RationaleThere is an increasing societal demand for quality assurance and transparency of medical care. The American National Academy of Medicine has determined patient centredness as a quality domain for improvement of healthcare. While many of the current quality indicators are disease specific, most emergency department (ED) patients present with undifferentiated complaints. Therefore, there is a need for generic outcome measures. Our objective was to determine relevant patient reported outcomes (PROs) for quality measurement of acute care.MethodsWe conducted semistructured interviews in patients ≥18 years presenting at the ED for internal medicine. Patients with a cognitive impairment or language barrier were excluded. Interviews were analysed using qualitative content analysis.ResultsThirty patients were interviewed. Patients reported outcomes as relevant in five domains: relief of symptoms, understanding the diagnosis, presence and understanding of the diagnostic and/or therapeutic plan, reassurance and patient experiences. Experiences were often mentioned as relevant to the perceived quality of care and appeared to influence the domain reassurance.ConclusionWe determined five domains of relevant PROs in acute care. These domains will be used for developing generic patient reported measures for acute care. The patients’ perspective will be incorporated in these measures with the ultimate aim of organising truly patient-centred care at the ED.

BACKGROUND The number of older individuals that live independently at home is rising. These older individuals often rely on caregivers who typically have a similar age and health status. Therefore, caregivers may experience a high burden. We determined the prevalence and risk factors of burden among caregivers of older patients in the emergency department (ED). Methods a prospective observational cohort study of primary caregivers of patients aged ≥ 70 years visiting the ED of a Dutch teaching hospital. Structured interviews were conducted with patients and their caregivers. Caregiver burden was measured using the caregiver strain index (CSI). Additionally, data from medical records were extracted to determine potential risk factors. Univariate and multivariate regression analyses were conducted to identify independent determinants for burden. RESULTS A primary caregiver was reported by 200 of 628 included ED patients. The mean age of patients with a caregiver was 82 (SD 6.7) years and the mean age of the caregivers was 66 (SD 12.4) years. Seventy-eight caregivers (39%) experienced a high burden. Multivariate analysis showed a significant association between high caregiver burden and patients with cognitive impairment or dependency for instrumental activities of daily living (IADL) and more self-reported hours of care per day. CONCLUSION Almost 40% of older patients in the ED have a caregiver who experiences a high burden. Formal assessment in the ED may help provide adequate care to the patients and their caregivers.