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.

中文翻译：

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老年患者对急诊频繁就诊因素的看法：一项定性访谈研究

由于医疗复杂性，老年患者很容易意外再次到急诊科 (ED) 就诊。为了减少急诊就诊次数，我们需要更多地了解所涉及的患者水平、环境和医疗保健因素。本研究的目的是描述老年患者就诊前后的观点和经历，并确定可能导致频繁再次就诊的因素。这是一项定性描述研究。我们对经常去急诊室就诊并在急性就诊后出院回家的老年患者进行了半结构化的个人访谈。患者在大学医疗中心的急诊部使用有目的的抽样进行登记。采访由两名研究人员独立记录、转录和编码。理论分析用于识别数据中重复出现的模式和主题。访谈一直进行到主题饱和为止。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) 患者未经治疗的健康问题，以及 3) 出院后持续存在的健康和日常功能问题。参与者在他们的急诊就诊前后确定了可能导致进一步急诊就诊的问题。这些问题包括导致危机感的症状增加、与全科医生的关系、急诊室出院信息不完整以及急诊室就诊后随访不充分和缺乏恢复。这项定性研究确定了可能导致老年患者频繁就诊的多种因素。需要急症护理的老年患者可能会受益于在家住院干预或初级护理环境中老年急诊团队提供的急症护理。需要识别 ED 的虚弱状况以改善出院沟通，并且需要充分的随访以改善急诊就诊后的恢复。