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急诊科护理中负面患者体验的混合方法分析:识别整个护理过程中的挑战和循证策略

A Mixed-Methods Analysis of Negative Patient Experiences in Emergency Department Care: Identifying Challenges and Evidence-Informed Strategies Across the Care Continuum.

作者信息

Fujioka J K, Walker M, Rajab D, Bartels S A

机构信息

Department of Medicine, Queen's University, Kingston, ON, Canada.

Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.

出版信息

J Patient Exp. 2025 Mar 2;12:23743735251323795. doi: 10.1177/23743735251323795. eCollection 2025.

DOI:10.1177/23743735251323795
PMID:40034841
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11873856/
Abstract

This mixed-methods study explores negative patient experiences within emergency departments (EDs), aiming to uncover systemic challenges and propose evidence-informed solutions. Of 2114 shared ED experiences, 306 (14.5%) were reported as "bad" or "very bad." Younger age, Indigenous status, financial instability, mental health disabilities, and non-heteronormative sexual identities were associated with negative ED experiences. Our research highlights key issues across the ED care continuum. During triage and registration, patients felt judged and perceived that their health concerns were under prioritized. Prolonged wait times contributed to feelings of neglect. During assessments, privacy concerns and lack of communication were prominent. Perceptions of misdiagnosis and stigmatization emerged as major concerns during the diagnosis and treatment phases. At discharge, insufficient follow-up and unclear instructions were frequently reported. Our findings underscore the need for improved communication, enhanced training to reduce stigma, and multi-pronged strategies to address the root causes of patient dissatisfaction. These insights can guide healthcare practitioners and policymakers in fostering a more inclusive and supportive ED environment, ultimately improving patient experiences and outcomes.

摘要

这项混合方法研究探讨了急诊科患者的负面经历,旨在揭示系统性挑战并提出基于证据的解决方案。在2114份分享的急诊科经历中,306份(14.5%)被报告为“差”或“非常差”。年龄较小、原住民身份、经济不稳定、心理健康问题以及非异性恋性身份与急诊科负面经历相关。我们的研究突出了急诊科护理连续过程中的关键问题。在分诊和登记过程中,患者感觉受到评判,认为自己的健康问题未得到优先处理。长时间等待导致被忽视的感觉。在评估过程中,隐私问题和沟通不畅较为突出。在诊断和治疗阶段,误诊和污名化的认知成为主要担忧。在出院时,经常报告后续跟进不足和指示不明确的情况。我们的研究结果强调需要改善沟通、加强培训以减少污名化,并采取多管齐下的策略来解决患者不满的根本原因。这些见解可以指导医疗从业者和政策制定者营造一个更具包容性和支持性的急诊科环境,最终改善患者体验和治疗结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f247/11873856/ebd394b98f7e/10.1177_23743735251323795-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f247/11873856/ebd394b98f7e/10.1177_23743735251323795-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f247/11873856/ebd394b98f7e/10.1177_23743735251323795-fig1.jpg

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本文引用的文献

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Emergency department care experiences among people who use substances: a qualitative study.急诊部门中使用物质的人群的就诊体验:一项定性研究。
Int J Equity Health. 2023 Dec 4;22(1):248. doi: 10.1186/s12939-023-02050-x.
2
Cognitive biases regarding utilization of emergency severity index among emergency nurses.急诊护士在使用急诊严重程度指数方面的认知偏差。
Am J Emerg Med. 2023 Nov;73:63-68. doi: 10.1016/j.ajem.2023.08.021. Epub 2023 Aug 12.
3
Emergency departments are in crisis now and for the foreseeable future.急诊部门目前处于危机之中,并且在可预见的未来也将如此。
CMAJ. 2023 Jun 19;195(24):E851-E852. doi: 10.1503/cmaj.230719.
4
Emergency department care experiences among members of equity-deserving groups: quantitative results from a cross-sectional mixed methods study.公平权益群体成员在急诊部门的就医体验:一项横断面混合方法研究的定量结果。
BMC Emerg Med. 2023 Feb 21;23(1):21. doi: 10.1186/s12873-023-00792-z.
5
The Association between Emergency Department Overcrowding and Delay in Treatment: A Systematic Review.急诊科拥挤与治疗延误之间的关联:一项系统综述。
Healthcare (Basel). 2023 Jan 29;11(3):385. doi: 10.3390/healthcare11030385.
6
The use of kiosks to improve triage efficiency in the emergency department.在急诊科使用信息亭以提高分诊效率。
NPJ Digit Med. 2023 Feb 3;6(1):19. doi: 10.1038/s41746-023-00758-2.
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Use of Real-Time Information to Predict Future Arrivals in the Emergency Department.利用实时信息预测急诊科未来到达人数。
Ann Emerg Med. 2023 Jun;81(6):728-737. doi: 10.1016/j.annemergmed.2022.11.005. Epub 2023 Jan 18.
8
Communicating Diagnostic Uncertainty at Emergency Department Discharge: A Simulation-Based Mastery Learning Randomized Trial.急诊科出院时传达诊断不确定性:一项基于模拟的掌握学习随机试验。
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Delayed medical care and its perceived health impact among US older adults during the COVID-19 pandemic.美国 COVID-19 大流行期间老年人群体延迟医疗及其感知健康影响。
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Int J Health Serv. 2022 Apr;52(2):246-260. doi: 10.1177/00207314221075515. Epub 2022 Jan 31.