Background
Methods
Aims and objectives
Study design
Setting
Description of safety survey
Item number | Item | Response mode |
---|---|---|
1 | I understood the purpose of the Safety Survey | Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree) |
2 | I understood what was meant by ‘your recent transfer’ | Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree) |
3 | I understood each of the questions | Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree) |
4 | The questions asked accurately captured what made me feel safe or unsafe | Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree) |
5 | There was nothing missing from the Safety Survey | Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree) |
6 | I did not experience difficulties completing the Safety Survey | Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree) |
7 | I felt that the colour scheme was useful | Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree) |
8 | The size of the text was appropriate | Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree) |
9 | The Safety Survey allows me to provide useful feedback about the healthcare I have received | Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree) |
10 | By receiving this form I feel I am more educated about patient safety | Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree) |
11 | Please use the space to expand on your answers or say anything about the survey that you think is relevant | Free-text |
Quantitative data
Patient reports of safety experiences (surveys)
Safety survey distribution rates
Safety survey response rates
Qualitative data
Patient interviews
Staff interviews
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Work on one of the included wards during the period where safety surveys were distributed, where:
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◦ They were responsible for managing the ward, or;
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◦ They had been involved in distributing the safety survey, or;
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◦ They had responsibility for discharging patients
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Had responsibility for the management of patients or services relating to the transfer of the patient
Staff incident reports
Mixed methods analysis
Results
Limited-efficacy testing
Patient reports of safety experiences via the survey
Departure | Safety rating | Differences in Characteristics | |||||
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N (% of all 366 respondents) | Safe (%) | Neutral (%) | Unsafe (%) | Clinical areaa | Ageb | Genderb | |
Communication | 346 (94.5) | 304 (87.9) | 32 (9.2) | 10 (2.9) | p = 0.808 | p = 0.132 | p = 0.607 |
Responsiveness | 342 (93.4) | 303 (88.6) | 31 (9.1) | 8 (2.3) | p = 0.075 | p = 0.285 | p = 0.807 |
Delaysc | 257 (70.2) | Cycle 1: 118 (64.8) Cycle 2: 34 (45.3) | Cycle 1: 51 (28) Cycle 2: 23 (30.7) | Cycle 1: 13 (7.1) Cycle 2: 18 (24.0) | Cycle 1: p = 0.874 Cycle 2: p = 0.151 | p = 0.097 | p = 0.768 |
Falls | 310 (84.7) | 268 (86.5) | 37 (11.9) | 5 (1.6) | p = 0.874 | p = 0.887 | p = 0.184 |
Medication | 335 (91.5) | 278 (83.0) | 36 (10.7) | 21 (6.3) | p = 0.107 | p = 0.650 | p = 0.182 |
Hygiene | 351 (96.0) | 319 (90.9) | 29 (8.3) | 3 (0.9) | p = 0.841 | p = 0.559 | p = 0.322 |
Journey | Safety rating | Differences in Characteristics | |||||
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N (% of all 366 respondents) | Safe (%) | Neutral (%) | Unsafe (%) | Transport typea | Ageb | Genderb | |
Communication | 231 (63.1) | 213 (92.2) | 14 (6.1) | 4 (1.7) | p < 0.001 Safe Ambulance, 93.3% Private car, 91.0% Patient transport, 85.7% | p = 0.121 | p = 0.876 |
Responsiveness | 230 (62.8) | 207 (90.0) | 20 (8.7) | 3 (1.3) | p < 0.001 Safe Ambulance, 90.8% Private car, 83.3% Patient transport, 66.7% | p = 0.911 | p = 0.463 |
Delays | 226 (61.7) | Cycle 1: 151 (73.5) Cycle 2: 34 (45.3) | Cycle 1: 29 (19.2) Cycle 2: 23 (30.7) | Cycle 1: 11 (7.3) Cycle 2: 18 (24.0) | p < 0.001 Safec Ambulance, 71.4% Private car, 67.2% Patient transport, 58.3% | p = 0.460 | p = 0.038 (male more likely to report safe) |
Falls | 230 (62.8) | 194 (84.3) | 29 (12.6) | 7 (3.0) | p = 0.009 Safe Ambulance, 90.8% Private car, 83.3% Patient transport, 66.7% | p = 0.420 | p = 0.501 |
Medication | 226 (61.7) | 197 (87.2) | 23 (10.2) | 6 (2.7) | p = 0.001 Safe Ambulance, 87.7% Private car, 87.2% Patient transport, 91.7% | p = 0.194 | p = 0.444 |
Hygiene | 232 (63.4) | 211 (90.9) | 18 (7.8) | 3 (1.3) | p < 0.001 Safe Ambulance, 91.7% Private car, 92.4% Patient transport, 81.8% | p = 0.536 | p = 0.703 |
Arrival | Safety rating | Differences in Characteristics | |||||
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N (% of all 366 respondents) | Safe (%) | Neutral (%) | Unsafe (%) | Arrival destinationa | Ageb | Genderb | |
Communication | 235 (64.2) | 219 (93.2) | 11 (4.7) | 5 (2.1) | p = 0.980 | p = 0.840 | p = 0.122 |
Responsiveness | 237 (64.8) | 210 (88.6) | 23 (9.7) | 4 (1.7) | p = 0.315 | p = 0.691 | p = 0.207 |
