What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

We started this work after hearing some Emergency Department (ED)  staff being dismissive of care home staff accompanying residents to the ED. To understand this better we spoke with senior carers in a care home who related some shocking experiences, “people talk condescending to us and to the service users, some service users sit there looking like ‘why are you talking to me like that’” We also spoke to some ED staff about their experiences with care home escorts. It left us thinking what can we do to make this better for all?

Professional boundaries hamper our ability to provide good care, especially between social and health care. We learnt there is a lack of understanding around the skills, knowledge, and roles and responsibilities of the different staff groups. All these differing perspectives contribute to residents at the sharp end not getting the care they need and deserve.

What does your project aim to achieve?

Through exploring the different perspectives of care home staff, residents, and ED teams, we will be able to highlight issues and work together to co-design solutions to help. Additionally, we will seek examples of good practice that can be learnt from, “one thing that is great is the care plans, they are amazing. I had a really good example and I showed everybody in the department because it was that good. Everything was in there, it was amazing.”

We know that residents often have poor experiences in the ED, care home staff can advocate and better support residents, if enabled by the ED culture. The ED staff can also benefit from their help, knowledge, and skills. In this way some of these inequalities of care can be redressed. Making transitions smoother will result in benefits for residents, care home and ED staff.

How will the project be delivered?

We will build on previous learning from speaking to ED staff and colleagues in care homes. Separate focus groups will be held for care home teams and ED staff (being mindful of psychological safety and the power dynamics that exist between staff groups). Thematic Analysis will be used to capture learning and feed this back to both groups simultaneously, with staff who volunteer to work with us. Staff working in the area have the best ideas and our role will be to coax these, capture and refine to develop an approach which will be tested in practice using QI methodology.

We have an ED and care home group ready to take part. Stakeholders will be asked what they want to get from this project and measures will be devised accordingly. In addition we will use measures around changes to team culture and experiences of all groups concerned.

How is your project going to share learning?

One of our project leads is the Chair of Royal College Emergency Medicine’s safer care committee and has clear routes and networks for highlighting both the learning and impacts from the work. We can share learning to care homes via pre-existing networks e.g. the Care Homes Support network that has been in operation since 2020 and is made up of key staff working in roles supporting social care providers. We also have clear links with both YQSR (co-located) and ARC YH, as we have actively engaged in research in this area.