Principal Investigator: Dr Daniel Lasserson

Lead institution: University of Oxford

Award amount: £68,163 over 16 months

An ethnographic study of frail, older patients’ health care journeys through, and experiences of, Emergency Multidisciplinary Units (EMUs)

Research evidence suggests that the acute hospital environment is not well-suited to older, frail people. The acute care pathway at Emergency Multidisciplinary Units (EMUs) was designed to be an alternative to emergency admission to an acute hospital for this patient group in particular.

The study aimed to explore the journeys and experiences of frail, older patients when they were assessed and treated at an EMU, based at Abingdon Hospital, Oxfordshire. The main objectives of the research were:

  • To investigate frail, older patients’ experiences of visiting the EMU and their journey through care within this ambulatory care setting.
  • To explore the main events and transitions in their care, such as admissions and discharges, and how these impact on the patients and their carers.
  • To identify how their experience of ambulatory care provision fits with their needs, priorities and expectations.

A qualitative, ethnographic approach was employed from March to September 2016, exploring patients’ and carers’ perceptions of care at an EMU, as it unfolded during time of stay, including observation and unstructured interviews. Follow-up interviews with patients were also conducted and permission sought to access their medical notes at the EMU. In total, 20 patients and 7 carers were recruited to take part in the study.

The main results of the study were:

  • That frail, older people viewed the care delivered at the EMU positively
  • They were appreciative of the ways in which members of staff communicated with them and their families and the friendly atmosphere of the EMU setting.
  • Patients and carers expressed the view that care was more personalised in the EMU than it would have been in a larger unit.
  • While frail, older people sometimes struggled with the long periods of time they needed to spend at the EMU, or if repeat visits were required, they were satisfied with what could be achieved for them during their care journeys.

The following quotes from patients and carers support these findings:

“And in general I mean I had a hundred percent attention you know so. It made me feel that, you know I’m being cared for and that was the main thing.”

“It’s great…laid back…I love it…” The carer was very positive about the Unit and told me “These EMUs are wonderful. We need more of these. The difference is incredible… It’s the best thing they ever come up with”

Between February and June 2017 recruitment was extended to the new acute ambulatory care unit (AAU), which the John Radcliffe Hospital had set up, as a result of their experience of delivering the EMU at Abingdon Hospital. The team recruited 3 patients to the study at the AAU. Similarly, patients were positive of the care they received there:

‘But no, I would recommend anybody to go in with any problems to be treated at the AAU, definitely… It’s just one hundred percent. I mean, as I said, if I was able to speak for them, I would say that the care is second to none.’

Overall patients’ and carers’ responses showed that they viewed this type of ambulatory care as a model of service provision, which was especially suited to the needs and priorities of older people living with frailty. This was largely due to the fact that dependent on the reason for admittance, patients were able go home between visits (a number of patients were themselves caring for frail, older people), food and drink were provided during their stay and patients received support in maintaining independence and functioning through the involvement of the multi-disciplinary team present at these sites.

The co-applicants on the project were Dr Margaret Glogowska, Professor Sarah Purdy, Dr Helen Cramer and Dr Sarah Pendlebury