A qualitative formative evaluation of a patient facing intervention to improve care transitions for older people moving from hospital to home

Background The Partners at Care Transitions (PACTs) intervention was developed to support older people's involvement in hospital to improve outcomes at home. A booklet, question card, record sheet, induction leaflet, and patient‐friendly discharge letter support patients to be more involved in their health and wellbeing, medications, activities of daily living and post‐discharge care. We aimed to assess intervention acceptability, identify implementation tools, and further develop the intervention. Methods This was a qualitative formative evaluation involving three wards from one hospital. We recruited 25 patients aged 75 years and older. Ward staff supported intervention delivery. Data were collected in wards and patients' homes, through semi‐structured interviews, observation, and documentary analysis. Data were analysed inductively and iteratively with findings sorted according to the research aims. Results Patients and staff felt there was a need for, and understood the purpose of, the PACT intervention. Most patients read the booklet but other components were variably used. Implementation challenges included time, awareness, and balancing intervention benefits against risks. Changes to the intervention and implementation included clarifying the booklet's messages, simplifying the discharge letter to reduce staff burden, and using prompts and handouts to promote awareness. Conclusion Patients and staff felt there was a need for, and understood the purpose of, the PACT intervention. Most patients read the booklet but other components were variably used. Implementation challenges included time, awareness, and balancing intervention benefits against risks. Changes to the intervention and implementation included clarifying the booklet's messages, simplifying the discharge letter to reduce staff burden, and using prompts and handouts to promote awareness

Modelling wave-current interactions off the east coast of Scotland

Densely populated coastal areas of the North Sea are particularly vulnerable to severe wave conditions, which overtop or damage sea-defences leading to dangerous flooding. Around the shallow southern North Sea, where the coastal margin is low-lying and population density is high, oceanographic modelling has helped to develop forecasting systems to predict flood risk. However coastal areas of the deeper northern North Sea are also subject to regular storm damage but there has been little or no effort to develop coastal wave models for these waters. Here we present a high spatial resolution model of northeast Scottish coastal waters, simulating waves and the effect of tidal currents on wave propagation, driven by global ocean tides, far-field wave conditions, and local air pressure and wind stress. We show that the wave- current interactions and wave-wave interactions are particularly important for simulating the wave conditions close to the coast at various locations. The model can simulate the extreme conditions experienced when high (spring) tides are combined with sea-level surges and large Atlantic swell. Such a combination of extremes represents a high risk for damaging conditions along the Scottish coast

Future policy implications of tidal energy array interactions

Tidal stream energy technology has progressed to a point where commercial exploitation of this sustainable resource is practical, but tidal physics dictates interactions between tidal farms that raise political, legal and managerial challenges that are yet to be met. Fully optimising the design of a turbine array requires its developer to know about other farms that will be built nearby in the future. Consequently future developments, even those in adjacent channels, have the potential to impact on project efficiency. Here we review the relevant physics, consider the implications for marine policy, and discuss potential solutions. Possible management paths range from minimal regulation to prioritise a free market, to strongly interventionist approaches that prioritise efficient resource use. An attractive exemplar of the latter is unitization, an approach to resource allocation widely used in the oil and gas industry. We argue that an interventionist approach is necessary if the greatest possible energy yield is to be produced for a given level of environmental impact

Modelling sea level surges in the Firth of Clyde, a fjordic embayment in south-west Scotland

Storm surges are an abnormal enhancement of the water level in response to weather perturbations. They have the capacity to cause damaging flooding of coastal regions, expecially when they coincide with astronomical high spring tides. Some areas of the UK have suffered particularly damaging surge events, and the Firth of Clyde is a region with high risk due to its location and morphology. Here we use a three-dimensional high spatial resolution hydrodynamic model to simulate the local bathymetric and morphological enhancement of surge in the Clyde, and disaggregate the effects of far-field atmospheric pressure distribution and local scale wind forcing of surges. A climatological analysis, based on 30 years of data from Millport tide gauges is also discussed. The results suggest that floods are not only caused by extreme surge events, but also by the coupling of spring high tides with moderate surges. Water level is also enhanced by a funnelling effect due to the bathymetry and the morphology of fjordic sealochs and the River Clyde estuary. In a world of rising sea level, studying the propagation and the climatology of surges and high water events is fundamental. In addition, high-resolution hydrodynamic models are essential to forecast extreme events and prevents the loss of lives, or to plan coastal defences solutions

Improving patient experience and safety at transitions of care through the Your Care Needs You (YCNY) intervention: a study protocol for a cluster randomised controlled feasibility trial

