Nursing research in profile
Fry M Elliott R Curtis K Fitzpatr ick L Groth R Murphy S Jones K Hofman C 2021 Family members’ perceptions of older person discharge from emergency departments. International Journal of Older Person Nursing 18/01/2021 DOI: 10.1111/opn.12365
Aim
The aim of this study was to explore older people’s family experience of ED discharge practices to inform alternative or innovative new models of care. The design was a multi-centre cohort study involving people aged over 64 years whom account for approximately 20% of emergency adult presentations with up to 60% of patients discharged home from Emergency Departments (ED). Many older people discharged home are supported by family. A convenience sample of family members were recruited from three EDs across Sydney New South Wales. Telephone interviews were conducted over a six-month period.
Results
Interviews were conducted with 133 family members of whom the majority were female (n=80, 60%) with a median age of 70 years (IQR 91-35). The majority (n=129, 97%) of family members reported that they understood the treatment, medical management and perceived that the older person’s condition was well managed (n=119, 86%). The majority (n=114, 86%) of family members reported being informed of the patient’s medical diagnosis and were confident (87%, n=115) to continue care of the older person at home. Over 87% of families were satisfied with care and discharge processes. Yet for some family members (n=40, 30%) the ED experience was not positive with three key themes to emerge from data: i) a sense of time - moving through ED; ii) Giving voice to the impact of clinician communication; and iii) the delivery of comfort and basic care.
Key points
Many family members reported a positive discharge experience, compliance with discharge advice, satisfaction with the emergency experience and were confident to continue home care. Elements of discharge communication, delivery of fundamental care and enduring the ED wait was suboptimal for some family members. Family members can support the discharge process, compliance with discharge advice, and confidence of the older person to better self-manage home care. Elements of discharge communication, delivery of fundamental care and enduring the ED wait was suboptimal for some family members and the older person. Discharge processes need to accommodate the older person with disabilities and/or comorbidities to optimise safety and self-management at home. Optimising authentic engagement with family members and the older person will better optimise health outcomes for those patients discharged home. Discharge practices need to be better communicated between clinical teams to improve efficiency, safety and quality of care.
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