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

Marica Cassarino; Úna Cronin; Katie Robinson; Rosie Quinn; Fiona Boland; Marie E Ward; Rosa McNamara; Margaret O'Connor; Gerard McCarthy; Damien Ryan; Rose Galvin

doi:10.1371/journal.pone.0269117

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

PLoS One. 2022 May 26;17(5):e0269117. doi: 10.1371/journal.pone.0269117. eCollection 2022.

Authors

Marica Cassarino^{1

2}, Úna Cronin^{3

4}, Katie Robinson², Rosie Quinn⁵, Fiona Boland⁶, Marie E Ward⁷, Rosa McNamara⁸, Margaret O'Connor^{9

10}, Gerard McCarthy¹¹, Damien Ryan^{4

10}, Rose Galvin²

Affiliations

¹ School of Applied Psychology, University College Cork, Cork, Ireland.
² School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland.
³ Rapid Innovation Unit, Graduate Entry Medical School, Health Research Institute, University of Limerick, Limerick, Ireland.
⁴ Retrieval, Emergency and Disaster Medicine Research and Development Unit (REDSPoT), Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
⁵ Emergency Department, Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland.
⁶ HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
⁷ School of Psychology, Trinity College, The University of Dublin, Dublin, Ireland.
⁸ Emergency Department, St. Vincent University Hospital, Dublin, Ireland.
⁹ Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
¹⁰ Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
¹¹ Emergency Department, Cork University Hospital, Cork, Ireland.

Abstract

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 stakeholders' 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.

Trial registration: ClinicalTrials.gov, NCT03739515; registered on 12th November 2018.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Emergency Service, Hospital*
Focus Groups
Humans
Patient Care Team*
Personnel, Hospital
Process Assessment, Health Care

Associated data

ClinicalTrials.gov/NCT03739515

Grants and funding

This research was supported by the Health Research Board of Ireland through the Research Collaborative for Quality and Patient Safety (RCQPS 2017-2) awarded to Prof. Rose Galvin. The sponsor is not involved in the design of the study and collection, analysis, interpretation of data, or in writing the manuscript.