Transitioning from hospital to home after a major lower extremity amputation: Interview study on patients' and relatives' perspectives.

INTRODUCTION: Patients often feel unprepared and concerned about their new life after a major lower extremity amputation (LEA). Therefore, we implemented an integrated care program, Safe Journey, to optimize the quality and continuity of care for patients with LEA due to vascular disease when transitioning from hospital to home. This study aims to illuminate and explore the experiences of patients with LEA and their relatives with the transition from hospital to home after implementing Safe Journey. MATERIAL AND METHODS: This qualitative, exploratory study individually interviewed six patients with a major LEA and four relatives and jointly interviewed eight patients with their relatives. RESULTS: The participants' experiences transitioning from hospital to home were centered around two major themes: (1) Going home: mixed emotions and confusion, and (2) bridging the gap. The main themes encompassed six subthemes: (1) simultaneously expectant and worried, (2) a lack of knowledge creating uncertainty, (3) an unexpressed but pending need for psychosocial support, (4) reassurance but safety comes at a price, (5) navigating the system, and (6) lack of involvement. CONCLUSION: Transitioning from hospital to home after a major LEA creates mixed emotions. Knowledge, feeling involved, and being prepared and cared for were highlighted as important during the transition. The Safe Journey program made patients and relatives feel physically reassured and safe, but all the home visits strained the families. The program's benefits are consistent with existing knowledge on patients with complex needs benefitting from integrated care models. However, a more individualized and person-centered approach is needed.

From hospital to home following a lower limb amputation: A focus group study of healthcare professionals' views and experiences with transitioning.

INTRODUCTION: Patients undergoing major lower limb amputation often have multiple comorbidities, requiring care from numerous healthcare professionals (HCPs). Furthermore, they may experience physical, medical and practical challenges post-amputation. Patients with complex needs are particularly vulnerable during care transitions and may benefit from integrated care models. AIM: This study aimed to explore HCPs' views and experiences regarding the transition process after implementing an integrated care model for patients with lower limb amputation. METHODS: We conducted two focus groups with 13 HCPs from a Danish hospital and three surrounding districts; all working in the Safe Journey programme. The interviews were analysed using thematic analysis. RESULTS: Three themes were created: 1) becoming a team across sectors, 2) continuity of care as a driver for patient safety and 3) challenges in achieving safe transitions. The Safe Journey programme facilitated the construction of an interdisciplinary team, cross-sectoral communication and professional relations, increasing HCPs' sense of improved patient safety and care continuity. However, HCPs experienced an increased workload, including coordination and at-home patient visits. CONCLUSIONS: HCPs found the Safe Journey programme to be valuable for patients undergoing major lower limb amputation and promotive of cross-sectoral professional relations, communication, continuity and patient safety. However, the programme was time- and resource-consuming compared to conventional models.

Standardized, Coordinated Care in Nursing Homes Lowers Rehospitalization After Hip Fracture.

OBJECTIVES: To assess the effect of enhanced standardized interdisciplinary cooperation between the orthogeriatric ward, municipality, and nursing home facility (NHF) on readmission rates in patients with hip fracture. DESIGN: Quasi-experimental design with a nonequivalent control group. SETTING AND PARTICIPANTS: From January 2018 to July 2020, patients with hip fracture who were admitted to the department of orthopedic surgery and traumatology at Lillebaelt Hospital, and later discharged to NHF were included. INTERVENTION: The intervention consisted of a safety program to the NHF for the first 14 days postdischarge and included assessment of vital signs, weight, pain, signs of constipation, hours of mobilization, and daily intake of fluids and high-protein beverages. Acute team nurses undertook visits (planned and unplanned) and could take blood samples and administer intravenous fluids or antibiotics at the NHF. Control participants received usual care. METHODS: The intervention was performed in 2 municipalities with an acute team; the remaining 3 municipalities comprised the control group. The primary outcome was 30-day readmission, and secondary outcomes were mortality, mobility, and quality of life. RESULTS: There were 100 patients in the intervention group and 152 in the control group. The median age was 86 years, 68% were female, and more than 60% had a low mental score; there were no statistical differences between groups in baseline variables. The 30-day readmission rate was 14% in the intervention group and 30% in the control group (P = .004). The 30-day mortality rate was 6% in the intervention group and 13% in the control group (P = .07). There was no statistically significant difference in mobility between the 2 groups but there was a higher health-related quality of life score in the intervention group (P = .045). CONCLUSIONS AND IMPLICATIONS: Enhanced standardized interdisciplinary cooperation between hospital, NHF teams, and visiting acute team nurses can lower readmissions and potentially mortality.