van den Broek Steef, Roordink Marije, Willems Odette, Sir Özcan, Westert Gert P, Hesselink Gijs, Schoon Yvonne
Department of Emergency Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
Department of Emergency Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
BMJ Open. 2025 Jan 2;15(1):e088972. doi: 10.1136/bmjopen-2024-088972.
Older adults are prone to unplanned emergency department (ED) return visits (URVs). Knowledge about patient perspectives on the preventability and reasons for these URVs is limited and lacks a representable ED study population. This study aims to determine the proportion of URVs and to explore the preventability and underlying causes as perceived by a wide range of older adults and their caregivers.
A multicentre mixed-methods study.
The ED of one academic and one regional hospital in the Netherlands.
Patients aged ≥70 years with a URV within 30 days after the index ED visit, consecutively sampled during a 6-week period.
Quantitative data regarding patient and clinical characteristics and perceived preventability of a URV were prospectively collected and analysed using descriptive statistics. Underlying causes of a URV were collected by semistructured interviews with patients and caregivers. Thematic content analysis was used to analyse the interview transcripts.
Out of 1291 patients of 70 years and older, 151 patients had a URV (11.7%). In total, 64 patients were included after informed consent (42.4%). A total of 33 patients (51.5%) found their URV preventable. Perceived causes for a URV were categorised in six themes: (1) suboptimal treatment of health complaints, (2) premature hospital discharge, (3) poor assessment and arrangement of postdischarge needs, (4) patient and caregiver behaviour, (5) lack of advance care planning and insight in treatment options and (6) deficits in general practitioner care.
Our high rate of preventable URVs (51.5%) perceived by patients and caregivers underscores the importance to reduce URVs among older adults. Perceived causes in this study add other unexplored themes to the existing knowledge and create support for further research and interventional opportunities.
老年人容易出现急诊科（ED）非计划复诊（URV）。关于患者对这些URV的可预防性及原因的看法的了解有限，且缺乏具有代表性的急诊科研究人群。本研究旨在确定URV的比例，并探讨广大老年人及其照护者所认为的可预防性及潜在原因。
一项多中心混合方法研究。
荷兰一家学术医院和一家地区医院的急诊科。
年龄≥70岁且在首次急诊科就诊后30天内出现URV的患者，在6周期间连续抽样。
前瞻性收集并使用描述性统计分析有关患者和临床特征以及URV可预防性的定量数据。通过对患者和照护者进行半结构化访谈收集URV的潜在原因。采用主题内容分析法分析访谈记录。
在1291名70岁及以上的患者中，151名患者出现了URV（11.7%）。在获得知情同意后，共纳入64名患者（42.4%）。共有33名患者（51.5%）认为他们的URV是可预防的。URV的可感知原因分为六个主题：（1）对健康问题的治疗不充分，（2）过早出院，（3）出院后需求评估和安排不佳，（4）患者和照护者行为，（5）缺乏预先护理计划以及对治疗选择的了解，（6）全科医生护理不足。
患者和照护者认为我们的可预防URV发生率较高（51.5%），这凸显了减少老年人URV的重要性。本研究中可感知的原因在现有知识基础上增加了其他未探索的主题，并为进一步研究和干预机会提供了支持。
