Emergency department admissions among older patients with frailty - a root cause analysis

Background: Acute hospitalizations have shown to be stressful and potentially harmful for older patients, as well as costly at a societal level. Identifying the factors contributing to these admissions is essential for preventing unnecessary hospitalizations among older adults. This study aims to identify the root causes behind acute hospital admissions in frail older patients. Approach: This exploratory study invited patients aged 65 or above to participate in face-to-face interviews during their acute admission at two hospitals in Southern Denmark, conducted between July 2023 and April 2024. Patients receiving home care and home nursing were included, as we assumed these patients were particularly affected by the complexity of their daily lives. The patients provided written consent to contact and invite their relatives, community nurses, and general practitioners to participate in a telephone interview about their experience of collaboration and care during the two weeks before the admission. Data from interviews with patients, relatives, community nurses, and general practitioners were included in a root cause analysis based on the Prevention and Recovery Information System for Monitoring and Analysis (PRISMA) tool. According to the Eindhoven Classification Model, root causes are classified as technical-, organizational-, human- (healthcare worker), and patient-related factors. Results: In total, ten patients, eight relatives, seven nurses, and seven general practitioners were interviewed. Four different perspectives on the same patient pathway highlight varied perceptions and knowledge of the root causes of the acute hospitalization of frail older adults. Preliminary results indicate that these admissions arise from multiple interrelated factors. Identified causes include patient-related factors (e.g., patient's inability to express needs), organizational-related challenges (e.g., inadequate planning, coordination, knowledge transfer, and staff availability), technical-related issues (e.g., incomplete feedback between general practitioners and community nurses), and human-related factors (e.g., limited skills among home care assistants, lack of triage and observation for patient safety, medication administration). The analysis is expected to be finished in May 2025. Implications: This project enhances the understanding of the diverse factors and root causes contributing to the acute hospitalization of frail older adults, as viewed from multiple perspectives. The insights will guide the development of a new research initiative to design and evaluate a user-driven, targeted, interdisciplinary, and cross-sectoral intervention. The goal is to improve transitions between primary care and hospitals, as well as reduce preventable acute hospitalizations among older adults

Acute care · Aged care · Emergency department · Exploratory research · Older people · Root cause · Root cause analysis · Telephone interview · Chronic Disease Management Strategies · Frailty in Older Adults · Intensive Care Unit Cognitive Disorders