Delays | 223 (60.9) | Cycle 1: 118 (79.7) Cycle 2: 34 (45.3) | Cycle 1: 21 (14.2) Cycle 2: 23 (30.7) | Cycle 1: 9 (6.1) Cycle 2: 18 (24.0) | p < 0.001 Safec Home, 58.8% Hospital, 68.8% | p = 0.084 | p = 0.039 (male more likely to report safe) |
Falls | 241 (65.8) | 204 (84.6) | 32 (13.3) | 5 (2.1) | p = 0.052 | p = 0.069 | p = 0.001 (male more likely to report safe) |
Medication | 239 (65.3) | 213 (89.1) | 21 (8.8) | 5 (2.1) | p = 0.433 | p = 0.404 | p = 0.400 |
Hygiene | 241 (65.8) | 219 (90.9) | 17 (7.1) | 5 (2.1) | p = 0.779 | p = 0.927 | p = 0.351 |
Staff incident reports
Major theme | Sub-theme |
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Communication failures | • Care home not informed of discharge • Difficulty booking transport • Discharge letter contained incorrect information • Handover not completed properly • Referral to other services not made • Discharged without test results |
Delayed discharge | • Result of communication error during booking of transport • Family cause of a delay • Internal delays to medication • Patient transport service aborted or late |
Documentation | • Missing documentation • Incomplete documentation • Mistake in documentation • Received wrong patient’s documentation (data breach) |
Medication | • Inappropriate medication • Incomplete medication • Incorrect dosage / prescription / dispensation • Missing or lost medication • Patient received someone else’s medication |
Pressure ulcers | • Identified prior to discharge • Identified after discharge |
Devices / equipment | • Device left in situ after discharge • Incorrect equipment given to patient |
Staffing shortages |
No sub-theme
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Patient actions | • Verbal/physical aggression or harassment • Self-discharge against advice • Patient refused discharge |
Using feedback for organisational learning
Participant | Participated during or post- survey distribution | Data collection method | Demographics | ||
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Gender
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Clinical area / Speciality
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Role
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1 | During | Interview | Female | Orthopaedic | Senior Ward sister |
2 | During | Interview | Female | Stroke | Discharge co-ordinator |
3 | During | Interview | Female | Cardiology | Ward sister |
4 | During | Interview | Female | Stroke | Discharge co-ordinator |
5 | During | Interview | Female | Cardiology | Ward administrator |
6 | During | Interview | Female | Orthopaedic | Ward sister |
7 | During | Focus group | Male | Stroke | Ward receptionist |
8 | During | Focus group | Female | Orthopaedic | Apprentice |
9 | During | Focus group | Female | Orthopaedic | Nurse (band 5) |
10 | During | Focus group | Female | Orthopaedic | Deputy Sister |
11 | Post | Interview | Female | Care of Older People | Ward manger |
12 | Post | Interview | Male | Site facilitator | Patient safety lead |
13 | Post | Interview | Male | Site facilitator | Senior Research Nurse |
14 | Post | Interview | Female | Care of Older People | Ward Sister |
15 | Post | Interview | Male | Site facilitator | Senior Research Nurse |
16 | Post | Interview | Female | Ambulance service | Patient relations co-ordinator |
17 | Post | Interview | Female | Care of Older People | Nurse (band 6) |
18 | Post | Interview | Female | Cardiology | Discharge co-ordinator |
19 | Post | Interview | Female | Cardiology | Ward sister |
20 | Post | Interview | Female | Community Care | Occupational Therapist |
21 | Post | Interview | Female | Community Care | Community Matron |
“I think it would be nice to see ‘cos if a patient has had a good experience on the ward … it would be nice to know that it has carried on afterwards. Cos as I say we try to put everything in place for when they get home or where they’re going, so it would be nice to know that that has carried on, actually worked.” (Participant 2)
“Just because I know that something is safe, doesn’t necessarily mean that it feels safe to my patients. If it doesn’t feel safe, then, to a degree, I’ve failed … . Even if something isn’t actually unsafe, the interpretation of it is just as important. It has to feel safe, it has to feel like a safe environment.” (Participant 17)
“It was encouraging to see that actually most people, most of the time - you’re hearing responses that are quite positive, and that’s a good thing.” (Participant 15)
“Some of those things [that could be useful] are ones that I wouldn’t have thought to ask someone how safe do they feel about the possibility of falling. That’s probably not something that I would think to ask a patient who was going, to be honest.” (Participant 11)
“I think the problem is NHS, really isn't always interested in things that go well. Not to be too negative, but people don’t ever focus on the things that go well. People only ever seem to be focused on things that haven’t gone well, and they’re the things that you hear about and read about more.” (Participant 11)
