Background: Hospitalisation of frail elderly patients contributes to decline in health status and loss of independence. Improving acute care for frail elderly patients is a national priority and an important aspect of the National Programme for Older People and ED task force report. Evidence from UK studies suggests that this interdisciplinary approach incorporating rapid comprehensive geriatric assessment improves patient flow and clinical outcomes. Hence, the importance of developing optimal care pathways for frail elderly patients in an Irish context.
Aim: To co-design frail elderly pathways and develop an implementation model for incorporating these pathways in the Irish setting.
Partnership: A strong partnership has been developing between UCD researchers (School of Medicine and School of Nursing, Midwifery and Health Systems) and knowledge users at St Vincent’s University Hospital (SVUH) along with collaborators in the community, rehabilitation facilities and patient advocacy groups.
Methods: Ethnographic study of acute care pathways for frail elderly patients.
1. Realist review on current literature and detailed mapping of current structures and process.
2. Co-design of improved pathways for delivery of care to frail elderly patients in acute hospitals, building on the acute frailty unit model, with PPI as a central tenet enabling the development of a truly patient-centred evidence-based and integrated model of care.
3. Iterative process refining the model of care through successive cycles of PSDA (plan, do, study, act). Qualitative analysis to uncover the barriers to implementation with continual evolution of the processes to address these.
Outcome: A clear plan for implementing integrated and patient-centred pathways for acute care of the frail elderly which has been tested in the Irish setting. A strong interdisciplinary team of researchers and knowledge users with the expertise to secure funding for a full-scale trial of an alternative model of care for frail elderly patients across the 11 hospitals of the Ireland East hospital group.
