Initial Development of a Patient-Reported Experience Measure for Older Adults Attending the Emergency Department: Part II—Focus Groups with Professional Caregivers

Abstract

A wide range of healthcare professionals provide care for patients in the emergency department (ED). This study forms part of a wider exploration of the determinants of patient experience for older adults in the ED, to assist the development of a new patient-reported experience measure (PREM). Inter-professional focus groups aimed to build on findings from earlier interviews with patients conducted in the ED, by exploring professional perspectives on caring for older people in this setting. A total of thirty-seven clinicians, comprising nurses, physicians and support staff, participated in seven focus groups across three EDs in the United Kingdom (UK). The findings reinforced that meeting patients’ communication, care, waiting, physical, and environmental needs are all central to the delivery of an optimal experience. Meeting older patients’ basic needs, such as access to hydration and toileting, is a priority often shared by all ED team members, irrespective of their professional role or seniority. However, due to issues including ED crowding, a gap exists between the desirable and actual standards of care delivered to older adults. This may contrast with the experience of other vulnerable ED user groups such as children, where the provision of separate facilities and bespoke services is commonplace. Therefore, in addition to providing original insights into professional perspectives of delivering care to older adults in the ED, this study demonstrates that the delivery of suboptimal care to older adults may be a significant source of moral distress for ED staff. Findings from this study, earlier interviews, and the literature will be triangulated to formulate a comprehensive list of candidate items for inclusion in a newly developed PREM, for patients aged 65 years and older.

Involving patients and caregivers to develop items for a new patient‐reported experience measure for older adults attending the emergency department. Findings from a nominal group technique study

“…An initial list of candidate items was developed by two researchers (B. G. and J. M. L.) following methodological triangulation of findings from prior studies conducted by the research team. These consisted of a qualitative metasynthesis of 22 studies of patient experience in the ED 17 ; interviews conducted with 24 patients aged over 65 attending the ED 18 ; and interprofessional focus groups with 37 ED staff 19 . Methodological triangulation describes the use of multiple data sources to study a phenomenon, and is useful to confirm findings, enrich data and increase overall validity 20 .…”

“…These consisted of a qualitative metasynthesis of 22 studies of patient experience in the ED 17 ; interviews conducted with 24 patients aged over 65 attending the ED 18 ; and interprofessional focus groups with 37 ED staff. 19 Methodological triangulation describes the use of multiple data sources to study a phenomenon, and is useful to confirm findings, enrich data and increase overall validity. 20 Therefore, similar findings that occurred across more than one of the studies were identified as particularly relevant as a focus for future measurement of older adults' experiences of ED care.…”

“…Confirmation of conceptual validity and expansion of the framework was then achieved by undertaking semi-structured interviews with older adults during an emergency care episode, and focus groups with staff responsible for the provision of emergency care to older adults across three EDs. 18,19 This study aims to describe the process of generating and prioritising a list of suggested items for PREM-ED 65 by involving multiple stakeholders including patient and public representatives, healthcare professionals and advocates for older adults.…”

“…This framework highlighted the importance of meeting patients' communication, emotional, care, physical/environmental and waiting needs. Confirmation of conceptual validity and expansion of the framework was then achieved by undertaking semi‐structured interviews with older adults during an emergency care episode, and focus groups with staff responsible for the provision of emergency care to older adults across three EDs 18,19 …”