Mary Cooke

Patient and public involvement in reducing health and care research waste

Plain English summaryAs much as 85 % of health research is believed to be wasted because it is not published or reported, the design is poor or does not consider what is already known in the topic area. Although a great deal of work has been done in the UK to reduce research waste, the role of patients and the public has not been discussed.This paper describes a survey, on the role of patients in reducing research waste, which was carried out as part of a larger piece of work on reducing waste in healthcare. The study found that patients were interested in reducing research waste. The key roles they play in research, for example being co-applicants for funding, members of project teams, co-researchers, means they have some shared responsibility for making sure the quality of research is high. This includes finding out what is already known about a topic and getting the study design right before seeking funding, publishing and reporting the results when the study is finished. Recognising where waste happens is part of good management of a research study.AbstractBackground Eighty five per cent of health research expenditure is potentially wasted due to failure to publish research, unclear reporting of research that is published, and the failure of new research studies to systematically review previous research in the same topic area, poor study design and conduct. A great deal of progress has been made to address this issue but the role of patients and the public has not been considered.Main A small survey was undertaken, as part of a larger programme of work on reducing health and care waste, to understand the role of patients in reducing research waste. The study showed that patients are interested in this issue particularly in relation to the prioritisation of research and patient and public involvement.Conclusions Patients undertake key roles in the research process including co-applicancy, project management, or as co-researchers. This brings responsibility for ensuring high quality research and value for money. Responsibility for recognition of the potential for wasteful practices is part of the conduct and operation of research studies.

PB10 Safe Elderly Emergency Discharge (SEED) project: determining best practice for safe discharge of the older emergency patient

Background and Objectives Increasing numbers of older patients presenting for emergency hospital care is a major worldwide concern. The fastest growth is in people aged ≥65 years representing 18% of all presentations. An ED visit for older people is a sentinel health event that can lead to substantial functional decline and adverse outcomes. This age group present with more complex conditions, consume more resources, have longer ED stays, are more likely to be admitted, have long hospital stays, and a higher rate of re-presentation. This will increase with population ageing. Although social/psychological support is often required there is little evidence this occurs in a systematic coordinated manner. SEED aims to Determine whether current models of emergency care ensure safe discharge and facilitate optimal health outcomes for older patients. Develop a tailored evidence-based care framework applicable to Australian and international settings. Methods PHASE 1: Review of best practice: Systematic review of best evidence for models of care for older patients in ED or short stay units. PHASE 2: Evaluation of methods for assessment of unsafe discharge risk: Evaluation of effectiveness of discharge risk screening tools designed to reduce risk of unsafe discharge. PHASE 3: Audit current practice against published best practice: Prospective process mapping of the patient care journey in 3 EDs in Australia and UK: during ED stay and post-discharge, with monitoring of health outcomes in the following 6 months. Expected Outcomes Development of an Older Patient Care Service Framework: Redesign of emergency care for older patients. To include: Development of policy and principles of management, care pathways, and performance improvement measures. Validation of an unsafe discharge screening tool in an Australian & English cohort. Development of a stream-lined care pathway. Reduced ED length of stay. Improved patient experience. Safe discharge with optimisation of health outcomes, reduced unplanned emergency re-presentations; reduced need for higher level residential care; reduced unplanned deaths. Reduced emergency demand and improved patient flow.

FRAILTY AS LIVED, FRAILTY AS APPLIED: EXPLORING LIVED EXPERIENCES IN OLDER PATIENTS WHO HAVE FALLEN AND CALLED 999

Rationale The aim of this pilot study was to explore the personal meanings of frailty within a purposive sample of older patients who had fallen, needed an Emergency Ambulance Service response and were subsequently referred to a falls service. A systematic literature review indicated that no qualitative studies had been carried out within such a sample previously. Methods The qualitative methodology used Interpretative Phenomenological Analysis; which explored the essential nature of frailty as a phenomenon though a series of subjective narrative accounts generated by focused interviews. Employing a reflexive approach to the analysis allowed completion of a participant-centred and ethically sound study. Results Analysis of six focused interviews with older adults provided a thick description which highlighted five themes: Adaptations to frailty, Focus on confidence as psychological frailty, A changing lifeworld-towards social frailty, Reconciling a frail future and Frailty as stigma. These themes were discussed in relation to sociological literature including theories concerning transitions from the third to fourth age, liminality and social death, frailty as stigma and frailty as lived and frailty as applied. Implications This sample of patients represented a group in transition. They occupied a liminal zone situated between the third and fourth age and while acknowledging oldness, they actively challenged biomedical assumptions of frailty through an emphasis on control and individual agency. This study enables paramedics to modulate their communications when encountering elders who reject the notion of frailty as a term applied. For service design, the results allow the voice of the patient group to be heard, so that solutions can be designed in an inclusive, rather than hierarchical fashion. Significantly, this thesis forms part of an emerging body of evidence that questions the usefulness of the term frailty as experienced by this sample of participants.