Hospital admissions can have a negative impact on the physical and emotional health of nursing home residents. Although evidence-based interventions have been developed to reduce hospitalisations, the evidence regarding their effectiveness is inconclusive and challenges have been reported in implementing these interventions within the nursing home context. Hence, this study aimed to implement and evaluate a complex intervention to reduce avoidable transitions between nursing home and hospital (RATHER-NH).
A capacity of at least 60 beds
The nursing home manager, head nurses and the coordinating & advisory physician agree that the implementation of the RATHER-NH intervention is a priority for their facility.
The nursing home manager agrees to provide time for the nursing home staff members to participate in activities related to the implementation of RATHER-NH such as attending information sessions, training workshops, and feedback moments.
The nursing home manager is willing to allocate time to at least two nursing home staff members (each approximately 0.1 FTE for the study duration) to act as local project champions and to at least four other staff members (type of staff to be decided with the nursing home manager) to form a local action team to support the implementation and evaluation of RATHER-NH.
Already participated in another project designed to reduce potentially avoidable hospitalisations.
Already taking part in another major quality improvement initiative or study.
A large reorganisation or change in staff is taking place or is planned during the study period.
Parallel
RATHER-NH Toolkit
Other intervention1. Quality Improvement Tool for Review of Acute Care Transfers 2. Stop and Watch Early Warning Tool 3. SBAR Communication Form 4. Engaging Your Hospitals - Tip Sheets 5. Care paths 6. Advance care planning document 7. 'In the moment' communication tool
Outcomes on healthcare use per 100 person-months
Rate of hospitalisations per 100 person-months, rate of out-of-hours GP contacts per 100 person-months, rate of emergency department visits (without hospitalisation) per 100 person-months.
Outcomes on healthcare use per hospitalisation
Length of hospital stay, cause of hospitalisation, hospitalisation in the last month of life (in case of death) and place of death
Self-Efficacy and Outcome Expectancy Scales for Job-Related applications questionnaire to measure the job-related self-efficacy of nursing home staff members on a 7-point Likert Scale
Staff self-efficacy will be measured through the validated 31-item Self-Efficacy and Outcome Expectancy Scales for Job-Related applications questionnaire, which involves four sub-scales (i.e. personal efficacy beliefs scale, personal outcome expectancy scale, collective efficacy beliefs scale, collective outcome expectancy scale) on a 7-point Likert Scale.
Process outcome: Notes of facilitated group discussions on implementation strategies using a framework analysis
The researcher will take notes during the facilitated group discussions in which the implementation strategies are adapted and tailored according to the specific needs and context of the nursing homes. A framework analysis will be used to analyse the data.
Process outcome: Case studies to examine the perspectives on the decision-making process prior to an unplanned hospitalisation using a cross-case analysis
Multiple case studies will be conducted using semi-structured interviews to examine the decision-making process prior to an unplanned hospitalisation. In every participating nursing home, 2 case studies will be conducted. For every case, semi-structured interviews will be conducted with: 1. the nurse most involved in the hospitalisation decision 2. the resident's GP or other physician involved in the hospitalisation decision 3. the resident and/or a family member, where feasible. A cross-case analysis will be used to analyse the data.
Process outcome: Minutes of action team meetings on the implementation process using a content analysis
The action teams will be asked, including the local project champions, to take minutes of their meetings to discuss the implementation process. Afterwards, the data of all the participating nursing homes will be compared in order to evaluate whether are not there were major differences between facilities regarding the topics that were discussed or challenges they experienced. A content analysis will be used to analyse the data.
Process outcome: Structured diaries on the use of the intervention tools, pre-implementation and implementation strategies using a content anaysis
To evaluate how the intervention tools were used, and how the pre-implementation and implementation strategies were delivered, the local project champions, trainer and researcher will be asked to keep diaries. Afterwards, the data of all the participating nursing homes will be compared in order to evaluate whether are not there were major differences between facilities regarding the use of the intervention tools and the used pre-implementation and implementation strategies. A content analysis will be used to analyse the data.
Click on the lead sponsor to view all of their trials.
This trial is not recruiting at the moment. You can still explore other options:
