JMIR Publications

ABSTRACT

Background:

Frailty constitutes a growing challenge for health and social care systems around the world. In England, 35% of adults aged 65 and over live with frailty, with international estimates indicating that almost half of all hospital inpatients within the same age group are frail. This population often experience multimorbidity and frequent care transitions. Written documentation and verbal handovers may lack the precision and nuance required to understand an older adult’s presentation and support needs. Video-recordings of individual patients, capturing aspects of their functional abilities and condition, may help to enhance multidisciplinary team communication and care continuity, yet little is known about their use in the care of older inpatients with frailty.

Objective:

We aimed to evaluate the acceptability, feasibility of implementation, and perceived effectiveness of video-based patient records (the Isla Health Digital Pathway Platform) for supporting the assessment and care of older inpatients with frailty within the acute hospital setting.

Methods:

A non-randomized mixed-methods pilot study was conducted within three acute medicine wards for older adults. The video-based patient records intervention, permitting videos to be embedded securely within the electronic patient record, was implemented over a three-month period alongside usual care. Patient enrollment and retention figures; qualitative interviews with patients, carers, and clinical staff; and video capture and view metrics were used to address study objectives. The Theoretical Framework of Acceptability of Healthcare Interventions was applied to the framework analysis of interview data, capturing concepts such as intervention ethicality, burden, and coherence. Patient and public involvement and engagement informed each research stage.

Results:

Twenty-nine patients were enrolled (56.9%); one patient withdrew before receiving the intervention. Modal reasons given by patients for non-participation included not wanting to take part in research (n = 8) or feeling too unwell (n = 2). Staff identified multiple opportunities for capturing patient videos, including documentation of mobility assessments or seizures. The intervention was considered acceptable, on the grounds that safeguards were always in place, including secure data storage and upholding of patient dignity. Implementation barriers and facilitators were identified; factors such as difficulties in capturing videos within busy ward environments and scheduling issues were voiced by participants. Video view metrics and data from interviews collectively suggested low rates of engagement with videos by clinical staff once captured. Potential intervention impacts included perceived enhancements to clinical assessment and person-centered care.

Conclusions:

Our findings suggest that the intervention is largely acceptable to patients, carers, and clinical staff. Conclusions as to intervention feasibility were mixed, with limited engagement with videos suggesting further work is required to promote sufficient uptake amongst staff. Finally, this research presents promising patient, carer, and clinical opinion as to the potential effectiveness of video-based patient records for improving aspects of patient care. Clinical Trial: ClinicalTrials.gov: NCT06504641