Experiences of Continuity of Care in Relation to Emergency Department Encounters for People with Kidney Failure: A Qualitative Study

Abstract

Background: People with kidney failure have complex care needs and use the emergency department (ED) at high rates. Little is known about how continuity of care (CoC) relates to ED care seeking for patients with kidney failure. Objectives: To understand the experiences of CoC (i.e., relational, informational, and management) among adults with kidney failure in relation to their recent ED encounter. Methods: Using a qualitative descriptive methodology, we purposively sampled adults with kidney failure (defined as eGFR < 15 mL/min/1.73m2 or receipt of maintenance dialysis) from Alberta who accessed the ED for a non-life-threatening indication within the preceding six weeks from May 2024 until January 2025. We conducted individual semi-structured interviews and analyzed transcripts using a framework analysis approach. Findings: 29 participants were included (12 in-centre hemodialysis, 1 in-centre hemodialysis nocturnal, 7 peritoneal dialysis, 5 home hemodialysis, and 4 without kidney replacement therapy). Themes were identified within CoC types and across before-acute care, during acute care, and after-acute care settings. Under relational continuity, key themes included: stability and trust in care teams, disrupted therapeutic relationships, and re-establishing engagement in circles of care. For management continuity, themes included: safeguarding kidney supports and kidney care fragmentation in the ED. Within information continuity, themes included: patients as continuity self-advocates, bridging care through information sharing and extending continuity beyond the ED. Conclusion: Participants expressed varied experiences of CoC and identified important gaps surrounding emergency care. Strategies addressing perceived gaps in management and informational continuity across both outpatient and acute care settings may help mitigate the burden of ED and acute care use for people with kidney failure.