“Around the clock”: Exploring health care professionals’ experience of discharge of older people during out of hours from the emergency department: A qualitative study

Mary Dunnion; Deborah Goode; A Ryan; Sonja J McIlfatrick

doi:10.1371/journal.pone.0313968

“Around the clock”: Exploring health care professionals’ experience of discharge of older people during out of hours from the emergency department: A qualitative study

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Abstract

Background
Older adults constitute a considerable number of attendances at emergency departments (EDs). Whilst many require hospital admission, a greater focus now is on admission avoidance with older adults being subsequently discharged from EDs. Little is known, however, about the experiences out of hours (OOH) when specialist older person support services are unavailable.

Aim
To explore senior health care professionals’ experiences of discharging older people during out of hours from EDs.

Method
A qualitative study involving individual semi-structured interviews was used to explore the experiences of healthcare professionals. Fourteen participants in total responded from a wide geographical spread. Data analysis was undertaken using Braun and Clarke’s (2022) six-step framework for Thematic Analysis.

Results
One overarching theme was identified focusing on risks and safety for the older person whilst being discharged OOH from the ED. Three sub-themes included “Should they stay, or should they go?”, “Bright lights and noise”, and “New ways of working”, which included risks in discharging an older person OOH from the ED, risks in delaying discharge, and recommendations for future practice. Significant differences were reported between office hours and OOH discharge of older adults from the ED. Diversity in practice assessments, and resources available was also evident across EDs. Significant adverse consequences were identified for older adults having to stay for prolonged periods in the ED.

Conclusions
There have been many welcome developments in healthcare services for older people who attend and are subsequently discharged from the ED. However, further innovative practice and collaboration with senior decision makers is needed to meet the healthcare needs of a rapidly ageing population. Safe, equitable and effective discharge practice 24/7 should be a norm for all older people in every ED regardless of location. Gaps in care identified must be addressed taking cognisance of the relevant recommendations for future practice.

Original language	English
Article number	e0313968
Pages (from-to)	1-15
Number of pages	15
Journal	PLoS One
Volume	20
Issue number	8
Early online date	22 Aug 2025
DOIs	https://doi.org/10.1371/journal.pone.0313968
Publication status	Published (in print/issue) - 25 Aug 2025

Bibliographical note

Publisher Copyright:
© 2025 Dunnion et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability Statement

All data underlying the results presented in the study cannot be shared publicly due to ethical restrictions and the personal nature of the responses which could be identifiable in their raw state. All data will be available elsewhere with limitations from the Ulster University Research Governance Department. Ms. Elaine Bell, Research Governance Officer; email: [email protected]
Phone: +44 28 9536 5028

Funding

The author(s) received no specific funding for this work.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

older people
emergency care
discharge
out of hours
health care professionals
experiences
views
Emergency Service, Hospital
Humans
Middle Aged
Patient Discharge
Male
After-Hours Care
Health Personnel
Aged, 80 and over
Female
Aged
Qualitative Research
Health Personnel/psychology
Health Personnel - psychology

Access to Document

10.1371/journal.pone.0313968Licence: CC BY

journal.pone.0313968Final published version, 561 KBLicence: CC BY

Cite this

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title = "“Around the clock”: Exploring health care professionals{\textquoteright} experience of discharge of older people during out of hours from the emergency department: A qualitative study",

abstract = "Background Older adults constitute a considerable number of attendances at emergency departments (EDs). Whilst many require hospital admission, a greater focus now is on admission avoidance with older adults being subsequently discharged from EDs. Little is known, however, about the experiences out of hours (OOH) when specialist older person support services are unavailable. Aim To explore senior health care professionals{\textquoteright} experiences of discharging older people during out of hours from EDs. Method A qualitative study involving individual semi-structured interviews was used to explore the experiences of healthcare professionals. Fourteen participants in total responded from a wide geographical spread. Data analysis was undertaken using Braun and Clarke{\textquoteright}s (2022) six-step framework for Thematic Analysis. Results One overarching theme was identified focusing on risks and safety for the older person whilst being discharged OOH from the ED. Three sub-themes included “Should they stay, or should they go?”, “Bright lights and noise”, and “New ways of working”, which included risks in discharging an older person OOH from the ED, risks in delaying discharge, and recommendations for future practice. Significant differences were reported between office hours and OOH discharge of older adults from the ED. Diversity in practice assessments, and resources available was also evident across EDs. Significant adverse consequences were identified for older adults having to stay for prolonged periods in the ED. Conclusions There have been many welcome developments in healthcare services for older people who attend and are subsequently discharged from the ED. However, further innovative practice and collaboration with senior decision makers is needed to meet the healthcare needs of a rapidly ageing population. Safe, equitable and effective discharge practice 24/7 should be a norm for all older people in every ED regardless of location. Gaps in care identified must be addressed taking cognisance of the relevant recommendations for future practice.",

