Amsterdam UMC, University of Amsterdam, Emergency Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands.
Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health, Meibergdreef 9, Amsterdam, Netherlands.
BMC Public Health. 2021 Sep 20;21(1):1709. doi: 10.1186/s12889-021-11755-z.
Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to describe older patients' perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits.
This was a qualitative description study. We performed semi-structured individual interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached.
In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients' untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit.
This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.
由于医疗复杂性，老年患者在急诊科（ED）有很高的计划外复诊风险。为了减少 ED 就诊次数，我们需要更多了解患者层面、环境和医疗保健因素。本研究旨在描述 ED 就诊前后老年患者的观点和体验，并确定可能导致频繁 ED 复诊的因素。
这是一项定性描述研究。我们使用目的抽样法，在大学医疗中心的 ED 中招募了经常就诊但急性就诊后出院回家的老年患者，对其进行半结构化个体访谈。访谈由两名研究人员独立记录、转录和编码。使用理论分析来识别数据中的重复模式和主题。直到达到主题饱和度为止，我们持续进行访谈。
对 13 名老年患者进行了深入访谈。出现了三个主要主题：1）导致危机感的医疗事件，2）患者未治疗的健康问题，3）出院后健康和日常功能的持续问题。参与者确定了在 ED 就诊前后可能导致再次就诊的问题。这些问题包括症状加重导致危机感、与全科医生的关系、ED 出院信息不完整以及 ED 就诊后随访和康复不足。
这项定性研究确定了可能导致老年患者频繁就诊 ED 的多个因素。需要急性护理的老年患者可能受益于医院居家干预，或在初级保健环境中由老年急诊团队提供的急性护理。在 ED 中识别脆弱性以改善出院沟通，并需要适当的随访以改善急性 ED 就诊后的康复。
