School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth Faculty of Health and Human Sciences, Plymouth, UK.
Emergency Department, Derriford Hospital, Plymouth, UK.
Emerg Med J. 2019 Jun;36(6):355-363. doi: 10.1136/emermed-2018-208156. Epub 2019 Apr 19.
Patient experience is positively associated with both clinical effectiveness and patient safety and should be a priority for emergency care providers. While both quantitative and qualitative approaches can be used to evaluate patient experience in the emergency department (ED), the latter is well aligned to develop a detailed understanding of features influencing the lived experience of ED patients. This study aimed to systematically review the literature of qualitative studies to identify determinants of adult patient experience in the ED.
A Preferred Reporting Items for Systematic review and Meta-Analysis compliant systematic review was conducted using PubMed, CINAHL, EMBASE, BNI and bibliography searches to identify qualitative studies exploring patient experiences in ED published in English between 1997 and 2018. Quality assessment was conducted using the Critical Appraisal Skills Programme checklist. Descriptive text and quotations relating to patient experience were extracted from included studies and a meta-synthesis conducted using thematic analysis.
A total of 625 records were screened from which 40 studies underwent full review and 22 were included. Results were coded by two researchers (BG and JML). Meta-synthesis identified 198 discrete units of analysis which were clustered around five analytical themes. These were based on the perceived 'needs' of patients visiting the ED and were defined as communication, emotional, competent care, physical/environmental and waiting needs. Findings were translated into a conceptual model for optimising patient experience in the ED.
This meta-synthesis provides a framework for understanding the determinants of patient experience in the ED. The resulting conceptual model and recommendations may have the potential to directly inform practice and improve the patient experience.
患者体验与临床疗效和患者安全均呈正相关，应当成为急诊医护人员关注的重点。虽然可采用定量和定性方法评估急诊科患者体验，但后者更有助于深入了解影响急诊科患者实际体验的特征。本研究旨在系统综述定性研究文献，以确定影响急诊科成年患者体验的决定因素。
采用符合系统评价和荟萃分析的首选报告项目，通过 PubMed、CINAHL、EMBASE、BNI 和文献检索，检索 1997 年至 2018 年间发表的英文定性研究，以确定探索急诊科患者体验的研究。采用批判性评估技能计划清单进行质量评估。从纳入研究中提取与患者体验相关的描述性文本和引语，并采用主题分析进行荟萃合成。
共筛选出 625 条记录，其中 40 项研究进行了全文审查，22 项研究被纳入。两名研究人员（BG 和 JML）对结果进行编码。荟萃合成确定了 198 个离散分析单元，这些单元围绕五个分析主题聚类。这些主题基于患者就诊急诊科的感知“需求”，定义为沟通、情感、护理能力、身体/环境和等待需求。研究结果被转化为优化急诊科患者体验的概念模型。
该荟萃合成提供了一个理解急诊科患者体验决定因素的框架。由此产生的概念模型和建议可能具有直接指导实践和改善患者体验的潜力。
