A 4-Bed Close-Observation Pod model of multidisciplinary care in hospital: A mixed methods study

Aims and objectivesTo examine activity, experiences, and outcomes of a 4-bed Close Observation Pod model of multidisciplinary care for patients, carers, and staff. This model provides additional surveillance by an assistant in nursing to support vulnerable older patients with cognitive or physical impairments at risk of hospital-acquired complications.DesignConcurrent mixed method design.MethodsData collection concluded in 2018 and entailed: (1) A retrospective cohort study of 12 months of patient outcome data; (2) Semi-structured interviews with manifest content analysis to describe the experiences of patients, carers, and staff, and (3) Cross-observational study with behavioural mapping to observe physical, social, and cognitive activity.ResultsPatients admitted to a 4-bed Close Observation Pod had significantly lower odds of falls than the control group; but were more than four times as likely to experience other adverse complications (pneumonia, delirium, pressure injuries, medical emergency team, personal threat) than those in the control group. The 4-bed Pod resulted in qualitatively perceived benefits of socialisation and monitoring for safety, but challenges of privacy, noise, staffing characteristics, and conflicting expectations. Patients were observed to have high levels of sedentary behaviour, spending on average only 34.7% of the observed time engaging in physical (18%), cognitive (5%), or social activity (15%).ConclusionComplex older patients provided with a close observation model of multidisciplinary care, where additional surveillance is provided by an assistant in nursing, were observed to experience lower odds of falls but higher rates of other potentially preventable complications, and high levels of sedentary behaviour.