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Int. J. Environ. Res. Public Health 2018, 15(2), 199; https://doi.org/10.3390/ijerph15020199

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

1
School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
2
The Ireland East Hospital Group, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
3
St. Vincent’s University Hospital, Elm Park, 196 Merrion Rd., Dublin 4, Ireland
4
Older Person’s Empowerment Network and Patient and Public Involvement Representative in Healthcare at the Health Service Executive, Dublin 8, Ireland
5
St. James Hospital, James’s St., Dublin 8, Ireland
6
School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
*
Author to whom correspondence should be addressed.
Received: 20 December 2017 / Revised: 15 January 2018 / Accepted: 17 January 2018 / Published: 25 January 2018
(This article belongs to the Special Issue Health Systems and Services)
Full-Text   |   PDF [1292 KB, uploaded 25 January 2018]   |  

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. View Full-Text
Keywords: frailty; older people; pathways; acute; realist review; co-design; implementation; stakeholder engagement frailty; older people; pathways; acute; realist review; co-design; implementation; stakeholder engagement
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Ní Shé, É.; Keogan, F.; McAuliffe, E.; O’Shea, D.; McCarthy, M.; McNamara, R.; Cooney, M.T. Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway. Int. J. Environ. Res. Public Health 2018, 15, 199.

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