Patient flow and safety in the acute care: focusing on older patients

The demand on the health care systems and the Emergency Department (ED) in particular, is increasing, influencing patient safety and quality of care. The increasing number of older patients and the complexity of their illnesses are challenges for the ED, which is increasing attention on the organisation of the acute care pathway. Why do older people present at the ED? Why do they stay there relatively long? And what makes them come back frequently? Understanding this can help us to improve the care for older patients while reducing the pressure on the ED. First, I mapped the root causes of long stays at the ED, ED presentations and return presentations of older patients and unplanned intensive care unit (ICU) admissions with a PRISMA root cause analysis. I also explored whether these events could potentially be prevented. Furthermore, I performed a literature review on the use of the PRISMA analysis for health care facilities and I interviewed 13 patients about their ED experience. The literature review shows that the PRISMA method is a useful method for analyzing events in healthcare. Disease related factors are the main causes of both a (repeat) visit to the ED and an unplanned ICU admission. Furthermore, organizational external factors appear to be an important cause of pressure in the ED. Finally, older patients indicate that they have negative experiences with the waiting time and the discharge policy in the ED. These study results can guide toward patients-centered improvement initiatives regarding communication, waiting times and discharge, that can contribute to a positive ED experience in the future. To improve the patient flow and safety in the acute care, it is important that the entire acute care chain unites so that older patients receive the right care and that the pressure on the ED is reduced.