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Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments a qualitative implementation study using the i-PARIHS model1.20 MB
Published VersionCC BY V4.0, Open Access
Journal article
Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model
BMC Health Services Research, Vol.22(1), pp.1-14
2022
PMCID: PMC9128293
PMID: 35606808
Abstract
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
- Authors
- Marianne Wallis (Corresponding Author) - Sunshine Coast Health Institute (Australian, Birtinya) - SCHIAlison Craswell (Author) - University of the Sunshine Coast, Queensland, School of Nursing, Midwifery and Paramedicine - LegacyElizabeth Marsden (Author) - University of the Sunshine Coast, Queensland, School of Nursing, Midwifery and Paramedicine - LegacyAndrea Taylor (Author) - University of the Sunshine Coast, Queensland, School of Nursing, Midwifery and Paramedicine - Legacy
- Publication details
- BMC Health Services Research, Vol.22(1), pp.1-14
- Publisher
- BioMed Central Ltd.
- Date published
- 2022
- DOI
- 10.1186/s12913-022-08081-4
- ISSN
- 1472-6963
- PMID
- 35606808; PMC9128293
- Copyright note
- This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
- Organisation Unit
- School of Health - Nursing; University of the Sunshine Coast, Queensland; School of Nursing, Midwifery and Paramedicine - Legacy
- Language
- English
- Record Identifier
- 99646379002621
- Output Type
- Journal article
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