Best Practices Recommendations for Microtransitions in Care-An Emerging Classification of Care Transitions: A Consensus Statement.

Abstract

Objectives: Microtransitions-defined as brief, nonurgent transitions in care-occur in post-acute and long-term care (PALTC) settings (eg, room changes, nonmedical outings, and medical outings). They occur at least as frequently as major transitions (eg, hospitalizations, discharges) and carry similar risks for adverse clinical outcomes if not properly managed. Limited evidence exists to guide safe microtransition coordination. This study aimed to establish best practice recommendations for staff facilitating microtransitions and evaluate the level of feasibility and clinical benefit of these recommendations in PALTC.

Design: Modified Delphi study.

Setting and participants: A total of 39 expert panelists.

Methods: Initial statements were developed based on a focus group and literature review. Consensus was defined as ≥80% agreement. Over 3 rounds, statements on safely facilitating room changes, recreational trips, and nonurgent (eg, outpatient) medical appointments were evaluated by panelists, then amended based on qualitative survey and focus group feedback until consensus was reached that statements were feasible and clinically beneficial. Five principles of important considerations for successful microtransitions were developed, and recommendations were categorized according to these principles: (1) communication; (2) adverse event monitoring, preparation, and prevention; (3) purpose and destination of transition; (4) equipment and environmental safety; and (5) skill level of the escort.

Results: Fifty-one of the 70 finalized (72.9%) statements reached consensus for feasibility and/or clinical benefit for at least 1 type of microtransition. Of these, 41 of 51 (80.4%) reached consensus for feasibility, 49 of 51 (96.1%) reached consensus for clinical benefit, 39 of 51 (76.5%) statements reached consensus for both feasibility and clinical benefit, and 19 of 70 (27.1%) statements did not reach consensus or were rejected.

Conclusions and implications: This is the first study to develop recommendations guiding PALTC staff in facilitating microtransitions. Implementing these recommendations may mitigate adverse event risk, such as falls and emergency departments transfers. Recommendations can guide situation-specific, patient-centered processes in coordinating safe microtransitions.