title: Early re-presentation to hospital after discharge from an acute medical unit: perspectives of older patients, their family caregivers and health professionals.
abstract: OBJECTIVE
  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.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  A qualitative, descriptive design was used.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia. s.slatyer@ecu.edu.au
authors.forename: Susan
authors.initials: S
authors.lastname: Slatyer
authors.forename: Christine
authors.initials: C
authors.lastname: Toye
authors.forename: Aurora
authors.initials: A
authors.lastname: Popescu
authors.forename: Jeanne
authors.initials: J
authors.lastname: Young
authors.forename: Anne
authors.initials: A
authors.lastname: Matthews
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
authors.forename: D James
authors.initials: DJ
authors.lastname: Williamson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001315:Australia; D017028:Caregivers / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D010351:Patient Discharge; D015203:Reproducibility of Results