Hospital care following emergency admission: a critical incident case study of the experiences of patients with advanced lung cancer and Chronic Obstructive Pulmonary Disease

Aims and objectives:
To explore the experiences of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and lung cancer, their carers and healthcare professionals following emergency admission to acute care hospital.

Background:
Emergency admissions of people with lung cancer and COPD have increased and there is global concern about the number of patients who die in hospital. The experience of patients with advanced lung cancer and COPD admitted to hospital as an emergency when nearing the end of life has not previously been investigated.

Design:
Qualitative critical incident case study.

Methods:
Semistructured interviews were conducted with 39 patients (15 with COPD and 24 with lung cancer), 20 informal carers and 50 healthcare professionals, exploring patients’ experiences of emergency hospital admission. Interviews took place after admission and following discharge. Participants nominated relatives and healthcare professionals for interview. Data were analysed thematically.

Results:
Patients were satisfied with their ‘emergency’ care but not the care they received once their initial symptoms had been stabilised. The poorer quality care they experienced was characterised by a lack of attention to their fundamental needs, lack of involvement of the family, poor communication about care plans and a lack of continuity between primary and secondary care. A conceptual model of ‘spectacular’ and ‘subtacular’ trajectories of care was used to relate the findings to the wider context of health care provision.

Conclusion:
The complex nature of illness for patients with advanced respiratory disease makes emergency hospital admissions likely. Whilst patients (with COPD and lung cancer) were satisfied with care in the acute ‘spectacular’ phase of their admission, more attention needs to be given to the continuing care needs of patients in the ‘subtacular’ phase.

Relevance to Clinical Practice:
This is the first study to explore the patient experience of acute care following an emergency admission and identifies where there is potential for care to be improved.