Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, P/O Box 7057, 1007 MB, Amsterdam, The Netherlands.
Department of Emergency Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands.
Eur Geriatr Med. 2022 Apr;13(2):339-350. doi: 10.1007/s41999-021-00581-6. Epub 2021 Nov 10.
Up to 22% of older patients who visit the emergency department (ED) have a return visit within 30 days. To achieve patient-centered care for this group at the ED it is important to involve the patient perspective and strive to provide the best possible experience. The aim of this study was to gain insight into the experiences and perspectives of older patients from initial to return ED visit by mapping their patient journey.
We performed a qualitative patient journey study with 13 patients of 70 years and older with a return ED visit within 30 days who presented at the Amsterdam UMC, a Dutch academic hospital. We used semi-structured interviews focusing on the patient experience during their journey and developed a conceptual framework for coding.
Our sample consisted of 13 older patients with an average age of 80 years, and 62% of them were males. The framework contained a timeline of the patient journey with five chronological main themes, complemented with an 'experience' theme, these were divided into 34 subthemes. Health status, social system, contact with the general practitioner, aftercare, discharge and expectations were the five main themes. The experiences regarding these themes differed greatly between patients. The two most prominent subthemes were waiting time and discharge communication, which were mostly related to a negative experience.
This study provides insight into the experiences and perspectives of older patients from initial to return ED visit. The two major findings were that lack of clarity regarding waiting times and suboptimal discharge communication contributed to negative experiences. Recommendations regarding waiting time (i.e. a two-hour time out at the ED), and discharge communication (i.e. checklist for discharge) could contribute to a positive ED experience and thereby potentially improve patient-centered care.
多达 22% 的老年患者在 30 天内会再次到急诊科（ED）就诊。为了在 ED 为这一群体提供以患者为中心的护理，重要的是要考虑患者的观点，并努力提供尽可能好的体验。本研究的目的是通过绘制患者的就诊旅程来深入了解老年患者从首次就诊到 30 天内再次就诊的经历和观点。
我们对阿姆斯特丹 UMC（荷兰一所学术医院）的 13 名年龄在 70 岁及以上且在 30 天内再次到 ED 就诊的患者进行了定性的患者就诊旅程研究。我们使用了半结构化访谈，重点关注患者在就诊过程中的体验，并开发了一个概念框架进行编码。
我们的样本包括 13 名年龄在 80 岁及以上的老年患者，其中 62%为男性。该框架包含一个患者就诊旅程的时间表，有五个按时间顺序排列的主要主题，辅以一个“体验”主题，这些主题分为 34 个子主题。健康状况、社会系统、与全科医生的联系、后续护理、出院和期望是五个主要主题。这些主题的体验在患者之间差异很大。两个最突出的子主题是等待时间和出院沟通，这主要与负面体验有关。
本研究深入了解了老年患者从首次就诊到再次就诊的经历和观点。两个主要发现是，缺乏关于等待时间的明确信息和出院沟通不佳导致了负面体验。关于等待时间（即 ED 有两小时的休息时间）和出院沟通（即出院检查表）的建议可能有助于改善 ED 体验，从而有可能改善以患者为中心的护理。
