Implementing the MIRROR-TCM Randomised Control Trial During the COVID-19 Pandemic: A Mixed-Methods Evaluation

Aim: To evaluate the implementation of the Transitional Care Model (TCM), an evidence-based, advanced practice registered nurse-led multi-component intervention, as part of a randomised controlled trial during the first year of the COVID-19 pandemic. Design: Parallel convergent mixed-methods approach. Methods: Data for this study were collected between June 2020 and February 2021. Data from 78 patients who received the intervention and 68 recorded meetings with system leaders and clinical teams were analysed using descriptive statistics, directed content analysis, and joint display. Results: Fidelity to delivery of elements of the TCM components was variable, with the Hospital-to-Home visit elements having the widest range (14.3%–100%) and Maintaining Relationships elements having the highest range (97.3%–98.6%). There were 27 identified challenges and 15 strategies for implementing the TCM with fidelity during the pandemic. Conclusion: The COVID-19 pandemic impacted all aspects of the delivery of the TCM across all sites. This historical event highlighted the need for services and support for patients and caregivers transitioning from the hospital to home. Implications for Nursing and Patient Care: Evidence-based solutions are needed to enhance healthcare delivery and patient outcomes. Findings will guide nurses in implementing proven transitional care interventions. Impact: Findings will inform the implementation and scaling of transitional care and other evidence-based interventions across diverse healthcare settings. Reporting Method: GRAMMS reporting guidelines. Patient or Public Contribution: No patient or public contribution. Trial Registration: ClinicalTrials.gov identifier: NCT04212962. https://www.clinicaltrials.gov/study/NCT04212962?titles=NCT04212962&rank=1.