INTRODUCTION: After emergency department (ED) discharge, persons living with cognitive impairment (PLWCI) and their care partners are particularly at risk for adverse outcomes. We sought to identify the barriers experienced by care partners of PLWCI during ED discharge care transitions. METHODS: We conducted a qualitative study of 25 care partners of PLWCI discharged from four EDs. We used the validated 4AT and care partner-completed AD8 screening tools, respectively, to exclude care partners of older adults with concern for delirium and include care partners of older adults with cognitive impairment. We conducted recorded, semi-structured interviews using a standardized guide, and two team members coded and analyzed all professional transcriptions to identify emerging themes and representative quotations. RESULTS: Care partners mean age was 56.7 years, 80% were female, and 24% identified as African American. We identified four major barriers regarding ED discharge care transitions among care partners of PLWCI: 1) unique care considerations while in the ED setting impact the perceived success of the care transition, 2) poor communication and lack of care partner engagement was a commonplace during the ED discharge process, 3) care partners experienced challenges and additional responsibilities when aiding during acute illness and recovery phases, and 4) navigating the health care system after an ED encounter was perceived as difficult by care partners. DISCUSSION: Our findings demonstrate critical barriers faced during ED discharge care transitions among care partners of PLWCI. Findings from this work may inform the development of novel care partner-reported outcome measures as well as ED discharge care transition interventions targeting care partners.

中文翻译：

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急诊科护理过渡障碍：对认知障碍老年人护理伙伴的定性研究

简介：急诊科 (ED) 出院后，认知障碍患者 (PLWCI) 及其护理伙伴尤其面临不良后果的风险。我们试图确定 PLWCI 的护理合作伙伴在 ED 出院护理过渡期间遇到的障碍。方法：我们对从四个急诊室出院的 25 名 PLWCI 护理伙伴进行了定性研究。我们分别使用经过验证的 4AT 和护理伙伴完成的 AD8 筛查工具来排除患有谵妄的老年人的护理伙伴，并包括患有认知障碍的老年人的护理伙伴。我们使用标准化指南进行了记录的半结构化访谈，两名团队成员对所有专业转录进行编码和分析，以确定新出现的主题和代表性引语。结果：护理伙伴的平均年龄为 56 岁。7 年中，80% 为女性，24% 被确定为非裔美国人。我们确定了 PLWCI 护理合作伙伴之间 ED 出院护理过渡的四个主要障碍：1) 在 ED 环境中的独特护理考虑会影响护理过渡的感知成功，2) 沟通不畅和护理合作伙伴缺乏参与是在ED 出院过程，3) 护理合作伙伴在急性疾病和康复阶段提供帮助时遇到了挑战和额外的责任，以及 4) 在护理合作伙伴认为遇到 ED 困难后，在医疗保健系统中导航。讨论：我们的研究结果表明 PLWCI 的护理合作伙伴在 ED 出院护理过渡期间面临的关键障碍。