Perspectives on Preventability of Emergency Department Encounters for People Receiving Dialysis: A Qualitative Critical Incident Study
Bibliographic record
Abstract
Background: People receiving dialysis have disproportionately high rates of emergency department (ED) utilization. While certain conditions underlying ED encounters have been characterized as potentially preventable, little is known about how contextual factors may influence perceived need for ED care. We explored the perspectives of patients with kidney failure, their caregivers, and healthcare providers regarding the potential preventability of ED encounters. Methods: In this qualitative critical incident study, we purposively sampled patients receiving dialysis who had received emergency care in the preceding four weeks for various acute health conditions, their informal caregivers, and healthcare providers working with dialysis patients. We conducted semi-structured interviews in person or virtually, coded transcripts in duplicate across participant roles, and generated themes through an inductive thematic analysis approach. Results: We completed interviews with 22 patients receiving hemodialysis and peritoneal dialysis, 8 caregivers, and 30 healthcare providers from nephrology, emergency medicine, and primary care disciplines. Across roles, participants discussed aspects of acute illness unique to people receiving dialysis and emphasized coordinated care across disciplines to prevent illness onset, decompensation, and ultimately need for urgent ED management. We characterized perceived preventability of ED encounters in relation to the following themes: (1) Connectedness of the acute condition to kidney failure; (2) Care continuity and engagement; (3) Reactions and behavioural responses to the acute illness experience; (4) Access to urgent care strategies outside of the ED. Conclusions: Patients, caregivers, and healthcare providers identified how the interplay between kidney failure, the acute illness experience, behaviours, and support structures influence the perceived preventability of ED encounters. Findings will inform coordinated approaches to averting potentially unnecessary ED use among this medically complex population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.012 | 0.009 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.002 | 0.007 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".