Partners at Care Transitions (PACT)

Improving patient flow is a laudable way to manage the chronic shortage of beds in hospitals.  It does however constrain hospital staff into a system that focuses on getting people medically fit for discharge and out.  For older people in particular, the focus on discharge, rather than transition to home, has problematic consequences.  As part of PACT we have extensive interview and observational data on the experiences of both older people transitioning from hospital to home and professionals delivering care and support. 

We now understand that when people come into hospital they hand themselves over to experts.  For many people this means handing over responsibility for themselves and becoming passive in their care.  This is important because a passive patient may not ask questions (for many reasons), seem disinterested or look like they understand everything that is going on around them.  

The problem is that many aspects of care are invisible, happening away from the bedside.  This means that planning discharge is mostly hidden and the actual discharge can appear sudden to the patient.  Patients may, during their hospital stay, loose independence and become less mobile.  When patients are given back responsibility for themselves, at the point of discharge, the experience can be daunting and very challenging.  Still under the weather and with little knowledge about their medicines and what life will be like after discharge, many struggle with how to access timely care and support.  The result is that many patients find that it is difficult to cope and sometimes end up being readmitted to hospital.

We aim to use the rich information we have gathered to develop an intervention that will support older patients and their caregivers to be more involved in their care and to be more resilient when they leave hospital.


For more information about PACT contact jenni.murray@bthft.nhs.uk  or r.j.lawton@leeds.ac.uk or  follow us on twitter @PACT_YQSR