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

Abstract

Frailty is the age-accelerated decline across multiple organ Background 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.: The SAFE study will employ a mixed methodology approach, Methods 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.: This research project will result in a plan for implementing an Discussion This research project will result in a plan for implementing an Discussion 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.

Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting

“…The SAFE study received funding from a national applied research scheme which ensured a partnership approach between a research lead (Cooney) and a knowledge lead (O’Shea). The purpose of this partnership was to ensure research findings were applied by the knowledge user organisations represented by a knowledge lead with the capacity and authority to implement research findings into policy and practice [2]. This project benefited from the involvement and commitment of the National Clinical Lead for the Care of Older People (O’Shea) who attended co-design meetings on a rotating basis.…”

“…Frailty considers the complex interplay of physical, psychological, social, and environmental factors and is associated with key clinical syndromes including loss of mobility, falls, confusion, incontinence and polypharmacy [1, 2]. Although not an inevitable part of ageing, frailty is an increasingly common condition in older people.…”

“…Our focus within the ‘Systematic Approach to improving care for Frail older patients’ (SAFE) study was to co-design quality improvement initiatives within an integrated care pathway for frail older people in an acute setting [2]. As part of the SAFE study we undertook a review of the literature to capture what works in the successful implementation of a frail older person’s pathway [14].…”

“…The literature highlights many challenges in enabling meaningful reciprocal engagement [14, 15, 17–19]. A co-design approach within health system improvement initiatives involves creating an equal partnership of people working within the system and those individuals who have lived experience of using the system (patients and their families/carers) [2, 14, 20–22]. Co-design in particular requires all participants to move out of their ‘comfort zone’ and be willing to engage with a diverse group [16, 23].…”

“…This paper presents a systematic approach to involving public and patient representatives (PPRs) in the co-design of care pathways for acute frail older patients [2, 24]. Through the meaningful engagement of PPRs five priority areas were identified for targeted quality improvement in the care of frail older people in an acute hospital setting.…”