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

• Published in: BMC emergency medicine Vol. 23; no. 1; pp. 1 - 123
• Main Authors: O'Shaughnessy, Ãde, Fitzgerald, Christine, Whiston, Aoife, Harnett, Patrick, Whitty, Helen, Mulligan, Des, Mullaney, Marian, Devaney, Catherine, Lang, Deirdre, Hardimann, Jennifer, Condon, Brian, Hayes, Christina, Holmes, Alison, Barry, Louise, McCormack, Claire, Bounds, Megan, Robinson, Katie, O'Connor, Margaret, Ryan, Damien, Shchetkovsky, Denys, Steed, Fiona, Carey, Leonora, Ahern, Emer, Galvin, Rose
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 20.10.2023; BioMed Central; BMC
• Subjects: Adults; Aged; Consensus; Delphi method; Delphi technique; Doors; Emergency department; Emergency medical care; Emergency medical services; Emergency medicine; Evaluation; Focus groups; Frailty; Frailty at the front door; Medical personnel; Methods; Older adults; Older people; Professionals; Rankings; Real time; Surveys; Teams
• DOI: 10.1186/s12873-023-00893-9
• ISSN: 1471-227X

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.