An exploration of the out of hours discharge of older people from the Emergency Department: a multiple methods study

Abstract

Background
Increased life-expectancy and population ageing is evident worldwide. An associated prevalence in complex needs and increased and protracted attendances at emergency departments also exists. While many older people attend emergency departments, many are subsequently discharged. Out of hours care in emergency departments is often a distinct and difficult experience for everyone, but particularly for an older person. A dearth in out of hours discharge research was apparent.

Aim
To explore experiences, discharge management practices and supports for older people discharged from the emergency department during out of hours.

Methods
An exploratory multi-methods approach involved four main phases informed by the Integrated Care Framework for Older People: an integrative review, quantitative analysis of emergency department data, semi-structed interviews with emergency department senior healthcare professionals, and also with older people and/or carers. The quantitative data was analysed using statistical analysis, while the qualitative data was analysed using Reflexive Thematic Analysis.

Findings
Many variations were obvious in practice nationally. Gaps in integration of care, incomplete assessments, patient frustration, and difficult emergency department trajectories were apparent. Difficulties for older people and staff out of hours in the emergency department included the unavailability of certain facilities to support the working of the department 24/7. A dearth in out of hours data was evident.

Conclusion
The findings suggest that a dissonance and heterogeneity exist between recommended best practice in older person care and current practice. Older people experienced difficult emergency care journeys, variances in discharge management practices and supports during out of hours which were affirmed by staff respondents. Suggested engagement with policy makers and care providers, alongside other several key recommendations have been provided to ensure appropriate and high-quality care for a growing and ageing population that is equitable, accessible, integrated and timely for safe out of hours discharge from the emergency department.

Date of Award	May 2026
Original language	English
Sponsors	Atlantic Technological University
Supervisor	Assumpta Ryan (Supervisor), Debbie Goode (Supervisor) & Sonja McIlfatrick (Supervisor)