PTOTQualitativeJournal of advanced nursing2025

Entangled in complexity: An ethnographic study of organizational adaptability and safe care transitions for patients with complex care needs.

Ann-Therese Hedqvist, Gesa Praetorius, Mirjam Ekstedt and 1 others

PMID 38641975

WHAT IT FOUND

Rushed or imprecise hospital discharge left patients with complex needs at home without records, plans, equipment, or family information.

Readmission, unsafe carrying, and extra staff workload followed.

Key findings

01Delay in care planning and imprecise preparation during John's discharge disrupted communication and led to ambulance return to hospital.

02Elsa was carried upstairs after discharge because a staircase and transport arrangements had not been considered.

03Late Friday and weekend discharges without complete information placed extra strain on already limited home care resources.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

The participants were healthcare and social care professionals, not patients or families, so patient and family experiences were not directly studied. The study was set in one region of Sweden's decentralized healthcare system, so the findings may not transfer to other regions or countries. The two patient stories are composites made from multiple observations and interviews, not complete accounts of individual patients. The safe care transition pathway was suggested, not tested for patient outcomes.

Declared interests

The overarching project was funded by the Kamprad Family Foundation for Entrepreneurship, Research and Charity; the funding body had no input on design, conduct or reporting of results. The authors declared no conflicts of interest.

The easy way to misread this

Do not treat the safe care transition pathway as tested evidence that it prevents readmissions or improves safety. It was proposed from qualitative observations and composite patient scenarios, not trialled in patients.

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