None listed
Conditions
Brief summary
In this study, the research group will work with staff on a vascular surgical ward to design and introduce changes to care which are more elder-friendly, to ensure that older patients regain their usual function faster after surgery. This will include prompt input from a physician to prevent early medical complications, early input from allied health professionals such as physiotherapists and nutritionists to reduce the risks of muscle loss, and resular encouragement from all staff members to keep their body and mind as active as possible. The changes in care will be made by working closely with ward staff using an evidence-based framework for implementing complex changes in health care settings. The investigators hope to show that the new model of care improves the rate of return to independence, reduces complications and reduces length of stay in this high risk patient group, compared to the usual way of organising care. They will also assess whether these improvements justify the additional intensity (and therefore cost) of staffing which would be necessary to provide this enhanced care.
Interventions
Pre-intervention cohort receives care from vascular surgical team, including referral to allied health and medical services as required, according to usual practice.
Intervention is a complex system change which directly engages team members of the intervention ward in an evolving redesign of care processes to meet the following broad goals:
1. Proactive medical consultation: consistent medical registrar supervised by a general physician will review older patients pre-operatively where feasib
Pre-intervention cohort receives care from vascular surgical team, including referral to allied health and medical services as required, according to usual practice. Intervention is a complex system change which directly engages team members of the intervention ward in an evolving redesign of care processes to meet the following broad goals: 1. Proactive medical consultation: consistent medical registrar supervised by a general physician will review older patients pre-operatively where feasible and throughout the post-operative course in collaboration with the surgical team to optimise management of comorbidities, until the time of discharge 2. Enhanced multidisciplinary care team focus to support implementation of cognitive orientation/stimulation, feeding assistance and exercise/ambulation, achieved using holistic facilitation based on the PARIHS framework 3. Staff and patient education regarding delirium, functional decline and malnutrition and strategies designed to minimise them, using small group interactive staff teaching (initally 30 minutes per week for 5 weeks, repeated every 10-12 weeks based on staff rotations) and staff and patient brochures Post-intervention cohort data will be collected after 6 months (August-December 2013) or when intervention is considered mature. Intervention will continue throughout the post-intervention data collection period.
Sponsors
Australian Centre for Health Services Innovation
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Aged 65 or older, admitted to vascular surgical unit with anticipated length of stay at least 3 days
Exclusion criteria
Unable to be reviewed within 4 days of admission Unable to consent and no statutory health authority available
Outcome results
None listed