What matters most in acute care?

We developed this lay report following our research with older people living with frailty. We consulted members of the Leicester, Leicestershire and Rutland Patient and Public Involvement Forum and community representatives identified through the Centre for Ethnic Health Research.

Lay report: defining what matters

We interviewed 22 participants aged 71 to 98. We asked them what outcomes they wanted as patients in Leicester’s Emergency Department (ED). ED used to be called A&E or Casualty. The participants were all living with frailty. ‘Frailty’ means that someone’s situation is vulnerable to a sudden health crisis.

We grouped participants’ outcome goals as Autonomy and Functioning. Having autonomy means being able to make one’s own choices. Participants wished to understand their situation. They wanted to know what was likely to happen. Most, but not all, wanted to be able to make choices about healthcare for themselves. They needed clear explanations from doctors and to feel heard during discussions.

Participants wanted to feel safe in their day-to-day lives. They wanted to maintain their current levels of activity. To do so, they needed pain relief, support getting around, and help for loved ones. Some delayed seeking help because they were anxious or did not want to burden the NHS: this caused them to suffer symptoms for longer.

People should feel comfortable telling healthcare staff their goals. Treatment plans can then focus on achieving what matters most.

The NHS measures quality of emergency care by looking at waiting times. This research shows that time targets may be less important to people who are living with frailty. We think that Emergency Departments should also measure whether patients’ goals are achieved. We are making surveys to assess this.

Getting emergency healthcare can be confusing. If seriously ill or injured, call 999 or go straight to an Emergency Department. Call 111 if you are unsure whether to go to the Pharmacy, GP Surgery, Urgent Treatment Centre, or Emergency Department.