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Quality and safety within elderly health and care services (EHCS)

There is an increasing number of elderly with chronically and complex care needs in society. This is resulting in an increased need for coordination between service levels and healthcare personnel.

The role of transitions and interactions (2011 - 2015)

Coordination challenges are defined as an area with risk of adverse events with elderly as a vulnerable group due to complex health conditions, treatment regimes and cognitive impairment.

Research has traditionally been focusing at transitions within the specialist healthcare services and to a lesser extent across service levels and within primary healthcare services. This research project therefore focuses on quality and safety in transitional care of the elderly across service levels and healthcare personnel.

This research project has resulted in three published literature reviews:

  • Risk related to elderly patients transitions across specialist and primary healthcare services.
  • Interventions related to elderly patients transitions across specialist and primary healthcare services.
  • Patient involvement related to elderly patients transitions across specialist and primary healthcare services.

Based on careful analysis of obe\servational data related to admission and discharge of elderly patients to and from specialist to primary healthcare services the project has identified six main factors that influences the quality of transitional care of the elderly:

  • Next-of-kin
  • Patient characteristics
  • Helathcare personnels competence
  • Information transfer
  • Context
  • Patient assessment

Two study protocols (Phase 1 and Phase 2) have been published to describe suitable data collection methods for quality and safety in transitional care of the elderly and to describe the interventional program "The meeting Point". The Meeting Point is a pedagogically intervention for healthcare personnel consisting of three seminars with the following topics: Risk perspective, patient perspective and system perspective. Approximately one hundred participants (nurses, doctors, patient coordinators, physiotherapists, auxiliary nurses and managers) from different wards and areas within specialist and primary healthcare services has participated in this program.

In the EHCS research project a detailed analysis of hospital discharge of elderly patients to primary healthcare services has been carried out. The analysis documents ten functions that are more or less dependent of each other. Considerable variation in terms of time, duration and precision was observed in the study in some cases leading to vulnerability. The study is documented in the PhD thesis of Kristin Alstveit Laugaland (2015).

In addition to the above, a detailed analysis of patient participation in hospital admission and discharge has been carried out. The analysis documents varying degrees of information exchange between healthcare personnel and patients in addition to a lack of patient involvement in decision making. This study is documented in the upcoming PhD thesis of Dagrunn Nåden Dyrstad (2016).