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The COVID-19 pandemic has triggered substantial changes to the healthcare context, including the rapid adoption of digital health to facilitate hospital-to-home transitions. This study aimed to: i) explore the experiences of hospital and community providers with delivering transitional care during the COVID-19 pandemic; ii) understand how rapid digitalization in healthcare has helped or hindered hospital-to-home transitions during the COVID-19 pandemic; and, iii) explore expectations of which elements of technology use may be sustained post-pandemic. Using a pragmatic qualitative descriptive approach, remote interviews with healthcare providers involved in hospital-to-home transitions in Ontario, Canada, were conducted. Interviews were analyzed using a team-based rapid qualitative analysis approach to generate timely results. Visual summary maps displaying key concepts/ideas were created for each interview and revised based on input from multiple team members. Maps that displayed similar concepts were then combined to create a final map, forming the themes and subthemes. Sixteen healthcare providers participated, of which 11 worked in a hospital, and five worked in a community setting. COVID-19 was reported to have profoundly impacted healthcare providers, patients, and their caregivers and influenced the communication processes. There were several noted opportunities for technology to support transitions.

ObjectivesClinicians are facing increasing demands on their time, exacerbated by fiscal constraints and increasing patient complexity. Volunteers are an essential part of the many healthcare systems, and are one resource to support improved patient experience and a mechanism through which to address unmet needs. Hospitals rely on volunteers for a variety of tasks and services, but there are varying perceptions about volunteers’ place within the healthcare team. This study aimed to understand the role of volunteers in stroke rehabilitation, as well as the barriers to volunteer engagement.DesignA qualitative case study was conducted to understand the engagement of volunteers in stroke rehabilitation services within a complex rehabilitation and continuing care hospital in Ontario, Canada.Participants28 clinicians, 10 hospital administrators and 22 volunteers participated in concurrent focus groups and interviews. Organisational documents pertaining to volunteer management were retrieved and analysed.ResultsWhile there was support for volunteer engagement, with a wide range of potential activities for volunteers, several barriers to volunteer engagement were identified. These barriers relate to paid workforce/unionisation, patient safety and confidentiality, volunteer attendance and lack of collaboration between clinical and volunteer resource departments.ConclusionsAn interprofessional approach, specifically emphasising and addressing issues related to key role clarity, may mediate these barriers. Clarity regarding the role of volunteers in hospital settings could support workforce planning and administration.

The WHO defined health workers as “all people engaged in actions whose primary intent is to enhance health” (1) and includes volunteers in this definition. The inclusion of volunteers suggests that they are not to be considered as a replacement workforce for busy health care providers, but recognized as a distinct member of the health care workforce. As the literature focused on integrated care begins to grow, so too does the attention given to the role of non-profits. Effective integrated care rests on the integration of sectors and organizations to meet the health needs of a population. As agents of the social prescribing movement whereby individuals are connected to non-medical sources of support in their community, non-profits have already started to demonstrate their ability to positively affect the mental, physical and social well-being of individuals (2, 3).  Their work has also contributed to individual and community empowerment, and has encouraged individuals to become more proactive in decisions around their health (4). What remains unclear is the type, nature and extent of the relationship between non-profits/non-profit sector and the state-funded sector in the provision of health and social care, and if and how cultures, values and norms are shared across these sectors and the organizations within them. Aims & Objectives: - Official launch of the SIG with in-person discussion and community-building interactions - Establish priority areas, topics of concern and activities to be addressed by the SIG Target audience: The workshop is designed for health practitioners, educators, managers, researchers, community organizations, health and social care volunteers, and policy makers interested in understanding and enhancing the role and contributions of non-profits as partners in integrated care. Format: Dr. Nelson will act as the facilitator for the Delphi. She has extensive experience with the Delphi method, and has published works utilizing the technique (5).   - Welcome and opening remarks (Dr. Michelle Nelson) (10 minutes) - General introduction of members (open forum) (10 minutes) - Group work:  Modified Delphi to establish consensus on thematic priorities for the SIG - Round one:  Selecting topics perceived as important from a pre-existing list (20 minutes) - Round two:  From all selected topics, rank in order of importance to choose top 10 (20 minutes) - Group discussion (open forum):                 -Brainstorm and identify activities to address ranked priorities (10 minutes)                 -Conduct resource scan to commit to activities (10 minutes)                 -Summary and next steps (10 minutes) Total Time:  90 minutes Learnings/Take away: - Develop consensus perspective on priority areas for the SIG - Establish and commit resources to meet SIG objectives

