Title: Models of Acute Care Resilience
Funder: Department of Health and Social Care

Abstract: Research Question Which care delivery models are most resilient to the effects of high volume activity during winter for acute medical illness for older adults in the NHS? Background The acute care system assesses and treats an ever increasing number of patients with greater complexity and older age. Against this backdrop of yearly increases in the demand for same day urgent healthcare, there are periods of sustained high volumes of activity, for example during flu season. The responses by different healthcare organisations to a sustained surge in activity may differ substantially. This provides an opportunity to study the impact of different strategies, within their organisational context. We plan to undertake a programme of work that will inform the best interventions for the NHS in order to deliver resilient acute medical care during winter pressures with a focus on older people. Aims 1. To determine a conceptual framework for resilience and its measurement with a novel index, to study how quality of acute medical care to older people is maintained during winter pressures. 2. To validate and map the degree of winter resilience of health and social care systems across England using the index. 3. To determine the structure, culture and processes of acute care systems (across community and hospital health and social care) that are associated with sustained high performance during winter pressures. Methods WP1: Development of an index for resilience in the NHS context (12 months) Narrative review of published and grey literature will be used to identify relevant system measures and interventions indicating preserved quality of care for older people treated in the NHS. Two focus groups with stakeholders will be undertaken to determine a conceptual framework for resilience and to identify resilience measures to use in an index. Methods that have established indices from conceptual frameworks will be followed to develop an index of resilience that is sensitive to health and care outcomes for older people during winter. WP2: Validation of the resilience index and mapping variation in resilience across England (14 months) We will use hospital episode statistics (HES) data of elective surgery during winter to validate the index. A qualitative assessment of publicly available documents and information will also identify positively deviant approaches and describe existing winter pressure strategies and interventions across localities. Findings from WP2 will be presented to stakeholder reference group to select local health systems for in-depth study in WP3. WP3: In depth study of resilient local health systems for acute care of older people (16 months) Mixed methods of quantitative and ethnographic work undertaken by researchers in residence , working with managers, clinicians, commissioners and patient groups in ambulatory care units. Patient and public involvement We will work with older people and their families to guide us in our conduct of the project. This will include determining performance measures, selecting units to study, interpretation of findings and advice on dissemination. Dissemination We will disseminate the research findings to patients, clinicians, professional bodies and, policy makers, as well as publish in academic journals.

Lay abstract: Background The NHS needs to treat people who become suddenly unwell within a very short time frame. However, emergency departments and general practices now see more patients than ever, with people waiting longer to be seen and treated as a result. More hospital beds are also being occupied, particularly during the times of high demand such as during flu season or stomach bug outbreaks. Different healthcare organisations respond to these demands differently. We therefore want to study the impact of these different strategies in ambulatory care units (where people with urgent medical problems are treated without staying overnight in hospital) to learn how best to organise the delivery of healthcare for older adults, and minimise the impact on the NHS services usually seen over the winter months. We discussed our proposal with older people and their carers who expressed a concern for how care services will develop in the future and highlighted that the experience of acute care during periods of intense demand is very challenging, from access to primary care through to the emergency department and general medical wards. They wanted us to find out how we can make this system better all year round. We have designed a project that will help us understand what makes ambulatory care units perform well and meet the unique needs of older adults during periods of acute illness at a time of winter pressures. Research plan We will look at published literature and healthcare data, and work with patients, careers clinicians, managers, social workers and policy makers to determine appropriate measures of healthcare system indicating quality of care for older adults during the times of high demand for care. We will undertake research to describe the existing winter pressure strategies across different healthcare settings and test our chosen measures. Finally, we will select a number of ambulatory care units by their performance on the measures, choosing units with high and low performance. We will then spend time in these different units and talk to health professionals and managers, looking at how they work, so we can learn what makes them perform better or worse than others do. Patient and public involvement During the study, we will work with older people and their families to guide us in our conduct of the project. This will include determining performance measures, selecting units to study, interpretation of findings and advice on dissemination. Dissemination We will disseminate the research findings to patients, clinicians, professional bodies and national societies, policy makers, as well as publish in academic journals.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE