Experiences of the emergency department environment: a qualitative study with caregivers of people with dementia.

Autor: Chary AN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA. anita.chary@bcm.edu.; Department of Medicine, Baylor College of Medicine, 2450 Holcombe Blvd., Suite 01Y, Houston, TX, 77021, USA. anita.chary@bcm.edu.; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA. anita.chary@bcm.edu., Suh M; Section of Emergency Medicine, University of Chicago, Chicago, IL, USA., Bhananker A; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA., Hernandez N; School of Medicine, Baylor College of Medicine, Houston, TX, USA., Rivera AP; School of Medicine, Baylor College of Medicine, Houston, TX, USA., Boyer E; Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA., Kunik ME; Department of Medicine, Baylor College of Medicine, 2450 Holcombe Blvd., Suite 01Y, Houston, TX, 77021, USA.; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.; Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA., Shah MN; School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine at the University of Wisconsin, Madison, WI, USA., Ritchie C; Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA., Naik AD; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.; School of Public Health, University of Texas, UT Health Science Center, Houston, TX, USA.; Institute On Aging, University of Texas Health Science Center, Houston, TX, USA., Liu SW; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Kennedy M; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Internal and emergency medicine [Intern Emerg Med] 2024 Nov 07. Date of Electronic Publication: 2024 Nov 07.
DOI: 10.1007/s11739-024-03797-z
Abstrakt: ED crowding and boarding adversely impact older patients' care and outcomes. Little is known about how ED crowding impacts persons living with dementia, a vulnerable population. This study sought to explore ED experiences of caregivers of people with dementia during a period of ED crowding and boarding. We performed semi-structured interviews with caregivers of people with dementia with an ED visit during a period of ED crowding and boarding at two public hospitals experiencing a threefold increase in boarding from pre-pandemic levels. Participants were recruited via chart review. We coded data using an inductive approach. Three themes emerged from 29 caregiver interviews: (1) difficulty obtaining assistance, (2) patient harms, and (3) concerns about triage and rooming processes. First, caregivers described having to be proactive to obtain symptom control and assistance with mobility. Second, caregivers observed harms of noise and stimulation provoking agitation and delays in administration of routine medications. Third, caregivers felt it was inappropriate for people with dementia to receive care in waiting room chairs or to receive prolonged hallway care. Caregivers advocated for preferential considerations for rooming and rapid assessment to avoid agitation, facilitatd access to ED staff, and promote patient comfort. Caregivers of people with dementia associated ED environments with difficulty obtaining assistance, patient harms, and triage concerns. Strategies to mitigate the negative impacts of ED crowding on people with dementia should focus on environmental modifications, uptriage of people with dementia, supporting activities of daily living and mobility, and innovation around patient disposition.
(© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)
Databáze: MEDLINE
Externí odkaz: