Shetty Nabha, MacLeod Tanya, Miller Ashley Paige, Buckler Melissa, Mallery Laurie, Krueger-Naug Anne-Marie, von Maltzahn Maia, Moorhouse Paige
Dalhousie University, Faculty of Medicine, Department of Medicine, Halifax.
Nova Scotia Health Authority, Halifax.
Can Geriatr J. 2025 Mar 1;28(1):1-15. doi: 10.5770/cgj.28.759. eCollection 2025 Mar.
During the COVID-19 pandemic, long-term care (LTC) facilities faced challenges in establishing appropriate goals of care (GoC) for residents during health crises. To address this, a virtual specialist consultation program was implemented to align care interventions with residents' frailty and expected outcomes.
We explored barriers and enablers to the implementation and sustainability of the program using structured interviews (n=20) with LTC leadership, health-care staff, and members of the program. Data were coded according to the constructs of the Consolidated Framework for Implementation Research (CFIR) using thematic analysis.
Participants described how the program improved care and reduced unnecessary transfers. Implementation was enabled by a high degree of tension for change, relative priority, relative advantage, and the team's shared mental model of frailty-care. Inconsistencies in GoC approaches and information silos between LTC and acute-care challenged implementation. Sustainability was hindered by decreased pandemic urgency, resulting in reallocation of resources to usual care. The need for a specialized GoC service in LTC became less obvious outside of a crisis.
This implementation study provides important insights for future spread and scale of embedding virtual specialist consultation services into LTC. The findings underscore the importance of collegial relationships and shared care philosophies to effectively implement frailty-informed care initiatives during crises. However, sustaining cross-sectoral GoC services may be challenging amidst evolving workloads and prevailing cultural perceptions of end-of-life care needs.
在新冠疫情期间，长期护理（LTC）机构在为居民在健康危机期间确立适当的护理目标（GoC）方面面临挑战。为解决这一问题，实施了一个虚拟专家咨询项目，以使护理干预措施与居民的虚弱程度和预期结果相匹配。
我们通过对长期护理机构领导层、医护人员和该项目成员进行结构化访谈（n = 20），探讨了该项目实施和可持续性的障碍与促进因素。使用主题分析法，根据实施研究综合框架（CFIR）的结构对数据进行编码。
参与者描述了该项目如何改善护理并减少不必要的转院。高度的变革紧迫感、相对优先级、相对优势以及团队对虚弱护理的共享心智模式推动了项目的实施。长期护理机构与急症护理机构之间护理目标方法的不一致以及信息孤岛对实施构成了挑战。疫情紧迫性的降低阻碍了项目的可持续性，导致资源重新分配到常规护理。在危机之外，长期护理机构对专门护理目标服务的需求变得不那么明显。
这项实施研究为未来将虚拟专家咨询服务嵌入长期护理机构的推广和规模提供了重要见解。研究结果强调了在危机期间有效实施基于虚弱情况的护理举措时， collegial关系和共享护理理念的重要性。然而，在不断变化的工作量和对临终护理需求的主流文化认知中，维持跨部门护理目标服务可能具有挑战性。
