Background: Models of emergent care evolve in response to an ageing population. The Medical Assessment Unit (MAU) receives patients from the Emergency Department (ED) for up to 48 hours to facilitate assessment, care and treatment before discharge home or to another inpatient unit. Aim: To describe the clinical and social characteristics of older people who had a stay in the MAU and then represent to the ED within 28 days of discharge from hospital. Methods: A retrospective observational study design was used. Data were extracted from electronic medical records of older people who represented to two public teaching hospital EDs in Queensland, Australia, over a two-week period in 2014. Findings: There were 78 older people who made 84 representations. The average age was 79 years; average number of co-morbidities was seven (range 1-18); almost one-quarter (23%) lived alone; more (63%) were female; half (58%) were married; and one-fifth (20%) had some form of cognitive impairment. Of those who represented with the same diagnosis, 46% had cardio-respiratory conditions. One-quarter (28%) of the re-presenters had a discharge summary from the last admission. Discussion: Most of the re-presenters in this study had cardio-respiratory conditions. While a discharge summary was available, it was not consistently completed, raising the importance of discharge summaries as part of continuity across services for older people. Conclusion: How the ED, MAU and primary health services are coordinated bears further investigation. Research into the value of coordination roles, such as nurse navigators, for older people representing to ED is recommended.

Findings from this review indicate that future policy, research and practice relating to MAUs should focus on older people with complex needs, patient-centred metrics and those MAU characteristics most likely to deliver positive health outcomes to this particular cohort of patients.