Key result
Efficiency pressures during cardiac transitions reinforce clinical silos and fragment communication.
Why the study?
Older patients in cardiac care often experience multiple intrahospital transitions, prompting an exploration of how organizational structures and priorities influence nursing workflow, documentation, communication, and interactions.
Observational
No
Nursing practice during intrahospital transitions in cardiac care is heavily influenced by siloed organisational structures that prioritize efficiency over continuity, compromising patient safety and communication.
Siloed transitions may risk safety in cardiac care; hypothesis-generating for interventions to improve continuity and engagement.
Background/Aims: Older patients in cardiac care often experience multiple intrahospital transitions during hospitalisation. This study explores nursing practice in relation to older patients' intrahospital transitions within cardiac care, focusing on whether and how organisational structures and priorities influence nursing workflow, as well as nurses' approach to documentation and communication, and their interaction with patients, relatives and healthcare professionals. Methods: Participant observation, using a focused ethnographic approach, was conducted to explore nursing practice during intrahospital transitions in a large, specialised department of cardiology. Field notes were analysed using reflexive thematic analysis, and the philosophical paradigm was hermeneutic. Results: 174 hours of nursing practice were observed, resulting in 115 pages of field notes. The overall theme: ‘silo division as a guiding principle during intrahospital transitions’ and the themes: ‘ensuring flow in and out of each silo’, ‘lack of awareness of risk embedded in intrahospital transitions’ and ‘assigning patients and relatives a passive role during intrahospital transitions’ were identified. Conclusions: Nursing practice during intrahospital transitions in cardiac care was strongly shaped by organisational imperatives prioritising efficiency, patient flow and productivity. While these priorities sustained specialised care, they also reinforced siloed structures that fragmented communication and compromised continuity and patient safety. Nurses frequently compensated for these systemic gaps, and older patients and relatives remained involved only to a limited extent. Improving the safety and quality of intrahospital transitions will require organisational action beyond individual professional effort. Intrahospital transitions need to be recognised as high-risk processes requiring structured inter-unit collaboration, shared accountability and leadership engagement. Sustainable change will depend on balancing efficiency demands with coordinated, person-centred transitional care across organisational boundaries.
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Axelsen et al. (2026) conducted an observational in Cardiac care. Intrahospital transitions was evaluated on Themes identified from field notes. Observation of 174 hours of nursing practice revealed that intrahospital transitions in cardiac care are shaped by efficiency imperatives, reinforcing siloed structures that fragment communication.
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