Care Delivery in Acute Hospital Settings: an Observational Study. WP1 P3
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 180
- 主要终点
- To observe and describe the general day-to-day practices and routines in three English acute hospitals for treating older patients with hip fracture.
研究概览
简要总结
This small observational study is a contractual component of a 5-year (2013-18) NIHR funded programme called PERFECTED (Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts with Dementia) whose overall aim is to develop and pilot an evidence-based intervention to improve the hospital care of patients with dementia suffering a fractured hip. The findings from this particular observational study will support other PERFECTED work-packages in establishing current care practices in acute hospital settings for older people in general with hip fractures.
Observation is a well-established qualitative technique widely used to understand cultures, processes and interactions in defined locations including hospitals. In this study, researchers will observe day-to-day practices on specific ortho-geriatric wards and Emergency Departments in three English hospitals (Norfolk and Norwich University Hospital, Bradford Royal Infirmary and Queen's Medical Centre in Nottingham). Observations will occur intermittently over a 4-week period, covering the full 24h cycle. The prime objective of the study is to describe delivery of care to older patients with a hip fracture including an assessment of cost consequences. Crucially, the observations will focus exclusively upon the hospital personnel that routinely provide care in the designated locations being observed. Other individuals who frequent the locations (patients, visitors and other more peripheral health care professionals) are NOT the focus of the research and will be regarded as "incidental others" rather than "participants". This approach is common in observational research.
Observations will be conducted by experienced qualitative researchers and assisted by specifically trained lay researchers to provide a valuable service-user dimension to the study. Field-notes and contextual information will be collected and thematically analysed, again in partnership with trained 'lay' researchers. Resulting data will address the pre-defined aims of the observational study and feed into the findings reported across the whole of work package 1 of PERFECTED.
详细描述
Rationale and background information
Hip fracture
Hip fracture is a common orthopaedic injury amongst older adults. It is estimated that more than 1.2 million individuals will suffer hip fracture annually worldwide (Gullberg et al, 1997) and this total is expected to surpass 6 million by the year 2050 (Cooper et al, 1992; Odén et al, 2013). Hip fracture has a significant impact on the health and independence of patients and their families, with an increased risk of functional decline, admission to long-term care institutions and high mortality rates within the first 12 months post-fracture (Seitz et al, 2011). Furthermore the economic implications for the NHS are significant in both direct and indirect costs (Hernlund et al, 2013).
People with dementia
It is estimated that 25% of all beds in UK acute hospital wards are occupied by people with dementia (PwD) (Royal College of Psychiatrists 2009). Improving acute hospital care for PwD is high on the national agenda, as this group is particularly vulnerable to poor quality care and adverse outcomes (NHS Confederation 2010). Patients with dementia - primarily older people, are highly susceptible to insensitive care as complex needs in relation to their memory, thinking, orientation, comprehension, calculation, learning capability, language, and judgment are often unrecognised and unaddressed (Alzheimer Society 2009). Older people and their families consistently place high value on hospital care which promotes personalised relationships between patients and staff. This is particularly pertinent for people with impaired cognition or communication difficulties ( Alzheimer Society 2009).
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Health Care Professioanls delivering care in the observational environments
排除标准
- •Those who are not Health Care Professioanls delivering care in the observational environments
结局指标
主要结局
To observe and describe the general day-to-day practices and routines in three English acute hospitals for treating older patients with hip fracture.
时间窗: Observations in each of the 3 sites will take place for a 4 week period.
The overall aim of this study (phase 3, WP1 of PERFECTED) is to observe and describe the general day-to-day practices and routines in three English acute hospitals for treating older patients with hip fracture. The influence on care practices of significant co-morbidities, particularly dementia, will especially be noted. Observations will take place in defined areas on specified ortho-geriatric wards and in EDs. The study's aims and objectives focus on the delivery of care. As such, the focus of the observations is solely upon those health professionals who routinely deliver care in the designated spaces.
次要结局
未报告次要终点