PACT: a feasibility trial of the PACT intervention
Research type
Research Study
Full title
Partners at Care Transitions (PACT): Improving patient experience and safety at transitions of care - Assessing the feasibility of using the PACT intervention to improve safety and experience of the transition process in a randomised controlled trial setting.
IRAS ID
253343
Contact name
Rebecca Lawton
Contact email
Sponsor organisation
Bradford Teaching Hospitals NHS Foundation Trust
ISRCTN Number
ISRCTN51154948
Duration of Study in the UK
0 years, 9 months, 29 days
Research summary
Research Summary:
Transitions of care from hospital to home can be risky, especially for older people with multiple health conditions. Previous research has suggested that the post-discharge period may be improved by better involving patients and families in their care. This study forms part of a programme of research which aims to develop an intervention to improve the safety and experience of transitions from hospital to home for people aged 75 years and over.In this study a feasibility cluster Randomised Control Trial will be conducted to explore the feasibility of using the intervention and trial methodology. The research will take place within 10 wards (three acute NHS Trusts) over a seven month period. In total, six wards will deliver the intervention and four wards will deliver care as usual.
A minimum of 200 patients will provide informed consent to complete a questionnaire at three time points post-discharge and for routine data about their care to be collected from medical records. On intervention wards, a sub-set of 20-24 of these patients will also consent to a qualitative evaluation of the intervention (interviews and observation). Up to 28 staff be interviewed to gain their views on the intervention.
In addition, this study seeks to identify an efficient and accurate way of accessing readmission data for patients who are discharged to their own homes rather than other usual places of residence (e.g. nursing homes). Confidentiality Advisory Group advice will be gained to access the medical records of 100 patients without their consent to assess their actual discharge destinations (own home vs nursing/care home or other).
The findings from this study will be used to optimise the intervention, implementation package, and the trial methodology, and ultimately inform the decision about whether to proceed to a full trial.
Summary of Results:
: In total, 10 wards were randomised (6 intervention, 4 control). 721 patients were successfully screened, and 161 consented to participate in the trial (141 intervention, 20 control).20.8% (n=35) patients withdrew from the trial post discharge. Primary outcome data (emergency readmissions) were gathered for 91.9% of participants with 75.2% and 59.0% of patints providing self-reported secondary outcome data at 5 and 30 day post discharge follow ups respectively. The completion of items within questionnaires was generally high. Post-discharge follow up was terminated early due to the COVID-19 pandemic affecting response rates at the 90 day follow up (16.8%).
Data from 88 non-consenting patients identified an error rate of 15% when using routine data as the primary outcome. No unexpected serious adverse events were identified.
Staff and patients viewed YCNY favourably, but implementation was hampered by ward pressures and organisational contexts. There was a need to sustain engagement, provide clarity on roles and responsibilities, and account for fluctuations in patients’ health, capacity, and preferences.If implementation challenges can be overcome, this novel intervention represents a step towards involving patients as partners in their care to improve the safety and experience of older people as they transition from hospital to home.
REC name
Wales REC 7
REC reference
19/WA/0162
Date of REC Opinion
27 Jun 2019
REC opinion
Further Information Favourable Opinion