Managing care for people in community hospitals
Research type
Research Study
Full title
Evaluating the feasibility of a new tool SPACE - Symptom and Psychosocial Assessment and Communication Evaluation to manage care for people in community hospitals and during clinical uncertainty
IRAS ID
280195
Contact name
Catherine Evans
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
1 years, 1 months, 31 days
Research summary
Summary of Research
We focus on the management of clinical uncertainty in community hospitals. These are small non-acute hospitals caring for mainly older people. Older people admitted to community hospitals often have complex care needs and uncertainty as to recovery or continued decline leading eventually to end of life. Using standardised documents can improve how care is managed, but these documents are mainly used in acute hospitals. We don’t know if they can be used in community hospitals or how to evaluate if they may benefit patients.We aim to evaluate the feasibility, processes and acceptability of a new tool SPACE - Symptom and Psychosocial Assessment and Communication Evaluation to manage care for people in community hospitals and during clinical uncertainty. SPACE uses standardised documents to support three areas of clinical care: (1) Assessing potential for recovery and ‘what matters to the person’; (2) Communication with the person and family about what to expect; and (3) Ensuring care continues as planned on discharge.
We will undertake the study in two community hospitals. We will recruit 40 patients to evaluate the processes of staff using the documents in clinical care, and the feasibility and acceptability of the research methods to inform a large study. We will evaluate the acceptability for staff to use the documents by reviewing participants’ health records to see if the documents are used, observe how staff use the documents with patients and families, and talking to staff about their experiences. We will ask patients (or a family member on the person’s behalf) to complete three questionnaires, twice in the hospital and once after discharge. The questionnaires ask about the participant’s experiences of care, how using the documents may benefit patients and the services used. The findings will inform a large study examining the benefit for patients if feasibility is demonstrated.
Summary of Results
Key findings People who use community hospitals are typically older, frail and have multiple conditions with complex needs. Evidence-based documents can support assessment and management of care needs and improve symptoms and concerns. However, this improvement is often not maintained after discharge.
Why is this work important?
Community hospitals provide multidisciplinary care for rehabilitation, recovery and palliative care to mainly older patients. Patients often have multiple, complex care needs with uncertain outcomes. Over one in four are in the last year of life. Most patients are admitted from an acute hospital after an unplanned admission. How to support recovery and anticipate nearness of end-of-life is unclear.
Our aim was to understand if evidence-based documents can help to manage care during clinical uncertainty for older adults with frailty and multimorbidity What did we do?
We used in two community hospitals evidence-based documents to support assessment and interdisciplinary working to manage recovery and anticipate nearness of end of life (fig.1). We recruited patients aged 65 years or over and measured their symptoms and concerns, physical disability, function and frailty on admission (baseline), during admission (T1) and after discharge (T2).
What did we find out?
103 eligible patients, 40 were recruited. Average age was 83.5 years. 72% lived alone and 54% had no primary carer. Patients had multiple conditions (average 6.6) and 90% more than one Acute Frailty Syndrome. 95% were admitted from an acute hospital after an unplanned admission, 49% from a fall. Distressing symptoms improved during admission (T1), but this improvement declined after discharge (T2).
Conclusion
This is an older, frail population with multiple conditions leading to multiple complex needs. Documents can support assessment and management of needs. However, maintaining improvement of distressing symptoms after discharge is a priority area for clinical care and future research.REC name
London - Queen Square Research Ethics Committee
REC reference
20/LO/0981
Date of REC Opinion
5 Oct 2020
REC opinion
Further Information Favourable Opinion