What are the experiences and perceptions of unplanned readmissions to hospital within 30 days of discharge from the perspective of older people and their families within an English NHS context?
Background: Older people continue to have a higher risk of unplanned readmission. The current landscape on unplanned readmissions is dominated by quantitative research exploring associations, patient characteristics and unplanned readmissions and little attention has been given to the experiences of older people and their families. There is a gap in understanding the patient perspective and viewing unplanned readmissions in a more holistic manner and a clinical need to further understand the patient and family experience of unplanned readmissions. Methodology and method: An interpretivist paradigm and constructivist approach were adopted. A collective case study informed by Stake (1995, 2006) was conducted. A case was defined as an adult aged 65 years or over and who has had an unplanned readmission to the study site hospital Trust within 30 days of discharge. Each case was viewed from the perspective of the patient, in addition to that of a family member if available, alongside documents, observations, and reflections. This is a case of experiences and perceptions of unplanned readmissions to hospital within 30 days of discharge situated within this context. 14 cases were included in this study. Data were collected via interviews; observations and a reflective diary was used. Case descriptions were written, and multiple case study analysis was conducted following the ethos of Stake (2006) combined with the tools of framework analysis as described by Ritchie and Spence (1994). Findings: Unplanned readmissions were experienced as a disrupter by patients and families, with disruptions to their existential condition, with emotional and practical impacts. Within this case study unplanned readmissions were a phenomenon characterised by misaligned expectation and need in both communication and expectations. Unplanned readmissions were also a catalyst for change and viewed as lifesaving and key to unlocking care and/or support. Finally, they were perceived as symptoms of perceived organisational pressures. Unique contributions: 1. The findings from this study present a deeper and richer understanding of experiences and perceptions of unplanned readmissions to hospital among older people and their families. This study has presented the magnitude of the disruption and illustrated how the impacts of these unplanned readmissions can ripple out across time and wider society. 2. Nuance around the experiences and perceptions of unplanned readmissions have captured the fact that as a catalyst for change they can be viewed as key to unlocking care and support. This suggests older people and their families are reaching a type of crisis point before things change for them. 3. This study’s findings involving the experiences and perceptions older people have of their unplanned readmission offer contextually bound first-hand accounts of the lived experience of being older and accessing healthcare, which contributes to diversifying the narrative around older age and supports combatting ageism. Conclusion: The experiences and perceptions of unplanned readmissions are based on experiences that transcend the specific moment of unplanned readmission incorporating instances before, during and after the unplanned readmission. The unplanned readmission has ripple effects with waves that touch on wide personal and professional networks which have deep and varied impacts on peoples’ lives. This study confirms the misalignment between how unplanned readmissions are conceptualised by organisations, health care professionals, patients, and families. It is imperative nurses appreciate and understand the experiences and perceptions older people and their families have of unplanned readmission so they can provide responsive, holistic care and support patients and families appropriately.
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