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 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, HRB Open Research(0) Comments 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.

Embedding collective leadership to foster collaborative inter-professional working in the care of older people (ECLECTIC): Study protocol

“…A policy of integration of health and social care along a continuum of care from the acute to the community is currently being adopted in Ireland and underpins the work of the NICPOP ( Ní Shé et al , 2018b ). Successful implementation of policy recommendation requires inter-professional collaborative approaches to care as well as a culture of collective leadership within multidisciplinary teams.…”

“…Over the next 30 years the number of people in Ireland aged 65 and older is projected to increase by 60–64% and the numbers aged 85 and older by 89–94% ( Ní Shé et al , 2018b ). The health system will, therefore, have to respond to this changing demographic and their specific healthcare requirements ( Ireland, 2017 ; McLoughlin, 2014 ; Office, 2013 ; O’Donnell et al , 2019 ).…”

“…Integrated Care (IC) has been adopted in Irish health and social care policy as a strategy for improving the coordination of health and social services across the continuum from acute to community care ( Ní Shé et al , 2018b ). Research evidence indicates that models of IC may enhance patient satisfaction, increase perceived quality of care and, importantly in the context of increasing demand, enable improved access to services ( Baxter et al , 2018 ).…”

“…While a strategic emphasis on IC is currently at the centre of the Irish health and social care policy, clarity is required regarding the aims of integration, what services are included, which professionals should be involved and how interagency collaboration is occurring ( Cameron et al , 2014 ; Shaw et al , 2011 ). Internationally the literature points to cultural and structural barriers to inter-professional collaboration across the continuum of care ( Ahmed et al , 2015 ; Ní Shé et al , 2018b ). More specifically, there is a knowledge gap concerning how different health and social care professionals can foster new ways of collaborative working which are foundational to the implementation of IC cultures ( Ahmed et al , 2015 ; Cameron et al , 2014 ).…”

“…More specifically, there is a knowledge gap concerning how different health and social care professionals can foster new ways of collaborative working which are foundational to the implementation of IC cultures ( Ahmed et al , 2015 ; Cameron et al , 2014 ). At the centre of the drive for greater integration of services is inter-professional collaboration along a continuum of care ( Ní Shé et al , 2018b ; Van der Heide et al , 2018 ). Therefore, if the policy agenda on integration is to be realised, it is necessary to understand the competencies and cultures that underpin collaborative approaches to care.…”