion: Commissioners, providers and regulators will be able to use the co-designed service specification to improve integrated care, leading to a positive impact on the health and care of older people.