Early re-presentation to hospital after discharge from an acute medical unit: perspectives of older patients, their family caregivers and health professionals
Article first published online: 10 JAN 2013
© 2013 Blackwell Publishing Ltd
Journal of Clinical Nursing
Volume 22, Issue 3-4, pages 445–455, February 2013
How to Cite
Slatyer, S., Toye, C., Popescu, A., Young, J., Matthews, A., Hill, A. and Williamson, D. J. (2013), Early re-presentation to hospital after discharge from an acute medical unit: perspectives of older patients, their family caregivers and health professionals. Journal of Clinical Nursing, 22: 445–455. doi: 10.1111/jocn.12029
- Issue published online: 10 JAN 2013
- Article first published online: 10 JAN 2013
- Manuscript Accepted: 5 AUG 2012
- Edith Cowan University Industry Collaboration Scheme
- Sir Charles Gairdner Hospital. Grant Number: 06-189
- acute medical unit;
- discharge planning;
- family caregivers;
- geriatric nursing, palliative care;
- older people;
- qualitative research
Aims and objectives
To explore the perceptions of older patients who re-presented to hospital within 28 days of discharge from an acute medical unit (AMU), their family caregivers and appropriately experienced health professionals.
Hospitals are increasingly using AMUs to provide rapid assessment and treatment for medical patients. Evidence of efficacy is building, however in-depth exploration of the experiences of older patients who re-present to hospital soon after discharge from an AMU, and those who care for them, appears to be lacking.
A qualitative, descriptive design was used.
In 2007, our team purposively sampled older patients who re-presented to hospital within 28 days of discharge from an AMU (n = 12), family caregivers (n = 15), and health professionals (n = 35). Data were collected using semi-structured interviews and subjected to thematic content analysis.
Four themes emerged: the health trajectory, communication challenges, discharge readiness and the decision to return. Re-presentation to hospital was seen as part of a declining health trajectory. The AMU was viewed as treating acute illness well, however patients and family caregivers left hospital with limited understanding of underlying health problems and, therefore, ill-prepared for future health crises.
There are clear benefits for older patients from AMUs, which expedite treatment for acute health crises. However, AMU discharge planning needs to consider patients' overall health status and likely future needs to optimise outcomes. Such a requirement is problematic in the context of acute time pressures.
Relevance to clinical practice
To ensure prompt and expert attention to key aspects of discharge planning for older people leaving AMUs, there is a role for in-depth clinical expertise in the care of older people facing deteriorating life-limiting conditions. Therefore, a leadership role for nurses with geriatric and palliative care expertise, alongside medical and allied health professionals, merits attention in this context.