Department of Acute Medicine, London North West Hospital, 601 Uxbridge Rd, Southall UB1 3HW, UK.
NIHR Academic Clinical Lecturer in Complex Health Needs, Humanitarian and Conflict Response Institute, University of Manchester and Salford Royal Foundation Trust.
Age Ageing. 2022 Mar 1;51(3). doi: 10.1093/ageing/afac057.
This commentary discusses the role and value of qualitative data when undertaking quality improvement (QI) focussing on the care of older adults. To illustrate this, we reflect on our own experiences of planning a QI project to improve the documentation of Clinical Frailty Scale (CFS) scores in the emergency department (ED) during the coronavirus disease of 2019 (COVID-19) pandemic. National clinical guidance for COVID-19 states that all adults over the age of 65 should be given a CFS at the first point of contact during hospital admission. Therefore, there is a need to improve CFS documentation, specifically in acute care settings. We describe how qualitative methods facilitated an understanding of the barriers to CFS documentation in ED. Staff see the CFS as a useful tool for inter-professional communication, though there are tensions between clinical guidance and their beliefs. Staff had moral concerns about how an ED-allocated CFS might limit available treatment options for older adults. Our findings demonstrate how qualitative methods can illuminate the important social and moral dimensions of why improvement does or does not occur.
本评论讨论了当专注于老年人护理时，定性数据在质量改进 (QI) 中的作用和价值。为了说明这一点，我们反思了自己在规划一个 QI 项目以改善在 2019 年冠状病毒病 (COVID-19) 大流行期间急诊科 (ED) 中临床虚弱量表 (CFS) 评分记录方面的经验。COVID-19 的国家临床指南指出，所有 65 岁以上的成年人在住院期间首次接触时都应接受 CFS。因此，需要改进 CFS 记录，特别是在急性护理环境中。我们描述了定性方法如何有助于理解 ED 中 CFS 记录的障碍。工作人员认为 CFS 是跨专业交流的有用工具，尽管临床指南与其信念之间存在紧张关系。工作人员对 ED 分配的 CFS 可能会限制老年人可用的治疗选择表示道德担忧。我们的研究结果表明，定性方法如何阐明为什么改进会或不会发生的重要社会和道德方面。
