Threats to safe transitions from hospital to home: a consensus study in North West London primary care

Ola Markiewicz, Mary Lavelle, Fabiana Lorencatto, Gaby Judah, Hutan Ashrafian, Ara Darzi

Research output: Contribution to journalReview articlepeer-review

22 Citations (Scopus)
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BACKGROUND: Transitions between healthcare settings are vulnerable points for patients.

AIM: To identify key threats to safe patient transitions from hospital to primary care settings.

DESIGN AND SETTING: Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England.

METHOD: Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3: 'not important', 4-6: 'somewhat important', 7-9: 'very important'). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%.

RESULTS: A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. 'Poor quality of handover instructions from secondary to primary care teams' achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a 'very important' threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients.

CONCLUSION: This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise.

Original languageEnglish
Pages (from-to)e9-e19
JournalThe British journal of general practice : the journal of the Royal College of General Practitioners
Issue number690
Early online date26 Dec 2019
Publication statusPublished - Jan 2020
Externally publishedYes

Bibliographical note

©The Authors.


  • Aged
  • Aged, 80 and over
  • Attitude of Health Personnel
  • Child
  • Child Health Services/organization & administration
  • Consensus
  • Delphi Technique
  • Female
  • Frail Elderly
  • Health Personnel
  • Health Services for the Aged/organization & administration
  • Humans
  • London/epidemiology
  • Male
  • Patient Discharge/standards
  • Patient Handoff/organization & administration
  • Patient Safety
  • Primary Health Care/organization & administration


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