Emergency department physician experiences managing patients labelled "community emergency" in Newfoundland and...

Patients labeled as "community emergency" are older adults who present to the emergency department (ED) with no apparent acute medical cause for their visit but rather, social, functional, or safety concerns that prevent them from staying in their existing living situations. Acute illness can sometimes be disguised due to non-specific complaints, atypical presentations, or insufficient time to manifest. These patients often remain in the ED for days or weeks awaiting a more appropriate care arrangement. While previous research has identified the difficulties associated with diagnosis and treatment in this population, there is limited qualitative research examining the experience of physicians managing this patient population in ED settings. Our study aimed to address this gap.

We interviewed nine ED physicians practicing at different hospitals in Newfoundland and Labrador to examine the experience of managing patients labeled as "community emergency." Interviews were transcribed verbatim and analyzed based on principles of grounded theory, including constant comparison and an iterative coding process.

We identified three main themes: First, while there are multiple labels for this patient population, the concept of "community emergency" is universally understood among ED physicians. Second, there are numerous barriers to supporting these patients in EDs, such as a lack of appropriate infrastructure and limited access to allied health professionals. Finally, there is inconsistency in how these patients are managed in rural and urban EDs, leading to disparities in care for this population.

Physicians felt that the ED was not an appropriate place to care for patients labeled as "community emergency" for extended periods of time while they await alternative care arrangements or diagnostic clarity. These findings suggest a need for improved policies that address the clinical and social needs of this population.