Table 1 Barrier Analysis Determined by Interviews and Focus Groups with a Multi-faceted Intervention to Overcome these Barriers
Barriers | Intervention | Description |
|---|---|---|
Individual: | Â | Â |
Access to and working knowledge of guideline recommendation | Referral pathway with resources and education | - A referral pathway adapted to local services was developed - A single education session was delivered to CCT with a pathway, neck pendant and resource folder including prefilled referrals |
Overly optimistic about performance | Audit and feedback to CCT | - Audit and feedback was provided on two occasions to CCT staff with key performance indicators presented and discussion about how to improve care |
Group: | Â | Â |
Lack of time Overlapping roles in ED Unclear after hours processes | CCT role clarified during review of processes for ED fallers | - Processes revised to avoid blocks in patient flow - Agreement that CCT would prioritize and have primary responsibility to refer ED fallers - CCT physiotherapy and OT to take lead referral role - Process for daily screening of patients presenting after hours with subsequent follow-up telephone calls |
Lack of peer support | New "OT falls specialist" role | - OT falls specialist role provided feedback and mentoring |
Organizational: | Â | Â |
Increased workload for existing services No community-based exercise programme | Expansion of falls services | - Geriatric Medicine Department employed an OT falls specialist and increased geriatrician time - Community-based group exercise program commenced |