Continuity of Care Surrounding Emergency Department Encounters for People with Kidney Failure in Alberta, Canada: A Qualitative Study.

key pointsPeople with kidney failure perceive disruptions in continuity of care before, during, and after their emergency care encounters. Patients report taking steps themselves to bridge gaps in continuity and ensure consistent informational flow across care teams. Strategies tailored to the unique emergency care needs of people with kidney failure may help strengthen continuity of care in this context.

backgroundPeople with kidney failure have complex care needs and frequently access care using the emergency department (ED). Little is known about how continuity of care (CoC) relates to ED care seeking for people with kidney failure. To understand the experiences of CoC among adults with kidney failure in relation to their recent ED encounter.

methodsUsing a qualitative descriptive methodology, we purposively sampled adults with kidney failure (defined as eGFR <15 ml/min per 1.73 m 2 and/or receipt of maintenance dialysis) from Alberta who accessed the ED for a non-life-threatening indication within the preceding 6 weeks between May 2024 and January 2025. We conducted individual semistructured interviews and analyzed transcripts in duplicate using a framework analysis approach with reference to an established framework defining CoC according to three types ( i.e ., relational, management, and informational). Thematic development involved both inductive and deductive techniques.

resultsTwenty-nine patients were included (12 in-center hemodialysis, one in-center nocturnal hemodialysis, seven peritoneal dialysis, five home hemodialysis, and four without KRT). Themes were identified within CoC types and across settings of before, during, and after the acute care encounter. Key relational continuity themes included stability and trust in care teams, disrupted therapeutic relationships, and re-establishing engagement in circles of care. Management continuity themes included safeguarding kidney supports and kidney care fragmentation in the ED. Informational continuity themes included patients as continuity self-advocates, bridging care through information sharing, and extending continuity beyond the ED.

conclusionsPatients with kidney failure expressed varied experiences of CoC and identified important gaps relevant to the emergency care context. Strategies that bridge these perceived gaps across outpatient and acute care settings may help to mitigate the burden of ED use in this population.