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Objective Older adults are prone to unplanned emergency department (ED) return visits (URVs). Knowledge about patient perspectives on the preventability and reasons for these URVs is limited and lacks a representable ED study population. This study aims to determine the proportion of URVs and to explore the preventability and underlying causes as perceived by a wide range of older adults and their caregivers.Design A multicentre mixed-methods study.Setting The ED of one academic and one regional hospital in the Netherlands.Participants Patients aged ≥70 years with a URV within 30 days after the index ED visit, consecutively sampled during a 6-week period.Outcome measurements Quantitative data regarding patient and clinical characteristics and perceived preventability of a URV were prospectively collected and analysed using descriptive statistics. Underlying causes of a URV were collected by semistructured interviews with patients and caregivers. Thematic content analysis was used to analyse the interview transcripts.Results Out of 1291 patients of 70 years and older, 151 patients had a URV (11.7%). In total, 64 patients were included after informed consent (42.4%). A total of 33 patients (51.5%) found their URV preventable. Perceived causes for a URV were categorised in six themes: (1) suboptimal treatment of health complaints, (2) premature hospital discharge, (3) poor assessment and arrangement of postdischarge needs, (4) patient and caregiver behaviour, (5) lack of advance care planning and insight in treatment options and (6) deficits in general practitioner care.Conclusions Our high rate of preventable URVs (51.5%) perceived by patients and caregivers underscores the importance to reduce URVs among older adults. Perceived causes in this study add other unexplored themes to the existing knowledge and create support for further research and interventional opportunities.

Background Optimal oncological care nowadays requires discussing every patient in a multidisciplinary team meeting (MDTM). The number of patients to be discussed is rising rapidly due to the increasing incidence and prevalence of cancer and the emergence of new multidisciplinary treatment options. This puts MDTMs under considerable time pressure. The aim of this study is therefore to identify the facilitators and barriers with regard to performing an efficient, competent and high-quality MDTM.Methods Semistructured interviews were conducted with Dutch medical specialists and residents participating in oncological MDTMs. Purposive sampling was used to maximise variation in participants’ professional and demographic characteristics (eg, sex, medical specialist vs resident, specialty, type and location of affiliated hospital). Interview data were systematically analysed according to the principles of thematic content analysis.Results Sixteen medical specialists and 19 residents were interviewed. All interviewees agreed that attending and preparing MDTMs is time-consuming and indicated the need for optimal execution in order to ensure that MDTMs remain feasible in the near future. Four themes emerged that are relevant to achieving an optimal MDTM: (1) organisational aspects; (2) participants’ responsibilities and requirements; (3) competences, behaviour and team dynamics and (4) meeting content. Good organisation, a sound structure and functioning information and communication technology facilitate high-quality MDTMs. Multidisciplinary collaboration and adequate communication are essential competences for participants; a lack thereof and the existence of a hierarchy are hindering factors.Conclusion Conducting an efficient, competent and high-quality oncological MDTM is facilitated and hindered by many factors. Being aware of these factors provides opportunities for optimising MDTMs, which are under pressure due to the increase in the number of patients to discuss.

Objective Suboptimal transitional care (ie, needs assessment and coordination of follow-up care) in the emergency department (ED) is an important cause of ED revisits and hospital admissions and may potentially harm patients, especially frail older adults. We aimed to systematically review the effect of ED-based interventions by health professionals who are dedicated to providing transitional care to older adults.Design Systematic review.Measurements We searched five biomedical databases for published (quasi)experimental studies evaluating the effects of health professionals in the ED dedicated to providing transitional care to older ED patients on clinical, process and/or service use outcomes. Reviewers screened studies for relevance and assessed methodological quality with published criteria (Robins-1 and the Cochrane risk of bias tool). Data were synthesised around study and intervention characteristics and outcomes of interest.Results From the 6561 references initially extracted from the databases, 12 studies were eligible for inclusion. Two types of interventions were identified, namely, individual needs assessment of ED patients (8 studies; 75%) and discharge planning and coordination of services (4 studies; 25%). Structured individual needs assessment was associated with a significant decrease in hospital admissions, hospital readmissions and ED revisits. Individualised discharge plans from the ED were associated with a significant decrease in ED revisits and hospital readmission. The overall methodological quality of the included studies was relatively low.Conclusions Comprehensive assessment of patient needs and ED discharge planning and coordination of services by health professionals interested in transitional care can help optimise the transition of care for older ED patients and reduce the risk of costly and potentially harmful (re)admissions for this population. However, more robust research is needed on the effectiveness of these interventions aiming to improve clinical, process and service use outcomes.PROSPERO registration number CRD42021237345.