Preparing in hospital to manage at home
Helping you to help patients prepare for managing at home
Welcome to ‘Your Care Needs You!’
‘Your Care Needs You’ is an evidenced-based approach designed to empower, encourage and support patients and their families to know more and do more in hospital so that they return home safely. It has been tested in a multi-site randomised controlled trial and was found to reduce the number of unplanned hospital readmissions (three months after discharge) and adverse events (one month after discharge) for older people. It is also cost-effective. The resources on this page aim to help staff understand why Your Care Needs You is important and what it is. We also provide some guidance on introducing it onto the ward and a list of references from our research are available at the bottom of the page.
Why ‘Your Care Needs You!’ is important
Take Home Messages
- Pressures from ‘patient flow’ affect communication between staff and patients
- Discharge is just a point in time…within a patient transition. Transition includes before, during and after discharge
- Doing everything for patients, all of the time, means that patients are less able to manage when they return home
- Getting patients to do more and communicating better with patients in hospital can improve the safety and experience of patients when they return home
What ‘Your Care Needs You!’ is
Take Home Messages
- Your Care Needs You! targets 4 things
- These are the skills that patients need for managing at home
- Hospital staff can help patients maintain or relearn these skills
- Preparation for being at home can only be done before returning home
Making it work on your ward
Take Home Messages
- Good communication between staff and patients is the foundation of Your Care Needs You!
- A whole ward approach offers Your Care Needs You! the best chance of success.
Evidence for Your Care Needs You
Your Care Needs You is evidence-based and our publications listed below are freely available.
Improving the safety and experience of transitions from hospital to home: : a cluster randomised controlled trial of an intervention to involve older people in their care (Your Care Needs You), , Age and Ageing 2025 Unpacking the Cinderella black box of complex intervention development through the Partners at Care Transitions (PACT) programme of research. Health Expectations 2023 Improving the safety and experience of transitions from hospital to home: a cluster randomised controlled feasibility trial of the 'Your Care Needs You' intervention versus usual care. Pilot Feasibility Studies 2022.
Transitions of care: helping older people to return home from hospital. Nursing Times [online]; 2022 Doing involvement: A qualitative study exploring the ‘work’ of involvement enacted by older people and their carers during transition from hospital to home. Health Expectations 2021 Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives. BMC Health Services Research 2020 Validation of the Partners at Care Transitions Measure (PACT-M): assessing the quality and safety of care transitions for older people in the UK 2020
How older people enact care involvement during transition from hospital to home: A systematic review and model. Health Expectations 2019 Developing a measure to assess the quality of care transitions for older people. BMC Health Services Research 2019 Scaffolding our systems? Patients and families “reaching in” as a source of healthcare resilience. BMJ Quality & Safety May 2018A qualitative formative evaluation of a patient facing intervention to improve care transitions for older people moving from hospital to home. Health Expectations, 2022
Partner Organisations
