Informing quality in emergency care: understanding patient experiences

Abstract

Purpose Assessing performance and quality in healthcare organisations is moving from focussing solely on clinical care measurement to considering the patient experience as critical. Much patient experience research is quantitative and survey based. The purpose of this paper is to report a qualitative study gathering in-depth data in an emergency department (ED). Design/methodology/approach The authors used empirical data from seven focus groups to understand patient experience as participants progressed through a major teaching hospital in an Ireland ED. A convenience sampling technique was used, and 42 participants were invited to share their perceptions and outline key factors affecting their journey. A role-playing exercise was used to develop improvement themes. Data were analysed using thematic analysis and data analysis software (NVivo 10). Findings Capturing ED patient experience increases our understanding and process impact on the patient journey. Factors identified include information, access, assurance, responsiveness and empathy, reliability and tangibles such as surroundings, food and seating. Research limitations/implications Owing to the ED patient’s emergency nature, participants were recruited if triaged at levels 3–5 (Manchester Triage System). The study explored patients’ immediate rather than post hoc experiences where recollections may change over time. Originality/value To the authors’ knowledge, no study has examined in-depth, ED patient experience in Ireland using qualitative interviewing, obtaining critical process insights as it occurs. The potential to inform patient process improvements in Irish EDs is significant.

A systematic mixed studies review of patient experiences in the ED

“…Researchers in five (9%) of the 54 studies provided a definition of patient experience (Supplementary File 4). [35][36][37][38][39] Three studies defined patient experience in relation to why it is a preferable measure for quality improvement as opposed to patient satisfaction. [35,36,39] These definitions stated that patient experiences "have shown to be more objective and to yield more detailed information for quality improvement" [35,36] as they "provide information identifying where in the process problems may reside and what can be done to improve patient care".…”

“…[35][36][37][38][39] Three studies defined patient experience in relation to why it is a preferable measure for quality improvement as opposed to patient satisfaction. [35,36,39] These definitions stated that patient experiences "have shown to be more objective and to yield more detailed information for quality improvement" [35,36] as they "provide information identifying where in the process problems may reside and what can be done to improve patient care". [39] In articulating the difference between patient experience and patient satisfaction, one study also stated that patient satisfaction is based on "expectations (or 'needs') and experiences" where "expectations are related to personal preferences, which make quality of care difficult to measure".…”

“…[35,36,39] These definitions stated that patient experiences "have shown to be more objective and to yield more detailed information for quality improvement" [35,36] as they "provide information identifying where in the process problems may reside and what can be done to improve patient care". [39] In articulating the difference between patient experience and patient satisfaction, one study also stated that patient satisfaction is based on "expectations (or 'needs') and experiences" where "expectations are related to personal preferences, which make quality of care difficult to measure". [35] Another study proposed a patient experience definition based on the domains addressed by the patient experience survey they employed.…”

“…Yet, there was also some evidence of discussion, suggesting patient involvement and partnership in their ED care. Patient experiences were optimised when care providers delivered the right amount of information in an understandable way, [35-37, 47, 50-55, 57, 58, 60-62, 65, 67, 69, 70, 75-78] when they communicated with empathy and compassion, [47,49,56,68,69,79] when patients were informed about care processes and treatment options, [46,49,52,56,62,65,68,69,72,80] updated throughout their ED journey, [39,66,69] were able to discuss matters that were important to them, [35-37, 47, 52, 54, 67, 68] and were encouraged to talk and ask questions. [50,65,69] Generally, patients who felt informed by their care providers, reported better experiences characterised by feeling reassured, safe and confident.…”

“…Patients experiencing long waiting times were more aware of their physical environment "because [they] ha [d] nothing else to do". [80] Hence, characteristics such as equipment wear and tear, [80] cleanliness, [39,48,58,80] noise, [48,51,65] and the health condition of other patients [39,87] were more noticeable. Patients who spent less time in the ED tended to report less about the physical aspects of the ED environment, instead focussing more on their relationships with care providers.…”