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Abstract: FR-PO443

Perspectives on Preventability of Emergency Department Encounters for People Receiving Dialysis: A Qualitative Critical Incident Study

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Elliott, Meghan J., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Ronksley, Paul E., University of Calgary Department of Community Health Sciences, Calgary, Alberta, Canada
  • Donald, Maoliosa, University of Calgary Department of Community Health Sciences, Calgary, Alberta, Canada
  • Lang, Eddy, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • MacRae, Jennifer M., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Mcrae, Andrew, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Love, Shannan, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Kotani, Hana, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Verdin, Nancy, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Hemmelgarn, Brenda, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
Background

People receiving dialysis have disproportionately high rates of emergency department (ED) utilization. While certain conditions underlying ED encounters have been characterized as potentially preventable, little is known about how contextual factors may influence perceived need for ED care. We explored the perspectives of patients with kidney failure, their caregivers, and healthcare providers regarding the potential preventability of ED encounters.

Methods

In this qualitative critical incident study, we purposively sampled patients receiving dialysis who had received emergency care in the preceding four weeks for various acute health conditions, their informal caregivers, and healthcare providers working with dialysis patients. We conducted semi-structured interviews in person or virtually, coded transcripts in duplicate across participant roles, and generated themes through an inductive thematic analysis approach.

Results

We completed interviews with 22 patients receiving hemodialysis and peritoneal dialysis, 8 caregivers, and 30 healthcare providers from nephrology, emergency medicine, and primary care disciplines. Across roles, participants discussed aspects of acute illness unique to people receiving dialysis and emphasized coordinated care across disciplines to prevent illness onset, decompensation, and ultimately need for urgent ED management. We characterized perceived preventability of ED encounters in relation to the following themes: (1) Connectedness of the acute condition to kidney failure; (2) Care continuity and engagement; (3) Reactions and behavioural responses to the acute illness experience; (4) Access to urgent care strategies outside of the ED.

Conclusion

Patients, caregivers, and healthcare providers identified how the interplay between kidney failure, the acute illness experience, behaviours, and support structures influence the perceived preventability of ED encounters. Findings will inform coordinated approaches to averting potentially unnecessary ED use among this medically complex population.