Here is the structured PICO analysis for the twenty-seventh article you uploaded:
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Full Title (verbatim and exact):
“A rapid response and treatment service for care homes: a case study”
Waldon M
British Journal of Community Nursing (2021); 26(1):6–12
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Type of Article:
Descriptive case study report with service evaluation elements
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PICO Analysis:
Population:
- Older adults living in residential and nursing care homes (n = ~2400 across 51 homes) in Berkshire West, UK
- Residents were typically frail, with multiple comorbidities, including those at risk of:
- Delirium, COPD exacerbation, falls, UTIs, dehydration, or suspected sepsis
Intervention:
- The Rapid Response and Treatment (RRaT) service, an integrated, nurse-led hospital avoidance model providing urgent assessment and treatment for care home residents at risk of deterioration
- Key features:
- Operates 365 days/year, 9am–7pm
- Responds within 2 hours to referrals
- Advanced nurse practitioner-led, with access to GPs, geriatricians, physiotherapists, pharmacists, and OTs
- Uses Comprehensive Geriatric Assessment (CGA)
- Provides IV/SC fluids, IV antibiotics, nebulisers, blood tests, and case reviews at the care home
- Works closely with out-of-hours services and the ambulance service
Comparator:
- Standard emergency referral pathways without RRaT involvement (i.e., care home → ED via 999 call or GP out-of-hours)
- The article implicitly compares the RRaT approach to hospital admissions avoided in similar cases
Outcome:
1. Person-centred outcomes:
- Illustrated in a detailed case study (“Sid’s story”):
- Sid avoided hospital admission for suspected sepsis and COPD exacerbation
- Received IV antibiotics, fluids, and regular review in the care home
- Expressed wish to remain at home, respected through ACP and updated ReSPECT form
- Family satisfaction was high, with involvement in decision-making
- Outcome: Full recovery with improved comfort and dignity, aligned with patient’s goals
2. Process outcomes:
- Hospital admissions avoided due to early response and intensive in-home care
- Care continuity maintained through MDT review and OOH handover (e.g., Adastra database)
- Timely escalation with proactive support for:
- Advanced care planning (ACP)
- End-of-life planning
- Medication optimisation
- The article notes a tripling of referrals during COVID-19, largely managed within care homes
3. Health system outcomes:
- Reduces burden on acute hospitals
- Supports early discharge and prevents emergency readmissions
- Aligns with NHS England’s Ageing Well programme and Enhanced Health in Care Homes (EHCH) framework
- Provides a scalable model for other regions or domiciliary (home) settings
- Emphasises cultural shift needed to deliver acute care “in place” for frail older people
Summary Conclusion:
This case study describes a highly effective Rapid Response and Treatment (RRaT) service for older people in Berkshire West care homes, illustrating how acute-level care—including sepsis treatment—can be delivered within the residential setting. The model supports hospital avoidance, person-centred decision-making, and end-of-life care aligned with patient values. With the COVID-19 pandemic accelerating its uptake, the RRaT service serves as a model of community-based hospital-at-home principles. Expansion of this model under the NHS Ageing Well programme is likely to benefit older people wishing to remain in familiar surroundings during health crises.
Life In The Slower Lane 
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