Strengths and limitations
hip fracture, cognitive impairment
SIL, RECRUITMENT
Our study benefits from multiple sources of data collected from a variety of stakeholders to examine implementation. Data collection involved PPI acting as co-interviewers. Data encompassed several cycles of implementation, obtaining a comprehensive view of the changes over time, processes of implementation, network usage and the role of contextual factors in implementation. Considering the challenges involved when caring for patients with hip fracture and cognitive impairment and the consequent variability in the quality of care,Limitations to this study include its reliance on SIL-generated data and most patients and carers being unable to compare usual and ‘enhanced’ care. Patient recruitment for interviews was difficult due to the levels of cognitive impairment, resulting in few patient participants. Most relatives interviewed were one generation younger than the patients, consequently their opinions regarding hospital care may differ. Additionally, staff members who participated in interviews or focus groups may have been those more open to the intervention and to change. The PERFECT-ER intervention required SILs to complete the checklist from individual patient documentary evidence to which researchers did not have access, to provide validation or incorporate assessments of inter-rater reliability. There may have also been inconsistency in intervention scoring. Although participants reported improved standardisation of practices, we cannot ascertain if the indicated implementation reflected change in care delivery, documentation practices or, in some cases, SIL self-implementation. Lastly, this evaluation was of a feasibility, not efficacy trial,