#29 Meeting a 24-hour safe discharge: the perceptions and experiences of health care professionals in the emergency department

<h3>Introduction</h3> Older adults constitute a significant number of attendances at emergency departments (ED). These trends are set to continue alongside increasing ageing demographics. Many older adults are subsequently discharged following an ED visit, but little is known about their experiences during out of hours (OOH) where specialist older person support services are unavailable. It is important that health and social care professionals working in the ED and in primary care are adequately prepared to be able to meet the discharge needs of older adults on a 24/7 basis. <h3>Methods</h3> This was a qualitative study which aimed to explore senior health care professional’s perceptions and experiences of discharging older people during normal hours versus OOH from EDs in Ireland using semi-structured interviews. Fourteen participants in total responded from a wide geographic spread. Analysis was undertaken using Braun and Clarke’s (2006) six-step framework for Thematic Analysis. <h3>Results</h3> One major theme identified was that of risks and safety for the older person whilst being discharged from the ED. Three sub-themes also emerged which included risks in discharging an older person OOH from the ED, risks in delaying discharge, and recommendations for future practice in reducing risk. Significant differences between office hours and out-of-hours discharge of older adults from the ED were reported by the respondents. A diversity in practice, assessments undertaken and resources available nationally was also evident. Significant adverse consequences were identified for older adults having to stay for long periods in the ED. <h3>Conclusion</h3> Whilst services for older people attending EDs in Ireland have improved, further collaboration and innovation is needed to meet the demands of a rapidly ageing population. Staff must ensure a safe and effective discharge home 24/7 for older people in every ED regardless of location, and address gaps in care identified in these findings.