Barriers and Facilitators to Best Practices in Microtransitions in Care in Post-acute and Long-Term Care: A Mixed-Methods Study.

OBJECTIVES

Microtransitions are brief, nonurgent transitions in care, such as room changes, recreational outings, and outpatient medical visits. Microtransitions occur at least as frequently as major transitions (eg, hospitalizations, discharges, etc.) and carry similar risks for adverse clinical outcomes if not properly managed. Post-acute and long-term care (PALTC) staff may be challenged to implement certain best practice recommendations for microtransitions. The objective of this study was to explore barriers and facilitators to successful execution of these recommendations in PALTC.

DESIGN

Mixed-methods study.

SETTING AND

PARTICIPANTS

A total of 39 panelists from the PALTmed modified Delphi study on best practices for microtransitions in care.

METHODS

Through 3 surveys and a focus group, panelists described implementation of best practice recommendations for microtransitions within PALTC settings. Panelist feedback was thematically analyzed to identify barriers and facilitators of successful microtransitions at patient, staff, and systems levels. Panelists' views on regulations related to microtransitions were explored using content analysis and a four-question quantitative survey.

RESULTS

Patient-level themes included safety and resident rights. Panelists emphasized that many microtransition-related standards of care are inconsistently implemented. Staff-level themes included burden, importance of communication, and training. Systems-level themes included staffing, regulation, material resource, and liability concerns, as well as "already standard of care." Most panelists agreed that microtransition needs vary by facility characteristics and patient-specific needs and would not benefit from federal (71.4%) or state regulations (74.3%). There was consensus (91.4%) that regularly updated best-practice recommendations are advisable.

CONCLUSIONS AND IMPLICATIONS: The care coordination required for successful execution of a microtransition is complex. Using best practice recommendations during microtransitions for PALTC residents may mitigate adverse event risk. However, ethical, liability, and regulatory barriers may limit effective implementation. Regulations around microtransitions may do more harm than good when it comes to improving patient care. Future research on interventions to facilitate adoption of best practices are needed.