Cognitive Interviews With Emergency Physicians to Understand Disposition Decisions With People With Dementia With Borderline Cases

People with dementia are often hospitalized from the emergency department (ED) for "borderline cases," where outpatient or inpatient management may be clinically reasonable. We sought to investigate how ED physicians make and communicate about decisions in borderline cases. Through cognitive interviews, we asked attending ED physicians from an academic hospital to share their approach to scenarios representing borderline cases with people with dementia and verbalize communication about ED disposition with patients and care partners. We deductively coded responses related to patient/care partner engagement and key features of communication and then elucidated themes related to content and phrasing of communication. Of 21 physicians, two-thirds stated they would offer the option of admission or discharge, but few explicitly communicated admission versus discharge as a choice. Shared decision-making is applicable to these situations and could provide a consistent structure to communication about disposition.