title: Qualitative critical incident study of patients' experiences leading to emergency hospital admission with advanced respiratory illness.
abstract: OBJECTIVE
  The high volume of emergency admissions to hospital is a challenge for health systems internationally. Patients with lung cancer and chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital as emergency cases. While the frequency of emergency admission has been investigated, few studies report patient experiences, particularly in relation to the decision-making process prior to emergency admission. We sought to explore patient and carer experiences and those of their healthcare professionals in the period leading up to emergency admission to hospital.
  
  
  METHODS
  3 UK hospitals located in different urban and rural settings.
  
  
  METHODS
  Qualitative critical incident study.
  
  
  METHODS
  24 patients with advanced lung cancer and 15 with advanced COPD admitted to hospital as emergencies, 20 of their carers and 50 of the health professionals involved in the patients' care.
  
  
  RESULTS
  The analysis of patient, carer and professionals' interviews revealed a detailed picture of the complex processes involved leading to emergency admission to hospital. 3 phases were apparent in this period: self-management of deteriorating symptoms, negotiated decision-making and letting go. These were dynamic processes, characterised by an often rapidly changing clinical condition, uncertainty and anxiety. Patients considered their options drawing on experience, current and earlier advice. Patients tried to avoid admission, reluctantly accepting it, albeit often with a sense of relief, as anxiety increased with worsening symptoms.
  
  
  CONCLUSIONS
  Patients with advanced respiratory illness, and their carers, try to avoid emergency admission, and use logical and complex decision-making before reluctantly accepting it. Clinicians and policy-makers need to understand this complex process when considering how to reduce emergency hospital admissions rather than focusing on identifying and labelling admissions as 'inappropriate'.
authors.affiliation: Warwick Manufacturing Group (WMG), University of Warwick, Coventry, UK.
authors.forename: Eleni
authors.initials: E
authors.lastname: Karasouli
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Munday
authors.affiliation: School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Cara
authors.initials: C
authors.lastname: Bailey
authors.affiliation: Division of Health Sciences, Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Staniszewska
authors.affiliation: School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Alistair
authors.initials: A
authors.lastname: Hewison
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Griffiths
mesh_terms: D001007:Anxiety; D017028:Caregivers / Q000523:psychology*; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology* / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology* / Q000628:therapy; D036301:Qualitative Research; D012944:Social Support; D006113:United Kingdom
keywords: QUALITATIVE RESEARCH; SOCIAL MEDICINE; cancer; chronic obstructive pulmonary disease; emergency hospital service; patient experiences