A Process Evaluation Exploring the Delivery of a CGA-Based Intervention in the ED: The SOLAR RCT

Background Evidence to support the delivery of CGA, to improve the care of older adults in ED, is encouraging but limited. The SOLAR trial is the first of its kind to explore this ED intervention. The trial process and delivery were underpinned by the development of a complex trial protocol, facilitation of stakeholder involvement and Multidisciplinary team (MDT)-based collaboration. The aim of this study was to utilise a mixed methods approach to explore the delivery of this trial. Methods Using the Medical Research Council (MRC) Framework, we investigated the trial design, implementation and delivery. Mechanisms of impact and contextual influences were explored by analysing participant recruitment logs, team activity logs and by interviewing SOLAR MDT members and trial participants. Qualitative insights were mapped to the theoretical domains framework (TDF) to inform implementation strategies. Results Clinical knowledge and experience is vital when delivering CGA to a complex heterogenous group in the ED. This approach is time consuming and needs to be delivered by skilled and highly motivated professionals who build positive relationships and foster a multidisciplinary and patient-centred ethos. To facilitate implementation, establishing preconditions to screening processes and involving relevant stakeholders in pre-implementation processes can facilitate acceptance of intervention operations. Conclusion This is the first evaluation to provide in-depth insights from both trial participants and the MDT trial team. Findings provide practical insights into the value of consistent stakeholder involvement when delivering a complex intervention. The importance of establishing a knowledgeable and highly skilled MDT team to successfully deliver CGA was emphasised. Experience in delivering complex care to a heterogenous group of older adults in the ED is vital to underpin this care and ensure CGA integration into current ED processes, this was recognised by both older adults and the trial team. A collaborative approach to CGA delivery ensured that participants had positive experiences throughout the trial.