ArticleInternational journal of integrated care
Acute Practitioners' Experiences of Implementing Frailty Same Day Emergency Care: A Researcher-in-Residence Study.
Article in International journal of integrated care. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
Introduction: NHS policy promotes Frailty Same Day Emergency Care (F-SDEC) units to alleviate pressure on emergency departments (ED) and improve care for frail people through comprehensive geriatric assessment and same-day discharge. However, evidence remains limited on how such services are implemented in practice, particularly in resource-constrained and geographically peripheral settings. This study aimed to examine how implementation barriers are experienced and negotiated during the day-to-day delivery of an F-SDEC pilot. Methods: Using a Researcher-in-Residence approach, a researcher embedded in a coastal hospital in Torbay, South-West England, collected field notes from prior observations to inform the interview guide, conducted semi-structured interviews with staff delivering F-SDEC, and held a feedback session. A framework-informed, reflexive thematic approach guided the identification of key implementation challenges and enablers. Results: Staff viewed F-SDEC as beneficial for improving care for older adults, but interacting barriers constrained implementation. ED-based triage was time-intensive and difficult to routinise due to fragmented, non-interoperable IT systems, inconsistent understanding of frailty across hospital teams, and shifting eligibility criteria. Operational pressures, workforce and skill-mix shortages, and an inconsistent understanding of F-SDEC's needs and purpose also limited CGA delivery and contributed to day-to-day variability in throughput. While staff expressed a desire to reorient towards community-based referrals, the same digital and workforce constraints also limited the feasibility of alternative routes, further raising sustainability concerns. Conclusions: F-SDEC implementation was shaped by interdependent system constraints rather than isolated barriers. In peripheral and resource-constrained settings, successful implementation may depend on whole-system alignment across digital infrastructure, workforce capacity, and cross-team collaboration, with national policy better accounting for local delivery conditions.
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