Understanding potentially avoidable emergency department visits in older adults: a survey with healthcare professionals across in- and outpatient care in Sweden
Hanna Bring, Monica Bergqvist, Lars L Gustafsson, Anikó Veg, Katarina Bohm, Karin Modig, Pia Bastholm-Rahmner, Katharina Schmidt-MendeObjectives
Older adults with multiple long-term conditions account for a large share of emergency department (ED) visits and up to 25% may be avoidable. Efforts to reduce such visits show mixed results, likely due to multiple caregivers and limited adaptation to local contexts. We explored factors contributing to avoidable ED visits as reported by multiple care providers, focusing on modifiable factors of importance in the design of a sustainable primary care (PC) intervention.
Design and setting
Web-based survey conducted across six in- and outpatient healthcare providers in Stockholm, Sweden: ED, geriatrics, ambulance services, advanced home-based healthcare, PC and home healthcare (both within and outside regular working hours). Closed-ended questions were analysed descriptively and open-ended questions using qualitative content analysis.
Participants
A total of 100 healthcare professionals (nurse assistants, registered nurses and physicians) with at least 6 months of working experience.
Results
All providers considered potentially avoidable ED visits a major concern, with home care workers seen as the main initiators of ED referrals. One overarching theme was generated—medical and psychosocial complexities in the assessment of older patients with multiple long-term conditions—and four categories of contributing factors: (1) insufficient access to health and social care, (2) poor communication and cooperation, (3) deficient professional competence and geriatric knowledge and (4) unclear responsibility and fragmented care. Five providers highlighted limited access to care as the most demanding concern while PC noted poor communication.
Conclusions
An intervention should combine enhanced home-based care, better collaboration across providers, direct geriatric admissions and targeted training for home care workers. Accounting for differences in provider perspectives in intervention design may enhance feasibility and acceptability.