How story authors helped our research into hospital discharge

This post is authored by Dr Helen Smith with the support of Dr Andria Hanbury, programme manager, Improvement Science theme, Yorkshire and Humber ARC

Designing and conducting a qualitative study involving older people and their discharge from hospital during the COVID-19 pandemic was one of the best learning opportunities I’ve experienced in my research career.

My initial concerns about conducting interviews safely and effectively during the pandemic were soon overshadowed by the greater challenge I faced in recruiting older people aged over 75 who had been in hospital in the last 6 months. Enter Care Opinion and its substantial archive of care stories and its active ‘research community’, which provided an effective way of engaging with the topic and an efficient process for recruiting eligible study participants.

Here, I summarise the study that I completed last year, to explore older people’s and caregiver’s experiences of recent hospital stays and of the discharge from hospital process, highlighting the valuable contribution of Care Opinion.

Older people tend to stay in hospital longer than they need to and this sometimes impacts on their physical and emotional wellbeing. Reducing delayed transfers of care (DToC) in older people from hospital to home or other community settings is an NHS England priority.

I designed a qualitative study using semi-structured interviews to explore older people’s and caregiver’s perceptions of hospital stays and the discharge process. By listening to older people’s experiences, the study sought to use these insights to develop recommendations for earlier discharge and shorter stays.

I needed rich insight into older people’s and carer’s perspectives, but COVID-19 restrictions meant I couldn’t access hospital wards to interview older people face to face during a hospital stay. Instead, I chose to use telephone interviews, and, thanks to Care Opinion, I was also able to review and analyse relevant care stories and feedback, and recruit eligible caregivers of older people.

I planned to engage with  Care Opinion from the start of the research, to identify patient and carer stories about recent hospital stays. The aim was to analyse these stories to distil barriers and facilitators to shorter hospital stays from the patient and carer perspective, as well as to identify any relevant issues to pursue in the telephone interviews.

Using Care Opinion for this early stage work meant that in a short space of time I had identified and analysed 371 stories authored by older people and their family members or caregivers. The content analysis revealed profound insight into the care environment and how care was organised for older people during a hospital stay as well as how care was experienced, especially what it meant to be older and in hospital. Combined with early discussions with a local patient and public engagement group, these findings helped ensure the subsequent interviews targeted the most pertinent topics and asked the right questions.

(image from the visual abstract, linked below)

In March 2021 the United Kingdom was at COVID-19 alert level 3 and government guidance allowed social contact indoors between members of a household only, restricting my access to older people in hospital wards or in their own home following discharge. I still needed to do this work to provide robust evidence of older people’s and carer’s perceptions.

Through engaging with the Care Opinion Research Community, I was able to recruit nine older people and their carers for the interviews, assisted by Care Opinion’s chief executive, James Munro, who contacted people meeting the eligibility criteria. We supplemented this recruitment strategy with other approaches (detailed in this blog) and eventually recruited a total of 10 family members and six older people for interviews.

(image from the visual abstract, linked below)

Our findings are published in the journal Health Expectations and also outlined in a visual abstract which you can download as a PDF file.

Visual abstract PDF

Without Care Opinion this important study would have been paused during the pandemic and the length of time to recruit to and complete the study would have been significantly impacted.

We would like to thank Care Opinion for supporting this study, and, as always, the people who provided their care stories and participated in the interviews.