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author = "Mary Dunnion and Deborah Goode and A Ryan and McIlfatrick, \{Sonja J\}",

note = "Publisher Copyright: {\textcopyright} 2025 Dunnion et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

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T1 - “Around the clock”: Exploring health care professionals’ experience of discharge of older people during out of hours from the emergency department: A qualitative study

AU - Dunnion, Mary

AU - Goode, Deborah

AU - Ryan, A

AU - McIlfatrick, Sonja J

N1 - Publisher Copyright: © 2025 Dunnion et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2025/8/25

Y1 - 2025/8/25

N2 - Background Older adults constitute a considerable number of attendances at emergency departments (EDs). Whilst many require hospital admission, a greater focus now is on admission avoidance with older adults being subsequently discharged from EDs. Little is known, however, about the experiences out of hours (OOH) when specialist older person support services are unavailable. Aim To explore senior health care professionals’ experiences of discharging older people during out of hours from EDs. Method A qualitative study involving individual semi-structured interviews was used to explore the experiences of healthcare professionals. Fourteen participants in total responded from a wide geographical spread. Data analysis was undertaken using Braun and Clarke’s (2022) six-step framework for Thematic Analysis. Results One overarching theme was identified focusing on risks and safety for the older person whilst being discharged OOH from the ED. Three sub-themes included “Should they stay, or should they go?”, “Bright lights and noise”, and “New ways of working”, which included risks in discharging an older person OOH from the ED, risks in delaying discharge, and recommendations for future practice. Significant differences were reported between office hours and OOH discharge of older adults from the ED. Diversity in practice assessments, and resources available was also evident across EDs. Significant adverse consequences were identified for older adults having to stay for prolonged periods in the ED. Conclusions There have been many welcome developments in healthcare services for older people who attend and are subsequently discharged from the ED. However, further innovative practice and collaboration with senior decision makers is needed to meet the healthcare needs of a rapidly ageing population. Safe, equitable and effective discharge practice 24/7 should be a norm for all older people in every ED regardless of location. Gaps in care identified must be addressed taking cognisance of the relevant recommendations for future practice.

AB - Background Older adults constitute a considerable number of attendances at emergency departments (EDs). Whilst many require hospital admission, a greater focus now is on admission avoidance with older adults being subsequently discharged from EDs. Little is known, however, about the experiences out of hours (OOH) when specialist older person support services are unavailable. Aim To explore senior health care professionals’ experiences of discharging older people during out of hours from EDs. Method A qualitative study involving individual semi-structured interviews was used to explore the experiences of healthcare professionals. Fourteen participants in total responded from a wide geographical spread. Data analysis was undertaken using Braun and Clarke’s (2022) six-step framework for Thematic Analysis. Results One overarching theme was identified focusing on risks and safety for the older person whilst being discharged OOH from the ED. Three sub-themes included “Should they stay, or should they go?”, “Bright lights and noise”, and “New ways of working”, which included risks in discharging an older person OOH from the ED, risks in delaying discharge, and recommendations for future practice. Significant differences were reported between office hours and OOH discharge of older adults from the ED. Diversity in practice assessments, and resources available was also evident across EDs. Significant adverse consequences were identified for older adults having to stay for prolonged periods in the ED. Conclusions There have been many welcome developments in healthcare services for older people who attend and are subsequently discharged from the ED. However, further innovative practice and collaboration with senior decision makers is needed to meet the healthcare needs of a rapidly ageing population. Safe, equitable and effective discharge practice 24/7 should be a norm for all older people in every ED regardless of location. Gaps in care identified must be addressed taking cognisance of the relevant recommendations for future practice.

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“Around the clock”: Exploring health care professionals’ experience of discharge of older people during out of hours from the emergency department: A qualitative study