SAFE: Systematic Approach to improving care for Frail Older patients

The project is funded by Health Research Board (HRB) and St. Vincent's University Hospital (SVUH). Programme: Applied Partnership Awards (APA)

Project's duration: 07-Nov-16 to 30-Apr-19

View our SAFE Patient Safety Conference poster     I     View our SAFE Integrated Care Poster

View our new paper published:

  1. Macdonald SH-F, Travers J, Ní Shé É, Bailey J, Romero-Ortuno R, Keyes M, et al. (2020) Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis. PLoS ONE 15(2): e0228821.
  2. O’Donnell, D., Ní Shé, É., McCarthy M., et al., Enabling Public, Patient and Practitioner Involvement by Co-Designing Frailty Pathways in Acute Care Settings. BMC Health Services Research 2019
  3. O'Mahony, E., Ní Shé, É., et al., Using Geographic Information Systems to map older people’s emergency department attendance for future health planning. BMC Emergency Medicine, 2019
  4. Macdonald, S. Gray, S. et al.,Screening for Frailty in the Emergency Department: Comparison of Tools, Age and Ageing, Volume 48, Issue 3, 2019, Pages iii1–iii16,
  5. Macdonald, S. Travers, J. et al., Meta-analysis of Primary Care Interventions to Address Frailty Among Adults Aged 65+, Age and Ageing, Volume 48, Issue Supplement_3, 2019, Pages iii17–iii65,
  6. Travers, J. Romero-Ortuno, R. Bailey, J.   Cooney, M-T. Delaying and reversing frailty: a systematic review of primary care interventions.Br J Gen Pract 2019; 69 (678): e61-e69. DOI: 10.3399/bjgp18X700241
  7. Éidín Ní Shé, Fiona Keogan, Eilish McAuliffe, Diarmuid O'Shea, Mary McCarthy, Rosa McNamara, Marie Therese Cooney (2018) 'Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway'. International Journal of Environmental Research and Public Health, 15 (199). doi:10.3390/ijerph15020199
  8. Ní Shé, É, McCarthy M, O'Donnell D et al. The systematic approach to improving care for Frail Older Patients (SAFE) study: A protocol for co-designing a frail older person’s pathway. HRB Open Res, 2018: 1:9
  9. Ní Shé, É., Keoghan, F. et al., What Works in Implementing a Frail Older Person’s Pathway? A Rapid Realist Review of the Literature, Age and Ageing, Volume 47, Issue suppl_5, 1 September 2018, Pages v13–v60
  10. O’Donnell, D., Ní Shé, É., McCarthy, M., et al., The Three Ps of Co-Designing Person-Centred Care for Frail Older People in Acute Care Settings: Public, Patient and Practitioner Involvement, Age and Ageing, 2018 Volume 47, Issue suppl_5, 1 September 2018, Pages v13–v60,
  11. Gray, S.  Hervas, J.A…Ní Shé, É. et al., Delivering on Patient Centred Outcomes: The Case for intentional Rounding, Age and Ageing, 2018; Volume 47, Issue suppl_5, 1 September 2018, Pages v1–v12


Much recent attention has focused on the problem of older people being treated in overcrowded emergency departments. Studies have clearly demonstrated an association between hospitalisation in older people and poorer outcomes, including loss of independence, admission to long-term care and mortality. Recent national strategy documents relating to the care of older people and emergency department management have stressed the importance of alternative models of care for frail older patients which prevent complications by avoiding or reducing hospital admissions where possible and support patients in the community enabling them to live independently for longer.

The SAFE project aims to explore current problems with care pathways for older people presenting to SVUH. A best practice pathway for the care of frail older people in acute hospitals will be developed. Substantial input for this will come from a patient and public involvement group who will ensure that patient priorities and perspectives will drive the development of the care pathway ensuring that this model of care will achieve outcomes that are important to patients/families.

Co-Design Partnership

A strong partnership has been developing between UCD researchers (School of Medicine and School of Nursing, Midwifery and Health Systems) and knowledge users at St Vincent’s University Hospital (SVUH) along with collaborators in the community, rehabilitation facilities and patient advocacy groups. Public and Patient Involvement is central to this project.  Our PPI partners are involved in the co-design of the improved pathways for delivery of care to frail elderly patients in acute hospitals, building on the acute frailty unit model, with PPI as a central tenet enabling the development of a truly patient-centred evidence-based and integrated model of care. Our PPI partners are:

·       Mary McCarthy and Thelma Doran-Older Peoples Empowerment Network (OPEN);

·       Ms Anne Donnellan- Glór and Age Action

·       Freda Smith, Jim Milton a Padraig Ruane, Bibiana Savin, and Barry O'Brien-Support and Advocacy Service For Older People (SAGE)

·       Eugene Callan- Disability Federation of Ireland (DFI)

·       Shirley Thornton- Family Carers Ireland (FCI)