Introduction: Volunteers are an essential part of the Canadian health care system. In 2013, 12.7 million Canadians or 44% of people aged 15 years and older participated in some form of volunteer work, and 12% of those individuals donated time to health related organizations and activities. Hospitals have come to rely on volunteers for a variety of tasks and services, but there are varying perceptions about volunteers’ place within the health care team. This study aimed to understand the role of volunteers in stroke rehabilitation, as well as the barriers to volunteer engagement within the stroke rehabilitation team. Methods: An exploratory case study was conducted within a complex rehabilitation hospital in Ontario, Canada. Sixty clinicians, hospital administrators and volunteers participated in focus groups and interviews. Organizational document pertaining to volunteer management were retrieved and analyzed. Results: While there is support for volunteer engagement in stroke rehabilitation, with a wide range of activities for volunteers, several barriers to volunteer engagement in inpatient stroke rehabilitation were identified. These barriers relate to unionization, patient safety and confidentiality, volunteer attendance, and lack of collaboration between clinical and volunteer resource department. Interpreting the results with an interprofessional practice lens, this study presents how these barriers could be addressed through improving role clarity for volunteers. Conclusions: Although there are a number of barriers to engagement of volunteers in stroke rehabilitation, an interprofessional approach, specifically emphasizing and addressing issues related to key role clarity, may mediate these barriers. Clarity surrounding the status of volunteers in hospital settings could necessitate more appropriate workforce planning and administration that account for their role in health care services. Limitations: As this was an exploratory case study, focused on a single case, the study results may have limited transferability. However, building upon an interprofessional concept (role clarity), and providing a rich description of the case, is intended to enhance credibility, and support transferability of results and by audience members to their own practice contexts. Future research: Additional research focused on the barriers to volunteer engagement on clinical teams is required to determine the nature of the barriers themselves–whether they are structural, institutional, cultural, or personal. This type of analysis could support the development of strategies to reduce and remove barriers to volunteer optimization.

The transition from hospital to home is a critical clinical juncture marked by significant risks. Third Sector Organizations (TSOs) are well-positioned to support these transitions through volunteer-based programs. Given the increasing complexity of patient needs and the push for reduced hospital lengths of stay, the integration of community resources into transitional care becomes vital. Study objectives were i) to identify where TSOs are engaged in supporting post-hospital transitions, ii) to document the characteristics of transitional care models delivered by TSOs, and iii) to characterize the clients participating in these volunteer-supported programs. Forty-eight articles that reported on a community-based program delivered by a third-sector organization supporting adults transitioning from hospital to home were included. Study results suggest that TSOs can fill critical gaps in transitional care by leveraging local knowledge and providing personalized, practical, and psychosocial support. TSOs leveraged volunteers to offer personalized, community-based support that addressed both practical and psychosocial needs during care transitions; however, significant variability in program structure and limited evaluation data hindered the assessment of effectiveness and transferability. All programs were time-limited, engaged volunteers in service delivery, and provided home-based and community-based services. This review highlights the importance of integrating volunteers and TSOs into health systems to develop a more comprehensive approach to transitional care. However, the scalability of volunteer and third-sector-facilitated programs may be challenged by a lack of consistency in programs and reporting, which can undermine transferability and evidence-based practice.

