Co-designing a frailty care pathway in the emergency department: integrating patient, carer and multidisciplinary perspectives through mixed-method service evaluation

Abstract

Purpose Emergency departments (EDs) increasingly operate at the interface between acute care, Hospital at Home (H@H) and community services for frail older adults. Despite this, frailty care in EDs often remains fragmented, time-pressured and insufficiently aligned with patient and carer priorities. This study aimed to co-design an integrated frailty care pathway for the ED that supports continuity across the ED, H@H and community services, incorporating patient, carer and multidisciplinary staff perspectives. Design/methodology/approach A mixed-methods service evaluation was conducted in a large UK tertiary hospital ED with established H@H services. Quantitative patient and carer surveys (n = 52) explored experiences of ED care, including communication, involvement, kindness and respect. Qualitative data were generated through staff co-design workshops and patient and carer engagement activities. Appreciative inquiry and co-design principles guided data analysis and pathway development. Findings Survey findings demonstrated consistently positive experiences overall, with kindness and involvement strongly associated with patient experience and kindness the strongest independent correlate in the multivariable model. Qualitative analysis identified four themes: challenges in current frailty care, what matters to patients and carers, co-designing a responsive frailty pathway and organisational learning and culture. Across data sources, participants prioritised clear communication, compassionate care, a calm environment, meeting basic needs and meaningful carer involvement. These convergent findings informed the co-design of a frailty pathway that explicitly addresses coordination among ED, H@H and community services, including communication across transitions, carer engagement and shared care planning. Practical implications The study demonstrates that co-design is feasible within a time-pressured ED and can support integrated frailty care across acute, H@H and community pathways. The resulting pathway offers a practical, transferable model to improve continuity, experience and person-centred care for frail older adults. Originality/value This study provides a pragmatic example of operationalising integrated care principles across ED and H@H interfaces through participatory service design.

The authors' abstract, as published at the source. Journal of Integrated Care, 2026 · DOI ↗