Cross E, Goodacre S, O'Cathain A, Arnold J
Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK.
Emerg Med J. 2005 Mar;22(3):171-6. doi: 10.1136/emj.2004.020180.
Waiting times in emergency departments (EDs) are an important government priority. Although substantial efforts are currently being made to reduce waiting times, little attention has been paid to the patients' view. We used qualitative methods to explore patients' perspectives on waiting times and other approaches to rationing and prioritisation.
Face to face, in depth, qualitative interviews (n = 11) explored how patients valued waiting times for non-urgent ED care. The framework approach (identifying a thematic framework through repeated re-reading) was used to analyse transcripts.
Interviewees found some forms of rationing and prioritisation acceptable. They expected rationing by delay, but required explanations or information on the reason for their wait. They valued prioritisation by triage (rationing by selection) and thought that this role could be expanded for the re-direction of non-urgent patients elsewhere (rationing by deflection). Interviewees were mainly unwilling or unable to engage in prioritisation of different types of patients, openly prioritising only those with obvious clinical need, and children. However, some interviewees were willing to ration implicitly, labelling some attenders as inappropriate, such as those causing a nuisance. Others felt it was unacceptable to blame "inappropriate" attenders, as their attendance may relate to lack of information or awareness of service use. Explicit rationing between services was not acceptable, although some believed there were more important priorities for NHS resources than ED waiting times. Interviewees disagreed with the hypothetical notion of paying to be seen more quickly in the ED (rationing by charging).
Interviewees expected to wait and accepted the need for prioritisation, although they were reluctant to engage in judgements regarding prioritisation. They supported the re-direction of patients with certain non-urgent complaints. However, they perceived a need for more explanation and information about their wait, the system, and alternative services.
急诊科候诊时间是政府的一项重要工作重点。尽管目前正在为减少候诊时间付出巨大努力，但患者的看法却很少受到关注。我们采用定性方法来探究患者对候诊时间以及其他资源分配和优先排序方法的看法。
通过面对面的深度定性访谈（n = 11），探讨患者如何看待非紧急急诊科护理的候诊时间。采用框架法（通过反复重读确定主题框架）对访谈记录进行分析。
受访者认为某些形式的资源分配和优先排序是可以接受的。他们预期会因延迟而进行资源分配，但需要对等待的原因作出解释或提供相关信息。他们重视分诊的优先排序（通过选择进行资源分配），并认为这一作用可以扩大，以便将非紧急患者转诊至其他地方（通过转移进行资源分配）。受访者主要不愿意或无法对不同类型的患者进行优先排序，公开表示仅优先考虑那些有明显临床需求的患者以及儿童。然而，一些受访者愿意进行隐性资源分配，将一些就诊者标记为不合适，比如那些造成麻烦的人。其他人则认为指责“不合适”的就诊者是不可接受的，因为他们前来就诊可能与缺乏信息或对服务使用的认知不足有关。尽管一些人认为国民保健服务资源有比急诊科候诊时间更重要的优先事项，但服务之间的明确资源分配是不可接受的。受访者不同意在急诊科付费以更快就诊（通过收费进行资源分配）这一假设概念。
受访者预期会等待并接受进行优先排序的必要性，尽管他们不愿对优先排序作出判断。他们支持将某些非紧急病症患者转诊。然而，他们认为需要更多关于等待、系统和替代服务的解释及信息。
