The systematic approach to improving care for Frail Older Patients (SAFE) study: A protocol for co-designing a frail older person’s pathway

Éidín Ní Shé,Marie Therese Cooney,Eilish Mcauliffe,Orla Collins,Diarmuid O'Shea,Coailfhionn O'Donoghue,Deirdre O'Donnell,Graham Hughes,Lisa Cogan,Andrew Patton,Nigel Salter,John O'Donovan,Emmet Mcgrath,Mary Mccarthy

doi:10.12688/hrbopenres.12804.1

Abstract

Background: Frailty is the age-accelerated decline across multiple organ systems which leads to vulnerability to poor resolution of homeostasis after a stressor event. This loss of reserve means that a minor illness can result in a disproportionate loss of functional ability. Improving acute care for frail older patients is now a national priority and an important aspect of the National Programme for Older People in Ireland. Evidence suggests that an interdisciplinary approach incorporating rapid comprehensive geriatric assessment and early intervention by an interdisciplinary team can reduces susceptibility to hospitalisation related functional decline. The aim of the Systematic Approach to Improving Care for Frail Older Patients (SAFE) is to develop and explore the process of implementing a model of excellence in the delivery of patient-centred integrated care within the context of frail older people's acute admissions. Methods: The SAFE study will employ a mixed methodology approach, including a rapid realist review of the current literature alongside a review of baseline data for older people attending the emergency department. Semi-structured interviews will be undertaken to document the current pathway. The intervention processes and outcomes will be jointly co-designed by a patient and public involvement (PPI) group together with the interdisciplinary healthcare professionals from hospital, community and rehabilitation settings. Successive rounds of Plan-Do-Study-Act cycles will then be undertaken to test and refine the pathway for full implementation. Discussion: This research project will result in a plan for implementing an integrated, patient-centred pathway for acute care of the frail older people which has been tested in the Irish setting. During the process of development, each element of the new pathway will be tested in turn to ensure that patient centred outcomes are being realised. This will ensure the resulting model of care is ready for implementation in the context of the Irish health service.

Highlights

There has been significant agreement within the literature that hospital admission is considered a health risk for frail older patients[1]
It is anticipated that the development of a frailty pathway, based on international experience and tailored to the context of the Irish healthcare setting through extensive co-design work, will deliver results across the system
Careful attention has been paid in the study design to tailor the pathways to allow the pathways to be implemented quickly and effectively in the local and afterwards the national setting

Summary

Introduction

There has been significant agreement within the literature that hospital admission is considered a health risk for frail older patients[1]. A recent Irish Department of Health special delivery unit report demonstrated that people aged over 65 year’s account for over one-third of ED attendances[7,8]. As this age group accounts for only 11.67% of the total population this indicates a disproportionate level of use of ED by the older population[9] and raises concern about whether services will be able to cope with rapidly increasing demand. Frailty is the age-accelerated decline across multiple organ systems which leads to vulnerability to poor resolution of homeostasis after a stressor event This loss of reserve means that a minor illness can result in a disproportionate loss of functional ability.

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Methods

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Conclusion