Table 3

Phase 3: re-evaluation

ThemeSubthemeRepresentative quotes
Coordination of care
Consultation with other physicians to address unmet needs‘I tried to contact outpatient GI and patient’s nephrologist to come up with outpatient monitoring plan at dialysis and a scheduled outpatient visit for EGD/colonoscopy, but it was later in the day and neither of these services could be reached to make a plan, so ended up admitting him to hospital’. (#128)
‘I spoke with Dermatology and they were able to see him in the ER quickly. They … made a solid plan for treatment and close follow up w them. Patient had no signs of ongoing systemic illness and minimal tenderness. I think call to medicine by ER was appropriate and ultimately, good plan was made with group effort by Derm, ER and me’. (#201)
Corroborating information from longitudinal providers‘PCP consulted and agreed that admission was warranted because they have been unable to get him into an adult family home from the community, but he does not have an acute medical illness requiring inpatient admission’. (#113)
Patient/social support advocacy
Preference expressed by patient‘He has a history of good abx adherence and health literacy, and he expressed a preference to d/c with oral abx and return if not improving’. (#289)
Preference expressed by a member of patient’s social support network‘ED had already had a patient centered discussion with pt’s daughter about home with strict return precautions vs admission, and she REALLY wanted him admitted’. (#105)
Physician disagreement
Discordance between ED and triage physician assessments‘ED worried about elevated lactate which I was convinced was due to med effect. Pt wanted to go home but ED strong-armed him into staying’. (#274)
Discordance between specialist and triage physician assessments‘Pt had probable TB but good outpt PCP f/u and sputum smear pending from PCP. ID wanted pt to be admitted for “coordination of care.” I thought this was a waste of time and money’. (#35)
Interventions in the ED
Adverse event‘Given fentanyl in ED then somnolent on evaluation so difficult to discharge’. (#236)
Stabilisation or improvement of medical issue‘After a liter of fluid, creatinine normalized and patient was comfortable with d/cing with follow-up at a PCP visit’. (#232)
  • Abx, Antibiotics; D/C, Discharge; ED, Emergency Department; EGD, Esophagogastroduodenoscopy; F/U, Follow Up; GI, Gastrointestinal Specialist; ID, Infectious Disease Specialist; PCP, Primary Care Physician; TB, Tuberculosis.