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. 2022 Apr;13(2):339-350.
doi: 10.1007/s41999-021-00581-6. Epub 2021 Nov 10.

Experiences and perspectives of older patients with a return visit to the emergency department within 30 days: patient journey mapping

Bo Schouten #  1 , Babiche E J M Driesen #  2 , Hanneke Merten  3 , Brigitte H C M Burger  4 , Mariëlle G Hartjes  4 , Prabath W B Nanayakkara  4 , Cordula Wagner  3   5
Affiliations

Experiences and perspectives of older patients with a return visit to the emergency department within 30 days: patient journey mapping

Bo Schouten et al. Eur Geriatr Med. 2022 Apr.

Abstract

Purpose: Up to 22% of older patients who visit the emergency department (ED) have a return visit within 30 days. To achieve patient-centered care for this group at the ED it is important to involve the patient perspective and strive to provide the best possible experience. The aim of this study was to gain insight into the experiences and perspectives of older patients from initial to return ED visit by mapping their patient journey.

Methods: We performed a qualitative patient journey study with 13 patients of 70 years and older with a return ED visit within 30 days who presented at the Amsterdam UMC, a Dutch academic hospital. We used semi-structured interviews focusing on the patient experience during their journey and developed a conceptual framework for coding.

Results: Our sample consisted of 13 older patients with an average age of 80 years, and 62% of them were males. The framework contained a timeline of the patient journey with five chronological main themes, complemented with an 'experience' theme, these were divided into 34 subthemes. Health status, social system, contact with the general practitioner, aftercare, discharge and expectations were the five main themes. The experiences regarding these themes differed greatly between patients. The two most prominent subthemes were waiting time and discharge communication, which were mostly related to a negative experience.

Conclusions: This study provides insight into the experiences and perspectives of older patients from initial to return ED visit. The two major findings were that lack of clarity regarding waiting times and suboptimal discharge communication contributed to negative experiences. Recommendations regarding waiting time (i.e. a two-hour time out at the ED), and discharge communication (i.e. checklist for discharge) could contribute to a positive ED experience and thereby potentially improve patient-centered care.

Keywords: Emergency/acute medicine; Older patients/aged; Patient journey mapping; Patient perspective; Patient-centered care.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no conflict of interests.

Figures

Fig. 1
Fig. 1
Conceptual frame work—coding tree
Fig. 2
Fig. 2
Visual representation of the patient journey of older people with a return ED visit within 30 days. *The upper part of the figure is a visual representation of the trajectory. The lower part incorporated the positive and negative experiences and medical characteristics per phase, in which the numbers represent the number of patients who voiced their experience regarding a subtheme. The numbers do not add up to 13 as one patient could mention multiple subthemes
See this image and copyright information in PMC

References

    1. (2013) Policy statement. Ann Emerg Med 61(6):726–727. 10.1016/j.annemergmed.2013.03.037. ISSN 0196-0644 - PubMed
    1. Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: a systematic review of causes, consequences and solutions. PloS One. 2018;13(8):e0203316. doi: 10.1371/journal.pone.0203316. - DOI - PMC - PubMed
    1. Pines JM, Griffey RT. What we have learned from a decade of ED crowding research. Acad Emerg Med Off J Soc Acad Emerg Med. 2015;22(8):985–987. doi: 10.1111/acem.12716. - DOI - PubMed
    1. NZa (2019) Monitor acute zorg 2018. Nederlandse Zorgautoriteit 2019
    1. Legramante JM, Morciano L, Lucaroni F, Gilardi F, Caredda E, Pesaresi A, et al. Frequent use of emergency departments by the elderly population when continuing care is not well established. PloS One. 2016;11(12):e0165939. doi: 10.1371/journal.pone.0165939. - DOI - PMC - PubMed