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Development and delivery of an allied health team intervention for older adults in the emergency department: A process evaluation

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posted on 2023-03-13, 15:17 authored by Marica Cassarino, UNA CRONIN, Katie Robinson, Rosie Quinn, Fiona Boland, Marie E. Ward, Rosa McNamara, MARGARET O'CONNOR, Gerard McCarthy, DAMIEN RYANDAMIEN RYAN, Rose GalvinRose Galvin

Background

There is encouraging evidence that interdisciplinary teams of Health and Social Care Professionals (HSCPs) can enhance patient care in the Emergency Department (ED), especially for older adults with complex needs. However, no formal process evaluations of implementations of ED-based HSCP interventions are available. The study aimed to evaluate the development and delivery of a HSCP team intervention for older adults in the ED of a large Irish teaching hospital.

Methods

Using the Medical Research Council (MRC) Framework for process evaluations, we investigated implementation and delivery, mechanisms of impact, and contextual influences on implementation by analysing the HSCP team’s activity notes and participant recruitment logs, and by carrying out six interviews and four focus groups with 26 participants (HSCP team members, ED doctors and nurses, hospital staff). Qualitative insights were analysed thematically.

Results

The implementation process had three phases (pre-implementation, piloting, and delivery), with the first two described as pivotal to optimise care procedures and build positive stake-holders’ involvement. The team’s motivation and proactive communication were key to promote acceptability and integration in the ED (Theme 1); also, their specialised skills and interdisciplinary approach enhanced patient and staff’s ED experience (Theme 2). The investment and collaboration of multiple stakeholders were described as essential contextual enablers of implementation (Theme 4). Delivering the intervention within a randomised controlled trial fostered credibility but caused frustration among patients and staff (Theme 3).

Discussion

This process evaluation is the first to provide in-depth and practical insights on the complexities of developing and delivering an ED-based HSCP team intervention for older adults. Our findings highlight the importance of establishing a team of HSCPs with a strong interdisciplinary ethos to ensure buy-in and integration in the ED processes. Also, actively involving relevant stakeholders is key to facilitate implementation.

Funding

OPTI-MEND: Optimising early assessment and intervention by Health and Social Care Professionals in the Emergency Department (ED)

Health Research Board

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History

Publication

PLoS ONE (17), 5, e0269117

Publisher

Public Library of Science

Also affiliated with

  • Health Research Institute (HRI)

Department or School

  • Allied Health

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