Claire O’Brien, Laura Hogan, Peter Ward, William Howard, Rebecca Mooney, Paul Bernard and Grace Corcoran
Emergency Department (ED) presentations in older people are associated with a wide range of adverse events, which increase the risk of lengthy hospitalisation and poor outcomes…
Abstract
Purpose
Emergency Department (ED) presentations in older people are associated with a wide range of adverse events, which increase the risk of lengthy hospitalisation and poor outcomes. Pathfinder is an inter-organisational initiative delivered in partnership between Beaumont Hospital Occupational Therapy and Physiotherapy departments and the National Ambulance Service. Pathfinder responds to non-serious and non-life-threatening emergency medical service (EMS) calls. This study aims to demonstrate how Pathfinder can safely treat a proportion of older people at home by using alternative care pathways (ACPs), therefore avoiding unnecessary ED presentations. Once a decision has been reached to treat the person at home, the Pathfinder follow-up team delivers functional rehabilitation and case management in the persons’ home over the subsequent days.
Design/methodology/approach
This paper outlines the Pathfinder assessment, management and interventions in one clinical case example. Outcome measures include the level of patient satisfaction obtained via routine telephone feedback questionnaire and re-presentation to Beaumont Hospital within 30 days.
Findings
This paper illustrates through a case example the benefit of a collaborative multi-disciplinary rapid response team for non-serious and non-life-threatening EMS calls in older adults. The patient in this case example had no further EMS calls or ED presentations for 30 days after Pathfinder intervention and reported a high level of satisfaction with the service.
Research limitations/implications
ED presentation was avoided through comprehensive multi-disciplinary assessment, including immediate access to intensive follow-up support in the person’s own home.
Practical implications
The Pathfinder service is improving access to ACPs for older people in the Beaumont Hospital catchment area. Pathfinder will now be spread nationally, with local adaptation, so that older people in other parts of Ireland will also benefit from this integrated model of care.
Originality/value
Patient feedback surveys confirm older adults want access to alternative care pathways.
Details
Keywords
Paul R. Carlile, Steven H. Davidson, Kenneth W. Freeman, Howard Thomas and N. Venkatraman
Shani Pindek, David J. Howard, Alexandra Krajcevska and Paul E. Spector
Surprisingly, most studies have failed to demonstrate a strong correlation between organizational constraints (conditions at work that make doing a job difficult) and job…
Abstract
Purpose
Surprisingly, most studies have failed to demonstrate a strong correlation between organizational constraints (conditions at work that make doing a job difficult) and job performance. The purpose of this paper is to challenge the view that constraints are a direct barrier on performance and take an alternative approach whereby constraints have an indirect effect via decreased motivation and increased workload. Further, differential effects of various constraints are examined.
Design/methodology/approach
Qualitative and quantitative data were collected from 660 engineers licensed in the state of Florida using a single online survey.
Findings
Qualitative results showed that the most commonly experienced constraints were from coworkers and organizational rules and procedures. Constraints identified as having a greater detrimental effect on motivation are from the supervisor, and organizational rules and procedures. Quantitative results supported an indirect effects model that includes an indirect path via motivation, and a path via workload, which had a curvilinear component.
Originality/value
This is one of few studies to explain the relationship between constraints and performance, rather than simply estimate it. The use of mixed methods allows us to gain an in-depth understanding of constraints, and the convergence of findings across the methods increases confidence in this study’s results.
Details
Keywords
Paul R. Carlile, Steven H. Davidson, Kenneth W. Freeman, Howard Thomas and N. Venkatraman