IntroductionOlder adults may experience challenges during the hospital to home transitions that could be mitigated by digital health solutions. However, to promote adoption in practice and realise benefits, there is a need to specify how digital health solutions contribute to hospital to home transitions, particularly pertinent in this era of social distancing. This rapid review will: (1) elucidate the various roles and functions that have been developed to support hospital to home transitions of care, (2) identify existing digital health solutions that support hospital to home transitions of care, (3) identify gaps and new opportunities where digital health solutions can support these roles and functions and (4) create recommendations that will inform the design and structure of future digital health interventions that support hospital to home transitions for older adults (eg, the pre-trial results of the Digital Bridge intervention; ClinicalTrials.gov Identifier: NCT04287192).Methods and analysisA two-phase rapid review will be conducted to meet identified aims. In phase 1, a selective literature review will be used to generate a conceptual map of the roles and functions of individuals that support hospital to home transitions for older adults. In phase 2, a search on MEDLINE, EMBASE and CINAHL will identify literature on digital health solutions that support hospital to home transitions. The ways in which digital health solutions can support the roles and functions that facilitate these transitions will then be mapped in the analysis and generation of findings.Ethics and disseminationThis protocol is a review of the literature and does not involve human subjects, and therefore, does not require ethics approval. This review will permit the identification of gaps and new opportunities for digital processes and platforms that enable care transitions and can help inform the design and implementation of future digital health interventions. Review findings will be disseminated through publications and presentations to key stakeholders.

IntroductionGiven the risks inherent in care transitions, it is imperative that patients discharged from hospital to home receive the integrated care services necessary to ensure a successful transition. Despite efforts by the healthcare sector to develop health system solutions to improve transitions, problems persist. Research on transitional support has predominantly focused on services delivered by healthcare professionals; the evidence for services provided by lay navigators or volunteers in this context has not been synthesised. This scoping review will map the available literature on the engagement of volunteers within third sector organisations supporting adults in the transition from hospital to home.Methods and analysisUsing the well-established scoping review methodology outlined by the Joanna Briggs Institute, a five-stage review is outlined: (1) determining the research question, (2) search strategy, (3) inclusion criteria, (4) data extraction and (5) analysis and presentation of the results. The search strategy will be applied to 10 databases reflecting empirical and grey literature. A two-stage screening process will be used to determine eligibility of articles. To be included in the review, articles must describe a community-based programme delivered by a third sector organisation that engages volunteers in the provisions of services that support adults transitioning from hospital to home. All articles will be independently assessed for eligibility, and data from eligible articles will be extracted and charted using a standardised form. Extracted data will be analysed using narrative and descriptive analyses.Ethics and disseminationEthics approval is not required for this scoping review. Members of an international special interest group focused on the voluntary sector will be consulted to provide insight and feedback on study findings, help with dissemination of the results and engage in the development of future research proposals. Dissemination activities will include peer-reviewed publications and academic presentations.

Background During the COVID-19 pandemic, rapid virtual qualitative methods have gained attention in applied health research to produce timely, actionable results while complying with the pandemic restrictions. However, rigour and analytical depth may be two areas of concern for rapid qualitative methods. Methods In this paper, we present an overview of a virtual team-based rapid qualitative method within a study that explored health care providers’ perspectives of how the COVID-19 pandemic has impacted hospital-to-home transitions, lessons learned in applying this method, and recommendations for changes. Using this method, qualitative data were collected and analyzed using the Zoom Healthcare videoconferencing platform and telephone. Visual summary maps were iteratively created from the audio recordings of each interview through virtual analytic meetings with the team. Maps representing similar settings (e.g. hospital providers and community providers) and Sites were combined to form meta-maps representing that group’s experience. The combinations of data that best fit together were used to form the final meta-map through discussion. Results This case example is used to provide a description of how to apply a virtual team-based rapid qualitative method. This paper also offers a discussion of the opportunities and challenges of applying this method, in particular how the virtual team-based rapid qualitative method could be modified to produce timely results virtually while attending to rigour and depth. Conclusions We contend that the virtual team-based rapid qualitative data collection and analysis method was useful for generating timely, rigorous, and in-depth knowledge about transitional care during the COVID-19 pandemic. The recommended modifications to this method may enhance its utility for researchers to apply to their qualitative research studies.

Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. This 2-phase rapid review involved a selective review of providers' roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults' hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients' status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. RR2-10.1136/bmjopen-2020-045596.