Steps towards a senior-FRiendly Emergency Department: context-driven, systematic implementation mapping, and evaluation in a Swiss University Hospital (FRED)

Objectives

Frail older adults frequently utilize Emergency Department (ED) services. This patient group often has complex medical conditions and is at increased risk for adverse outcomes, such as more extended ED stays and hospitalizations. Comprehensive senior-friendly ED programs have demonstrated benefits for both older patients and healthcare organizations. However, these interventions are often not adopted sustainably. This project aims to systematically re-implement a comprehensive senior-friendly ED program at an urban tertiary university hospital in Switzerland, with the goal of improving patient outcomes, including person-centered care. Since previously introduced elements of the program have only been partially adopted, tailored implementation strategies are essential for the successful and sustainable adoption of the intervention program.

Aims

The goals of the project are as follows:

1) To assess the current implementation of senior-friendly interventions in the ED setting. This involves identifying barriers and facilitators that affect their successful reach, adoption, person-centeredness, and maintenance.

2) To systematically map the implementation process to develop tailored implementation strategies for reintroducing components of a comprehensive senior-friendly ED program.

3) To evaluate the implementation strategies and the intervention components of a senior-friendly ED program using the RE-AIM framework as a basis (Reach, Effectiveness – Adoption, Implementation, Maintenance).

Methods

Overall, this study will use a convergent parallel mixed-method design. Implementation mapping will ensure a systematic approach comprising five steps across two phases.

Phase A – Focuses on context analysis and strategy development. It begins with: (1) conducting a stakeholder analysis and a context analysis through a mixed-method rapid ethnography (observations with informal conversations, interviews, and patient chart reviews). The subsequent steps include: (2) identifying expected intervention and implementation outcomes, as well as defining performance objectives; (3) adapting, extending, or developing implementation strategies based on the ERIC taxonomy and in cooperation with emergency clinicians; and (4) co-designing implementation protocols.

Phase B – Incorporate the tailored implementation strategies for the evaluation process. It involves (5) using a hybrid type 2 design to evaluate both implementation outcomes (reach, adoption, and maintenance) and effectiveness outcomes (person-centeredness) while monitoring the implementation process over time.

Contribution

Creating senior-friendly EDs is essential for providing person-centered emergency care, enhancing patient safety and the quality of care for frail older adults. Involving key stakeholders—including patients, emergency clinicians, and hospital leadership—and analyzing the specific context allows us to develop culturally aware, tailored implementation strategies. These strategies can assist emergency clinicians in effectively managing the complex medical conditions of older patients, leading to sustainable treatment decisions. The findings will benefit both national and international emergency departments by showcasing adaptable implementation strategies designed for complex ED settings while supporting the maintenance of evidence-based interventions.