Sharing Frailty-related Information in Perioperative Care: An Analysis from a Temporal Perspective

Daniel Fürstenau, Claudia Spies, Martin Gersch, Amyn Vogel, Rudolf Mörgeli, Akira-Sebastian Poncette, Ursula Müller-Werdan, Felix Balzer*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: Especially patients older than 65 years undergoing surgery are prone to develop frailty-related complications that may go far beyond the index hospitalization (e.g., cognitive impairment following postoperative delirium). However, aging-relevant information are currently not fully integrated into hospitals' perioperative processes. Methods: We introduce a temporal perspective, which focuses on the social construction of time, to better understand existing barriers to the exchange of frailty-related data, targeting complexity research. Our chosen context is perioperative care provided by a tertiary hospital in Germany that has implemented a special track for patients over 65 years old undergoing elective surgery. The research followed a participatory modelling approach between domain and modelling experts with the goal of creating a feedback loop model of the relevant system relationships and dynamics. Results: The results of the study show how disparate temporal regimes, understood as frameworks for organizing actions in the light of time constraints, time pressure, and deadlines, across different clinical, ambulant, and geriatric care sectors create disincentives to cooperate in frailty-related data exchanges. Moreover, we find that shifting baselines, meaning continuous increases in cost and time pressure in individual sectors, may unintentionally reinforce - rather than discourage - disparate temporal regimes. Conclusions: Together, these results may (1) help to increase awareness of the importance of frailty-related data exchanges, and (2) impel efforts aiming to transform treatment processes to go beyond sectoral boundaries, taking into account the potential benefits for frail patients arising from integrated care processes using information technology.

Original languageEnglish
Article number105
JournalBMC Health Services Research
Volume19
Issue number1
Number of pages11
ISSN1472-6963
DOIs
Publication statusPublished - 7 Feb 2019
Externally publishedYes

Keywords

  • Critical care
  • Frailty
  • Geriatric medicine
  • Health data exchange
  • Information technology
  • Intensive care medicine
  • Perioperative care
  • Temporal dynamics

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