BMC Emergency Medicine (Oct 2023)

Establishing the core elements of a frailty at the front door model of care using a modified real-time Delphi technique

  • Íde O’Shaughnessy,
  • Christine Fitzgerald,
  • Aoife Whiston,
  • Patrick Harnett,
  • Helen Whitty,
  • Des Mulligan,
  • Marian Mullaney,
  • Catherine Devaney,
  • Deirdre Lang,
  • Jennifer Hardimann,
  • Brian Condon,
  • Christina Hayes,
  • Alison Holmes,
  • Louise Barry,
  • Claire McCormack,
  • Megan Bounds,
  • Katie Robinson,
  • Margaret O’Connor,
  • Damien Ryan,
  • Denys Shchetkovsky,
  • Fiona Steed,
  • Leonora Carey,
  • Emer Ahern,
  • Rose Galvin

DOI
https://doi.org/10.1186/s12873-023-00893-9
Journal volume & issue
Vol. 23, no. 1
pp. 1 – 8

Abstract

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Abstract Background Innovations in models of care for older adults living with frailty presenting to the emergency department (ED) have become a key priority for clinicians, researchers and policymakers due to the deleterious outcomes older adults experience due to prolonged exposure to such an environment. This study aimed to develop a set of expert consensus-based statements underpinning operational design, outcome measurement and evaluation of a Frailty at the Front Door (FFD) model of care for older adults within an Irish context. Methods A modified real-time Delphi method was used. Facilitation of World Café focus groups with an expert panel of 86 members and seperate advisory groups with a Public and Patient Involvement panel of older adults and members of the Irish Association of Emergency Medicine generated a series of statements on the core elements of the FFD model of care. Statements were analysed thematically and incorporated into a real-time Delphi survey, which was emailed to members of the expert panel. Members were asked to rank 70 statements across nine domains using a 9-point Likert scale. Consensus criteria were defined a priori and guided by previous research using 9-point rating scales. Results Fifty members responded to the survey representing an overall response rate of 58%. Following analyses of the survey responses, the research team reviewed statements for content overlap and refined a final list of statements across the following domains: aims and objectives of the FFD model of care; target population; screening and assessment; interventions; technology; integration of care; evaluation and metrics; and research. Conclusion Development of a consensus derived FFD model of care represents an important step in generating national standards, implementation of a service model as intended and enhances opportunities for scientific impact. Future research should focus on the development of a core outcome set for studies involving older adults in the ED.

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