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Perceptions of frailty pathway implementation in an acute setting among healthcare professionals: a qualitative study
Rebecca Hui Shan Ong1, Jin Wee Ng2, Fuyin Li3
1Health Services Research, SingHealth, Changi General Hospital, Singapore, Singapore. Rebecca.ong.h.s@singhealth.com.sg.
Background:
Frailty is prevalent among older inpatients and is associated with poor outcomes. Hospital frailty pathways are structured approaches to identify, assess, and manage frailty in acute care, and can potentially improve patient outcomes, but they require adaptation to the local context for successful implementation. This study explored healthcare professionals' perspectives on implementing a frailty pathway in a tertiary acute-care hospital in Singapore.
Methods:
A qualitative study was conducted using focus group discussions with healthcare professionals from diverse disciplines involved in older adult care at a tertiary hospital. Participants were recruited by purposive sampling. The semi-structured topic guide and template thematic analysis were informed by the updated Consolidated Framework for Implementation Research (CFIR 2.0). Findings were presented narratively, organised by CFIR 2.0 domains and constructs.
Results:
Seven focus groups (n = 41 participants: physicians, nurses, and allied health) were conducted. Facilitators included the perceived credibility and compatibility of the frailty pathway, supportive leadership and teams, tailored staff education, dedicated infrastructure, recognition of frailty as a growing population need, caregiver involvement, community partnerships, interdisciplinary collaboration, and availability of financial resources. Barriers included complex and ambiguous processes, caregiver burden, delirium complicating care, competing clinical priorities, staffing and equipment constraints, sociocultural and health literacy challenges, and financial constraints.
Conclusions:
Implementing frailty pathways in acute hospitals requires addressing structural and cultural barriers while leveraging key enablers such as multidisciplinary collaboration, targeted staff training, caregiver involvement, and integration with community care services. Focusing on these factors may enhance uptake of frailty pathways into acute care settings.
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