title: Hospital care following emergency admission: a critical incident case study of the experiences of patients with advanced lung cancer and Chronic Obstructive Pulmonary Disease.
abstract: OBJECTIVE
  To explore the experiences of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and lung cancer, their carers and healthcare professionals following emergency admission to acute care hospital.
  
  
  BACKGROUND
  Emergency admissions of people with lung cancer and COPD have increased and there is global concern about the number of patients who die in hospital. The experience of patients with advanced lung cancer and COPD admitted to hospital as an emergency when nearing the end of life has not previously been investigated.
  
  
  METHODS
  Qualitative critical incident case study.
  
  
  METHODS
  Semistructured interviews were conducted with 39 patients (15 with COPD and 24 with lung cancer), 20 informal carers and 50 healthcare professionals, exploring patients' experiences of emergency hospital admission. Interviews took place after admission and following discharge. Participants nominated relatives and healthcare professionals for interview. Data were analysed thematically.
  
  
  RESULTS
  Patients were satisfied with their 'emergency' care but not the care they received once their initial symptoms had been stabilised. The poorer quality care they experienced was characterised by a lack of attention to their fundamental needs, lack of involvement of the family, poor communication about care plans and a lack of continuity between primary and secondary care. A conceptual model of 'spectacular' and 'subtacular' trajectories of care was used to relate the findings to the wider context of health care provision.
  
  
  CONCLUSIONS
  The complex nature of illness for patients with advanced respiratory disease makes emergency hospital admissions likely. Whilst patients (with COPD and lung cancer) were satisfied with care in the acute 'spectacular' phase of their admission, more attention needs to be given to the continuing care needs of patients in the 'subtacular' phase.
  
  
  CONCLUSIONS
  This is the first study to explore the patient experience of acute care following an emergency admission and identifies where there is potential for care to be improved.
authors.affiliation: Nursing, Health and Population Sciences, Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Cara
authors.initials: C
authors.lastname: Bailey
authors.affiliation: Nursing, Health and Population Sciences, Medical School, College of Medical and Dental 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: Eleni
authors.initials: E
authors.lastname: Karasouli
authors.affiliation: RCN Research Institute, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Staniszewska
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Munday
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D036301:Qualitative Research
keywords: COPD; complex care; emergency admission; end of life care; lung cancer; nursing; quality of care; supportive care