Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model

Marianne Wallis; Alison Craswell; Elizabeth Marsden; Andrea Taylor

doi:10.21203/rs.3.rs-779354/v1

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Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model

Journal article

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Peer reviewed

Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model

Marianne Wallis, Alison Craswell, Elizabeth Marsden and Andrea Taylor

BMC health services research, Vol.22

10/08/2021

DOI: https://doi.org/10.21203/rs.3.rs-779354/v1

PMCID: PMC9128293

PMID: 35606808

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Abstract

Health Policy

Occupational Medicine

Geriatric

Emergency medical services

Implementation science

Hospital

Delivery of health care

Background Frail older adults require specific, targeted care and expedited shared decision making in the emergency department (ED) to prevent poor outcomes and minimise time spent in this chaotic environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to help limit these undesirable consequences. This qualitative study aimed to explore the ways in which two hospital implementation sites implemented the structures and processes of the GEDI model and to examine the ways in which the i-PARIHS (innovation-Promoting Action on Research Implementation in Health Services) framework influenced the implementation. Methods Using the i-PARIHS approach to implementation, the GEDI model was disseminated into two hospitals using a detailed implementation toolkit, external and internal facilitators and a structured program of support. Following implementation, interviews were conducted with a range of staff involved in the implementation at both sites to explore the implementation process used. Transcribed interviews were analysed for themes and sub-themes. Results There were 31 interviews with clinicians involved in the implementation, conducted across two hospitals, including interviews with the two external facilitators. Major themes identified included: (i) elements of the GEDI model adopted or (ii) adapted by implementation sites and (iii) factors that affected the implementation of the GEDI model. Both sites adopted the model of care and there was general support for the GEDI approach to the management of frail older people in the ED. Both sites adapted the structure of the GEDI team and the expertise of the team members to suit their needs and resources. Elements such as service focus, funding, staff development and service evaluation were initially adopted but adaptation occurred over time. Resourcing and cost shifting issues at the implementation sites and at the site providing the external facilitators negatively impacted the facilitation process. Conclusions The i-PARIHS framework provided a pragmatic approach to the implementation of the evidenced-based GEDI model. Passionate, driven clinicians ensured that successful implementation occurred despite unanticipated changes in context at both the implementation and host facilitator sites as well as the absence of sustained facilitation support.

Details

Title: Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model
Creators: Marianne Wallis - Southern Cross University
Alison Craswell - University of the Sunshine Coast
Elizabeth Marsden - Sunshine Coast University Hospital
Andrea Taylor - Sunshine Coast University Hospital
Publication Details: BMC health services research, Vol.22
Publisher: Springer Science and Business Media LLC
Identifiers: 991013154204902368
Copyright: This work is licensed under a Creative Commons Attribution 4.0 International License.
Academic Unit: Nursing; Faculty of Health
Language: English
Resource Type: Journal article

Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model

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