“There are no big surprises there for me, to be quite honest. I would imagine that the delays section is the biggest issue for everybody going home. That’s not a surprise to me. Loads of people, just anecdotally, complain about how long it takes to get the drugs up and all that sort of thing.” (Participant 13)
“Yes, I think [quantitative survey data] adds an important dimension, but probably needs to be not looked at in isolation … What it does is show that these are areas that we should perhaps dig into more. I don’t think it gives you enough information to understand what the real issues are in order to then say, ‘Right, well, we need to look at making these improvements.’” (Participant 12)
Acceptability
Patient acceptability of providing safety experience feedback
Patient acceptability as represented by survey response rates
Age | Gender | |||||||
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Survey respondents
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All discharges
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Survey respondents
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All discharges
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Clinical Area (total number of discharges) |
Eligible
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Weighted mean age, years (std dev)
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Age Range
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Weighted mean age, years (std dev)
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Age Range
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Eligible
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Weighted gender
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All discharges weighted gender
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Cardiology (3318) | 145 | 66.8 (12.4) | 28 to 96 | 66.2 (15.0) | 19 to 100 | 138 | 50% male 50% female | 54% male 46% female |
Care of Older People (2947) | 16 | 77.4 (5.7) | 68 to 93 | 84.6 (6.1) | 41 to 105 | 17 | 31.2% male 68.8% female | 52.7% male 47.3% female |
Orthopaedics (3859) | 108 | 60.1 (15.0) | 19 to 88 | 62.8 (17.5) | 16 to 105 | 115 | 66.1% male 33.9% female | 53.6% male 46.4% female |
Stroke (1260) | 22 | 62.1 (20.6) | 21 to 91 | 74.3 (13.9) | 21 to 103 | 21 | 45% male 55% female | 43.8% male 56.2% female |
Staff acceptability of patients providing safety experience feedback
“I think, yes, obviously the more we know about things like [the patient’s experience of safety], the more we can do to reduce the risks of patients being injured or something happening with patient safety relating to our care, I think yes, it [their feedback] would be valuable”. (Participant 16)
There was also a persistent belief among interviewees that older adults were generally less likely to report any issues or concerns and were more likely to trust the care team without question. One individual stated that some members of the older generation were “inappropriately trusting of the system” (Participant 15) and reluctant to be perceived as causing a “fuss” (Participant 16) or to question the clinicians’ decisions. There was also concern expressed that older adults were less likely to complain due to “the thought of having to take on a bigger organisation” (Participant 16).“Of course that’s the big C word, communication. It’s all about making sure people have got the information in a format they can understand. That we’re not patronising, not making assumptions about what people know and don’t know. You have put up frank explanations for things, and we check out what people have understood.” (Participant 15)
“[Older people] never really want to say anything negative, but I think that’s just because of the age that they are. It’s that generation.” (Participant 11)
Integration
Integration of the survey with existing systems and practices
“I think it’s just trying to prompt each other sometimes... I mean it depends who's on ‘cause everybody's different really, but I mean what I like to do is try and sort of prompt, you know like, ‘Ooh you could’, you know, ‘have given them that as well’ and you kind of get people who'll remind you.” (Participant 5)
“I think it’s a bit unfair to ask the nurses to do anymore, personally, do you know what I mean? But not everybody has a discharge co-ordinator and I think probably in the absence of the discharge co-ordinator there’s probably the receptionist that could do it, but I think nursing staff I just think sometimes they’ve got too much on the plate to ask” (Participant 18)
“I feel they get bombarded sometimes with information and things that they need to do and all they want to do is just get home, and once they’re home, I don’t know, they might not want to complete them, complete any surveys. I mean I’m sure if they thought it was going to help patients in the future then they might think differently about it, but I know just from feedback we’ve had about surveys, they do find it a bit much completing lots of paperwork.” (Participant 6)