Background: Patients, particularly older people, often experience safety issues when transitioning from hospital to home. Although the evidence is currently equivocal as to how we can improve this transition of care, interventions that support patient involvement may be more effective. The ‘Your Care Needs You’ (YCNY) intervention supports patients to ‘know more’ and ‘do more’ whilst in hospital in order that they better understand their health condition and medications, maintain their daily activities, and can seek help at home if required. The intervention aims to reduce emergency hospital readmissions and improve safety and experience during the transition to home. Methods: As part of the Partners At Care Transitions (PACT) programme of research, a multi-centred cluster randomised controlled trial (cRCT) will be conducted to explore the feasibility of the YCNY intervention and trial methodology. Data will be used to refine the intervention and develop a protocol for a definitive cRCT. Ten acute hospital wards (the clusters) from varying medical specialties including older peoples’ medicine, trauma and orthopaedics, cardiology, intermediate care, and stroke will be randomised to deliver YCNY or usual care on a 3:2 basis. Up to 200 patients aged 75 years and over and discharged to their own homes will be recruited to the study. Patients will complete follow-up questionnaires at 5-, 30-, and 90-days post-discharge and readmission data up to 90-days post-discharge will be extracted from their medical records. Study outcomes will include measures of feasibility (e.g. screening, recruitment, and retention data) and processes required to collect routine data at a patient and ward level. In addition, interviews and observations involving up to 24 patients/carers and 28 staff will be conducted to qualitatively assess the acceptability, usefulness, and feasibility of the intervention and implementation package to patients and staff. A separate sub-study will be conducted to explore how accurately primary outcome data (30-day emergency hospital readmissions) can be gathered for the definitive cRCT. Discussion: This study will establish the feasibility of the YCNY intervention which aims to improve safety and experience during transitions of care. It will identify key methodological and implementation issues that need to be addressed prior to assessing the effectiveness of the YCNY intervention in a definitive cluster randomised controlled trial

Multi-scale ocean response to a large tidal stream turbine array

The tidal stream energy sector is now at the stage of deploying the world's first pre-commercial arrays of multiple turbines. It is time to study the environmental effects of much larger full-size arrays, to scale and site them appropriately. A theoretical array of tidal stream turbines was designed for the Pentland Firth (UK), a strait between Scotland and the Orkney Islands, which has very fast tidal currents. The practical power resource of a large array spanning the Pentland Firth was estimated to be 1.64 GW on average. The ocean response to this amount of energy extraction was simulated by an unstructured grid three-dimensional FVCOM (Finite Volume Community Ocean Model) and analysed on both short-term and seasonal timescales. Tidal elevation mainly increases upstream of the tidal array, while a decrease is observed downstream, along the UK East Coast. Tidal and residual flows are also affected: they can slow down due to the turbines action or speed up due to flow diversion and blockage processes, on both a local and regional scale. The strongest signal in tidal velocities is an overall reduction, which can in turn decrease the energy of tidal mixing and perturb the seasonal stratification on the NW European Shelf

The bottom mixed layer depth as an indicator of subsurface Chlorophyll a distribution

Acknowledgements The authors thank Marine Scotland Science for providing the CTD data. Financial support This research has been supported by a MarCRF (Marine Collaboration Research Forum, jointly sponsored by the University of Aberdeen and Marine Scotland Science) PhD grant awarded to Arianna Zampollo.Peer reviewedPublisher PD

The Cooperative Participatory Evaluation of Renewable Technologies on Ecosystem Services (CORPORATES)

Publisher PD

A qualitative formative evaluation of a patient facing intervention to improve care transitions for older people moving from hospital to home

Background The Partners at Care Transitions (PACTs) intervention was developed to support older people's involvement in hospital to improve outcomes at home. A booklet, question card, record sheet, induction leaflet, and patient-friendly discharge letter support patients to be more involved in their health and wellbeing, medications, activities of daily living and post-discharge care. We aimed to assess intervention acceptability, identify implementation tools, and further develop the intervention. Methods This was a qualitative formative evaluation involving three wards from one hospital. We recruited 25 patients aged 75 years and older. Ward staff supported intervention delivery. Data were collected in wards and patients' homes, through semi-structured interviews, observation, and documentary analysis. Data were analysed inductively and iteratively with findings sorted according to the research aims. Results Patients and staff felt there was a need for, and understood the purpose of, the PACT intervention. Most patients read the booklet but other components were variably used. Implementation challenges included time, awareness, and balancing intervention benefits against risks. Changes to the intervention and implementation included clarifying the booklet's messages, simplifying the discharge letter to reduce staff burden, and using prompts and handouts to promote awareness. Conclusion The PACT intervention offers a promising new way to improve care transitions for older people by supporting patient involvement in their care. After further development of the intervention and implementation package, it will undergo further testing. Patient or Public Contribution This study regularly consulted a panel representing the local patient community, who supported the development of this intervention and its implementation

Partners at Care Transitions: exploring healthcare professionals’ perspectives of excellence at care transitions for older people

Introduction Hospital admissions are shorter than they were 10 years ago. Notwithstanding the benefits of this, patients often leave hospital requiring ongoing care. The transition period can therefore be risky, particularly for older people with complex health and social care needs. Previous research has predominantly focused on the errors and harms that occur during transitions of care. In contrast, this study adopts an asset-based approach to learn from factors that facilitate safe outcomes. It seeks to explore how staff within high-performing (‘positively deviant’) teams successfully support transitions from hospital to home for older people. Methods and analysis Six high-performing general practices and six hospital specialties that demonstrate exceptionally low or reducing 30-day emergency hospital readmission rates will be invited to participate in the study. Healthcare staff from these clinical teams will be recruited to take part in focus groups, individual interviews and/or observations of staff meetings. Data collection will explore the ways in which teams successfully deliver exceptionally safe transitional care and how they overcome the challenges faced in their everyday clinical work. Data will be thematically analysed using a pen portrait approach to identify the manifest (explicit) and latent (abstract) factors that facilitate success. Ethics and dissemination Ethical approval was obtained from the University of Leeds. The study will help develop our understanding of how multidisciplinary staff within different healthcare settings successfully support care transitions for older people. Findings will be disseminated to academic and clinical audiences through peer-reviewed articles, conferences and workshops. Findings will also inform the development of an intervention to improve the safety and experience of older people during transitions from hospital to home