Understanding the experience of healthcare providers in delivering care to older adults presenting in emergency departments: a qualitative study

Abstract Background Knowledge gaps remain regarding the current challenges of delivering care to meet the needs of older adults presenting in the Emergency department (ED). This study aimed to explore the experiences of ED healthcare providers (HCPs) in providing care to older adults (OA). Methods A qualitative descriptive approach was employed in this study, which was part of an ongoing five-year experience-based co-design project. Participants who were Australian registered clinicians (e.g. medical, nursing, and allied health), non-clinical staff who support clinical care (e.g., clerks and orderlies), or who manage the delivery of patient care were recruited from the EDs of three public hospitals in Sydney, Australia from March 2023 to April 2024. Semi-structured interviews and a focus group took place either in-person or via videoconference, depending on the participants’ preferences. Inductive thematic analysis was employed with no predetermined list of codes. Results Forty-five semi-structured interviews and one focus group were conducted with 52 participants. A total of 34.6% participants were aged between 34 and 53 years old; 34 of 52 participants were female. Participants comprised 44% nurses, 27% doctors, and 17% allied health providers. Five major themes were identified: (1) patient complexity challenges care delivery, (2) organisational constraints challenge care delivery, (3) workforce issues undermine quality of care, (4) physical environments do not meet geriatric care needs, and (5) system interface issues constrain care transition. HCPs reported that excessive workload within time constraints, lack of resources, poor physical environment, and system interface issues create challenges in providing quality care to OAs with medical complexity. These challenges were further exacerbated by the mismatch between ED models of care and the needs of OAs. Conclusion The development of a geriatric-specific ED pathway is likely to improve ED performance and better meet the needs of OAs. Partnering with ED HCPs and OAs offers a feasible approach to co-design a sustainable ED model of care and deliver quality of care that is geriatric-friendly.