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To evaluate the implementation of the Transitional Care Model (TCM), an evidence-based, advanced practice registered nurse-led multi-component intervention, as part of a randomised controlled trial during the first year of the COVID-19 pandemic.
Parallel convergent mixed-methods approach.
Data for this study were collected between June 2020 and February 2021. Data from 78 patients who received the intervention and 68 recorded meetings with system leaders and clinical teams were analysed using descriptive statistics, directed content analysis, and joint display.
Fidelity to delivery of elements of the TCM components was variable, with the Hospital-to-Home visit elements having the widest range (14.3%–100%) and Maintaining Relationships elements having the highest range (97.3%–98.6%). There were 27 identified challenges and 15 strategies for implementing the TCM with fidelity during the pandemic.
The COVID-19 pandemic impacted all aspects of the delivery of the TCM across all sites. This historical event highlighted the need for services and support for patients and caregivers transitioning from the hospital to home.
Evidence-based solutions are needed to enhance healthcare delivery and patient outcomes. Findings will guide nurses in implementing proven transitional care interventions.
Findings will inform the implementation and scaling of transitional care and other evidence-based interventions across diverse healthcare settings.
GRAMMS reporting guidelines.
No patient or public contribution.
ClinicalTrials.gov identifier: NCT04212962. https://www.clinicaltrials.gov/study/NCT04212962?titles=NCT04212962&rank=1
To evaluate staffing conditions, patient outcomes, quality of care, patient safety and nurse job outcomes in British Columbia (BC), Canada hospitals.
Cross-sectional study of 58 hospitals in BC with surveys of nurses and independent measures of patient outcomes.
58 hospitals in BC.
6685 hospital-based nurses working in a direct patient care role.
Hospital-wide and unit-specific patient-to-nurse staffing ratios derived from registered nurse reports of how many patients and how many nurses were on their unit during their last shift worked.
Objective patient outcome measures included the Hospital Standardized Mortality Ratio (HSMR) and 30-day Readmission Rate, from 2022 to 2023 Canadian Institute for Health Information data. Nurses4All@BC provided data from 2024 using validated items on multiple measures (eg, nurse burnout, missed health breaks, intentions to leave, quality and safety measures such as culture of patient safety, quality of nursing care, missed nursing care).
Burnout (59.4%), missed health breaks (41.7%), job dissatisfaction (36.0%), intentions to leave (19.3%) and patient outcomes (HSMR mean 95.4, median 96.0, range 26–180; readmission rate mean 10.0%, median 9.5%, range 7.9%–13.8%) were high and varied across hospitals. 68.3% of nurses reported there were not enough staff, and 77.3% reported their workloads were unsafe for patients. 60.6% of nurses gave their hospital an unfavourable patient safety rating. More patients per nurse were associated with poorer hospital mortality and readmission rates, poorer job outcomes for nurses, more adverse events for patients, less favourable ratings of quality of care and patient safety, more missed nursing care and poorer ratings of staffing adequacy and management.
Given the variability in staffing, quality and patient outcomes across BC hospitals, the implementation of a minimum nurse-to-patient ratio policy has the potential to improve patient care safety and retention of nurses.
Background
Readmissions following hospitalization for common surgical procedures are prevalent among older adults and are disproportionally experienced by Hispanic patients. One potential explanation for these disparities is that Hispanic patients may receive care in hospitals with lower-quality nursing care.
Objectives
The objective of this study was to evaluate the relationship between the hospital-level work environment of nurses and hospital readmissions among older Hispanic patients.
Methods
Using linked data sources from 2014 to 2016, we conducted a cross-sectional analysis of 522 hospitals and 732,035 general, orthopedic, and vascular surgical patients (80,978 Hispanic patients and 651,057 non-Hispanic White patients) in four states. Multivariable logistic regression models were employed to determine the relationship between the work environment and older Hispanic patient readmissions at multiple time periods (7, 30, and 90 days).
Results
In final adjusted models that included an interaction between work environment and ethnicity, an increase in the quality of the work environment resulted in a decrease in the odds of readmission that was greater for older Hispanic surgical patients at all time periods. Specifically, an increase in three of the five work environment subscales (Nurse Participation in Hospital Affairs, Nursing Foundations for Quality of Care, and Staffing and Resource Adequacy) was associated with a reduction in the odds of readmission that was greater for Hispanic patients than their non-Hispanic White counterparts.
Discussion
System-level investments in the work environment may reduce Hispanic patient readmission disparities. This study’s findings may be used to inform the development of targeted interventions to prevent hospital readmissions for Hispanic patients. 
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