title: A Perfect Storm: Care Transitions for Vulnerable Older Adults Discharged Home From the Emergency Department Without a Hospital Admission.
abstract: OBJECTIVE
  The purpose of the study was to describe, from the perspectives of emergency department (ED) providers, factors that influence quality and safety of transitions home from the ED for vulnerable older adults.
  
  
  METHODS
  A grounded theory approach was used to analyze data from 9 focus groups conducted with ED staff that included representatives from nursing, medicine, pharmacy, social work, and respiratory therapy.
  
  
  RESULTS
  From the perspectives of these care providers, 5 antecedent concepts contribute to the perceived quality and safety of transitions from the ED to home. These 5 concepts include the nature of geriatric presentations, provider knowledge, consumer knowledge, the ED resource base, and health care system fractures. Co-occurrence and interaction among the 5 identified antecedents set up conditions for what one focus group participant described as a perfect storm.
  
  
  CONCLUSIONS
  Older adults discharged home from the ED without a hospital admission are an increasingly important but understudied group within the transitional care literature. Although they share some similarities with those undergoing different health transitions, their unique needs and the specific characteristics of ED care require a novel approach. The model that emerged in this study provides direction for understanding the complex and interrelated aspects of their transitional care needs.
authors.affiliation: School of Nursing, Center for the Advancement of Gerontological Nursing Science, University of California, Los Angeles and mcadogan@sonnet.ucla.edu.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Cadogan
authors.affiliation: School of Nursing, Center for the Advancement of Gerontological Nursing Science, University of California, Los Angeles and.
authors.forename: Linda R
authors.initials: LR
authors.lastname: Phillips
authors.affiliation: College of Nursing, Michigan State University, East Lansing.
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Ziminski
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000379:methods*
keywords: Emergency department discharge to home; Emergency department staff perspectives; Transitions of care