PRIME Centre Wales, Cardiff University School of Medicine, Cardiff, Wales.
Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales.
BMC Emerg Med. 2022 Jan 22;22(1):12. doi: 10.1186/s12873-021-00562-9.
Patient experience is an important outcome and indicator of healthcare quality, and patient reported experiences are key to improving quality of care. While patient experience in emergency departments (EDs) has been reported in research, there is limited evidence about patients' specific experiences with primary care services located in or alongside EDs. We aim to identify theories about patient experience and acceptability of being streamed to a primary care clinician in an ED.
Using theories from a rapid realist review as a basis, we interviewed 24 patients and 106 staff members to generate updated theories about patient experience and acceptability of streaming to primary care services in EDs. Feedback from 56 stakeholders, including clinicians, policymakers and patient and public members, as well as observations at 13 EDs, also contributed to the development of these theories, which we present as a programme theory.
We found that patients had no expectations or preferences for which type of clinician they were seen by, and generally found being streamed to a primary care clinician in the ED acceptable. Clinicians and patients reported that patients generally found primary care streaming acceptable if they felt their complaint was dealt with suitably, in a timely manner, and when clinicians clearly communicated the need for investigations, and how these contributed to decision-making and treatment plans.
From our findings, we have developed a programme theory to demonstrate that service providers can expect that patients will be generally satisfied with their experience of being streamed to, and seen by, primary care clinicians working in these services. Service providers should consider the potential advantages and disadvantages of implementing primary care services at their ED. If primary care services are implemented, clear communication is needed between staff and patients, and patient feedback should be sought.
患者体验是医疗质量的重要结果和指标，患者报告的体验是改善护理质量的关键。虽然已经有研究报告了急诊科（ED）的患者体验，但关于患者在位于或毗邻急诊科的初级保健服务中的具体体验的证据有限。我们旨在确定关于患者体验和接受在 ED 转至初级保健临床医生的理论。
我们使用快速现实主义审查的理论作为基础，对 24 名患者和 106 名工作人员进行了访谈，以生成有关患者体验和接受在 ED 转至初级保健服务的理论。来自包括临床医生、政策制定者以及患者和公众成员在内的 56 名利益相关者的反馈，以及在 13 个 ED 的观察，也为这些理论的发展做出了贡献，我们将这些理论作为一个方案理论呈现。
我们发现患者对他们将由哪种类型的临床医生就诊没有期望或偏好，并且通常认为在 ED 转至初级保健临床医生处就诊是可以接受的。临床医生和患者报告说，如果患者感到他们的投诉得到了适当处理、及时处理，并且临床医生清楚地传达了进行检查的必要性，以及这些检查如何有助于决策和治疗计划，那么患者通常会接受将他们转至初级保健临床医生处就诊的服务。
根据我们的研究结果，我们已经制定了一个方案理论，表明服务提供者可以期望患者通常会对他们被转至初级保健临床医生处就诊的体验感到满意，这些临床医生在这些服务中工作。服务提供者应考虑在其 ED 实施初级保健服务的潜在优势和劣势。如果实施了初级保健服务，则需要在工作人员和患者之间进行清晰的沟通，并应征求患者的反馈意见。
