Bringing a patient perspective to understanding interventions that aim to reduce length of stay in hospital: a mixed methods synthesis
2University of Plymouth, United Kingdom
3Royal Devon University Healthcare NHS Foundation Trust, United Kingdom
4University College London, United Kingdom
Background: Hospital-led, multicomponent organisational strategies that aim to enhance recovery after surgery are associated with improved clinical outcomes. Less is known about aspects of interventions or their delivery which can lead to better patient outcomes.
Objectives: To establish which aspects of multi-component interventions to enhance recovery after surgery and reduce length of stay in hospital are associated with better outcomes for older adults admitted to hospital for planned procedures.
Methods: Working in partnership with expert clinical advisors, older adults and carers with experience of hospital stays for planned procedures, we undertook a mixed methods synthesis. We first conducted a quantitative review (of comparative studies reporting length of stay and patient reported-outcome or experience measures) and a qualitative review (of the experiences of patients, carers and staff of interventions received/delivered). We then developed a logic model based on patient perspectives represented in the qualitative review and discussions with clinical stakeholders and our patient and carer groups. The logic model was used as the focus of a Qualitative Comparative Analysis (QCA) to integrate the findings of the quantitative and qualitative reviews.
Results: A complex balance of intervention components trigger successful interventions: these represent approaches that allow patients to understand their treatment (e.g. through providing information in different formats), to ask questions about their treatment (through spending additional time with patients), and to build supportive relationships (through having a consistent point of care) and strategies that facilitate patients to monitor their own progress (goal-focussed) and challenge themselves in recovery (through early mobilisation). Limitations: We did not consider the efficacy of different clinical procedures (largely unseen or unknown to most patients) that may also influence outcomes; evidence for some of the components came from weak studies; most studies screened patients with more complex needs out of the intervention; poor or absent reporting meant that we had to discard or combine some elements identified within the logic model.
Conclusions: Grounding our synthesis in the experiences of patients, carers and clinicians, enabled us to generate meaningful implications for policy and practice that go beyond measuring success in terms of reducing time spent in hospital.