Characterizing Emergency Department Disposition Conversations for Persons Living With Dementia: Protocol for an Ethnographic Study

Background: Almost 40% of persons living with dementia make an emergency department (ED) visit each year. One of the most impactful and costly elements of their ED care is the decision to discharge or admit them to the hospital-the "disposition" decision. When more than one reasonable option exists regarding a health care decision, such as the decision to admit or not, it often requires a complex conversation between patients, care partners, and ED providers, ideally involving shared decision-making. However, little is known about how these conversations are conducted and the real-world context in which they take place. Best practices in ED communication and shared decision-making for persons living with dementia and their care partners are limited.

Objective: This study aims to characterize current practices in ED disposition conversations for persons living with dementia and their care partners, informed by perspectives from patient and care partner participants.

Methods: This study will use an ethnographic design, including direct observation methods with a semistructured data collection tool to capture the ED encounter for up to 20 patient and care partner dyads, including all discussions about dispositions. Follow-up qualitative, semistructured interviews will be conducted with persons living with dementia and their care partners to explore specific observations made during their ED encounter, and to gain insight into their perspective on their role and elements of decision support used during that conversation.

Results: Data collection was initiated in October 2023, with 13 dyads recruited and observed as of July 2024. This study is expected to be completed by December 2024.

Conclusions: Novel methods can offer novel insights. By combining direct observation and follow-up interviews about an ED visit, our study design will provide insights into how ED disposition occurs in real-world settings for persons living with dementia. Findings can inform more patient-centered interventions for disposition decision-making.

International registered report identifier (irrid): DERR1-10.2196/65043.