Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway

Éidín Ní Shé, Fiona Keogan, Eilish McAuliffe, Diarmuid O’Shea, Mary McCarthy, Rosa McNamara and Marie Therese Cooney
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Éidín Ní Shé: School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
Fiona Keogan: The Ireland East Hospital Group, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
Eilish McAuliffe: School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
Diarmuid O’Shea: St. Vincent’s University Hospital, Elm Park, 196 Merrion Rd., Dublin 4, Ireland
Mary McCarthy: Older Person’s Empowerment Network and Patient and Public Involvement Representative in Healthcare at the Health Service Executive, Dublin 8, Ireland
Rosa McNamara: St. James Hospital, James’s St., Dublin 8, Ireland
Marie Therese Cooney: St. Vincent’s University Hospital, Elm Park, 196 Merrion Rd., Dublin 4, Ireland

IJERPH, 2018, vol. 15, issue 2, 1-11

Abstract: We addressed the research question “what factors enable the successful development and implementation of a frail older person’s pathway within the acute setting”. A rapid realist review (RRR) was conducted by adopting the RAMESES standards. We began with a sample of 232 articles via database searches supplemented with 94 additional records including inputs from a twitter chat and a hospital site visit. Our final sample consisted of 18 documents. Following review and consensus by an expert panel we identified a conceptual model of context-mechanism-(resources)-outcomes. There was overall agreement frailty should be identified at the front door of the acute hospital. Significant challenges identified related to organisational boundaries both within the acute setting and externally, the need to shift outcomes to patient orientated ones, to support staff to sustain the pathway by providing ongoing education and by providing role clarity. RRRs can support research such as the systematic approach to improving care for frail older adults (SAFE) study by producing accounts of what works based on a wide range of sources and innovative engagement with stakeholders. It is evident from our provisional model that numerous factors need to combine and interact to enable and sustain a successful frail older person’s pathway.

Keywords: frailty; older people; pathways; acute; realist review; co-design; implementation; stakeholder engagement (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2018
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