This document summarizes a research project that aims to improve care for frail older patients through a co-design approach. Key points: - Researchers from University College Dublin are partnering with healthcare practitioners and patient advocacy groups to design and test a frailty care pathway at St. Vincent's University Hospital. - Five co-design workshops over two years have brought together stakeholders to share perspectives and collaboratively develop solutions. This has helped build a shared understanding of challenges from all viewpoints. - Emerging ideas from workshops include improved communication, mobility, nutrition, hydration and information for patients. Intentional rounding is being tested as a method to regularly check on patients' needs. - The pilot of

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3. Systematic Approach to
Improving Care for Frail Older
Patients (SAFE)
• Knowledge users in
SVUH in partnership
with UCD researchers
are collaborating with
patient representatives
and advocacy groups to
co-design and explore
the process of
implementing a model
of excellence in the
delivery of patient
centred integrated care
within the context of
frail older persons
acute admissions.

4. What is Frailty?
• Often is the age associated decline
in multiple organ systems;
• Results in decreased strength
reduced physical activity, slowing
of mobility, exhaustion and weight
loss or loss of muscle mass;
• Frail patients are vulnerable to
major changes in health and
functioning with a relatively minor
illness;
• They are particularly susceptible
to the effects of deconditioning
while in hospital.

5. Using a Co-design
Approach
The co-design employed in this study was
guided by principles of authentic
collaboration with older people and
representatives of frail older people.
Ten participants were recruited from the
membership of NGO and community-based
patient and public advocacy organisations.
Eight healthcare practitioners were involved
on a rotating basis along with three
academic researchers from UCD.
Five co-design workshops have been held
thus far over a two-year period running
parallel to the implementation and
evaluation of a frailty pathway within the
study site.

6. Enabling a Shared Understanding
“We come with a degree of knowledge and expertise
on how things can be done but we don't have the
knowledge of the environment that the health
professionals are operating in and the myriad of
factors that they have to take into account in their
everyday lives particularly in the emergency
department or the intensive care unit. I'm hopeful by
co-design that we both get a shared understanding
each other’s perspectives, and issues and also we can
create something that’s manageable within the
confines of a large hospital.” PPI Panel member
Workshop 1

7. Emergency Department
FITT
ICT
Daily
Huddle
Accepted
6 week 12 week
Finish
Nothing
further
RHD DHLight comm
help
Discharge from
ED
GP Self referral Ambulance
Home
Admit to
Ward
DC Rehab
DC LTC
DC home
Admit to
AMU
FITT (NB) ref
to Carew
Discharge from
ED by FITT
Home
+/- CIT
Fast
track
Carew Rapid Access
Admit to
Ward
Transfer to
Rehab
Home Admit to
AMU
ICT
+/- CIT
+/- CIT
Rockwood Frailty Screening

8. What
Emerged
Public and
Patient Co
Design
Workshop
Communication
Continence
Care
Improved
Mobility
End PJ
Paralysis
Access to
Hydration
Access to
Food
Improved
Patient
Information
Signage

9. I really like the idea of a plan for each
patient So that you know what you should
be aiming for that day. One of the
difficulties with being asked the same
information when you go into the hospital
is that the patient can lose confidence you
are very vulnerable so a lot of your
recovery on how much confidence you
have. So if you have a plan that’s aimed at
you saying maybe you could sit up today or
go for a walk I think that’s all very good
psychologically for patients”. PPI Panel
Member Workshop 3
Being up and dressed makes
you feel human and that you
do matter…It’s a huge amount
to do with self-esteem. The
difference between seeing a
visitor when you’re in your
pyjamas and seeing a visitor
when you’re in your choice of
clothes […] we all want to
appear well”. PPI Panel
Member Workshop 5

10. Intentional Rounding-Promoting Patient Centred Care PDSA
• Intentional Rounding (IR) is a structured process, where the nursing team
conducts one to two hourly checks with every patient using a standardised
approach (Sims et al, 2018);
• Intentional Rounding was chosen as a structure method and tool for quality
improvement for patient safety and standards of care;
• It aims to improve bedside, safe and quality nursing care in the hospital by
addressing the patient’s 4Ps:
Pain Position Personal Needs Possession

12. Act -Boards

16. What Next?
• PDSA cycles and testing of the frailty pathways is
ongoing;
• Pilot has been positive with positive engagement;
• Currently rolling out IR to other wards;
• Changing the culture has been key with supported
education;
• SAFE study –end stages write up is ongoing;
• We wish to acknowledge the Health Research Board, who
are funding this research under the Applied Partnership
Award Grant No. (APA-2016-1857)
• Contact: Dr Éidín Ní Shé: Eidin.nishe@ucd.ie