Different patient groups request different emergency care – A survey in a Swedish emergency department

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Abstract

Aim

This study investigates possible differences in the perception of quality of care at an emergency department, as related to patient background and visit characteristics.

Methods

The study uses a prospective, descriptive survey design with data collected in May 2002 from the emergency department of a Swedish university hospital. It included 200 patients with an average age of 51 yr (range 18–91 yr). The research-based Quality from the Patient’s Perspective (QPP) questionnaire, emergency department version, was used for data collection.

Results

Several factors, for example, information after procedures, respect and empathy, nutrition, general atmosphere and routines, were rated significantly lower by patients with gastrointestinal symptoms, general surgery patients and patients admitted to a hospital ward, than by patients with other background or visit characteristics.

Conclusions

There are differences in the perception of quality of care related to patient background and visit characteristics at the emergency department. Clinical guidelines for different patient groups could facilitate the quality improvement work. However, to improve the quality of care at the emergency department there should be a balance between standardized care and individualized patient care. In addition, there has to be a changed attitude and behaviour towards the ED patients to improve their perception of the emergency care.

Introduction

Studies show that patients are not always satisfied with the care received in emergency departments (Hansagi et al., 1992, Nyström et al., 2003, Cooke et al., 2006, Nuñez et al., 2006). Frequent organizational changes and changes in political and economical conditions constitute a challenge for the health care service of today (Aiken et al., 2001, Forsberg et al., 2001, Mortimore and Cooper, 2007). In order to maintain high quality of care despite such changes, it is necessary to focus on health care from the patient’s point of view (Koziol-McLain et al., 2000). Furthermore, there is a growing awareness in hospitals and communities in general of the importance of safety improvements. It is vital that we understand the relationship between quality and safety (Institute of Medicine, 2000, Kyrkjebø, 2004), as the level of patient safety influences the level of patient satisfaction (Boudreaux et al., 2000, Zed et al., 2005).

Section snippets

Background

A Swedish study (Muntlin et al., 2006) at a university hospital found a variation in how patients perceived the quality of care in the emergency department (ED). One reason for this could be that patients have different demands for care depending on their particular ailments and situation. About one fifth of the patients rated some parts of the care as being of low quality, for example, the respect and empathy shown by ED personnel, pain relief, nutrition, and the care environment. On the other

Study design

The study utilized a prospective, descriptive survey design.

Setting

The study was conducted in the main ED of a Swedish university hospital. The hospital is a level 1 trauma centre that served about 46,000 patients per year (mean age = 54, 50% women, 50% men). At the time of the study, the ED covered three medical specialties: internal medicine, general surgery and orthopedic surgery.

Personnel and work routines

For each specialty and shift at the ED, there were one or two physicians, one or two registered nurses (RNs) and two

Results

In several dimensions and factors, the results showed differences in how the patients perceived the quality of care (Table 3).

Discussion

The present study shows that patient background and visit characteristics were related to how the patients rated the quality of care. There were differences in several factors in the dimensions of identity-oriented approach, physical–technical conditions and sociocultural atmosphere. However, the results showed no significant differences in the factors measuring the medical–technical competence dimension. This suggests that the patient’s experiences of medical care and waiting time were

Conclusions

Different patient groups perceived the quality of care in the ED in different ways depending on their age, education, reasons for attending the ED, medical specialty or medical outcome. Clinical guidelines for different patient groups might facilitate the quality improvement work in the ED. These guidelines could focus on nutrition status for general surgery patients, regularly education and practice of communication skills, continuing information during the whole ED visit, developing the

Conflict of interest

The authors could not identify any potential conflicts of interest.

Funding

This study was supported by grants from the Emergency Department of University Hospital Uppsala, and the Swedish Society of Nursing (SSF). Apart from providing the funding and access, they had no other input or involvement in the study.

Acknowledgement

We would like to extend special thanks to Anne-Sophie Norrman Saleh Lavasani for help with the data collection.

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