Abstract Background Hospital referral in acute situations is a complex process with a significant impact on older adults. This study aims to explore the considerations of healthcare providers from both primary and secondary care when deciding whether or not to refer an older patient to the hospital in acute situations. By including perspectives of different health care providers, this study seeks to provide a more comprehensive understanding of the decision-making process. Methods In February 2025, three online semi-structured focus group discussions were conducted with 16 primary and secondary healthcare providers. Three case studies (two hip fractures, one COPD exacerbation) guided the discussion. Data were analysed using a combination of inductive and deductive thematic analysis and were iteratively clustered and visualized around four key consideration factors. Results Twenty subthemes were identified and mapped onto four overarching main themes, corresponding to the four key consideration factors: patient-related (e.g. network, quality of life, patient and family preferences, emotional status and living situation), healthcare provider-related (e.g. professional attitude, collaboration and familiarity with patients), case-specific (e.g. age, medical history, activities of daily living (ADL) and mobility, cognitive functioning, frailty, prognosis, the acuity of situation, alternative treatment, and risk of complications) and structural factors (e.g. ability to arrange appropriate care and the patients’ increasing care demand). Conclusions Decision-making in hospital referrals is not determined solely by the acute condition, but is a complex and dynamic process. This highlights the importance of strengthening interprofessional communication and collaboration, addressing the shortages in the availability of appropriate patient care, and extending advance care planning (ACP) practices by involving family members to support more patient-centred referral decisions.
Cardol et al. (Mon,) studied this question.