Original research Being a patient in a crowded emergency department: a qualitative service evaluation Alex I P Craston, 1 Harriet Scott-Murfitt, 1 Mariam T Omar, 1 Ruw Abeyratne, 2 Kate Kirk, 3 Nicola Mackintosh, 3 Damian Roland , 2,3 James David van Oppen 3,4
ABSTRACT Background Emergency department (ED) crowding causes increased mortality. Professionals working in crowded departments feel unable to provide high-quality care and are predisposed to burnout. Awareness of the impact on patients, however, is limited to metrics and surveys rather than understanding perspectives. This project investigated patients’ experiences and identified mitigating interventions. Methods A qualitative service evaluation was undertaken in a large UK ED. Adults were recruited during periods of high occupancy or delayed transfers. Semi-structured interviews explored experience during these attendances. Participants shared potential mitigating interventions. Analysis was based on the interpretative phenomenological approach. Verbatim transcripts were read, checked for accuracy, re-read and discussed during interviewer debriefing. Reflections about positionality informed the interpretative process. Results Seven patients and three accompanying partners participated. They were aged 24–87 with characteristics representing the catchment population. Participants’ experiences were characterised by ’loss of autonomy’, ’unmet expectations’ and ’vulnerability’. Potential mitigating interventions centred around information provision and better identification of existing ED facilities for personal needs. Conclusion Participants attending a crowded ED experienced uncertainty, helplessness and discomfort. Recommendations included process and environmental orientation. INTRODUCTION Crowding affects emergency departments (ED) worldwide and is a current pressing UK concern. 1 It is caused by increased attendances and delayed transfers. 2 Reduced throughput is associated with increased mortality. 3 Crowding impacts on patient safety and outcomes, including delayed time to treatment and increased patients departing unseen. 4 5 Qualitative work has explored the impact of working in crowded EDs, citing moral stress, dissat- isfaction with working conditions and deviation from care protocols. 6–8 While there is a growing body of evidence for professionals’ poor experi- ences working in crowded environments, aware- ness of the impact on patients is limited to analyses of service outcomes rather than a more detailed understanding of perspectives. 2 Qualitative work with patients has tended to explore their reasons for attending departments (aiming to reduce or divert
Handling editor Liza Keating ► Additional supplemental material is published online only. To view, please visit the journal online (https://doi. org/1 0.1136/e mermed-2023- 213751). 1 Medical School, University of Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK 3 Department of Population Health Sciences, University of Leicester, Leicester, UK 2 Emergency & Specialist Leicester, Leicester, UK 4 Centre for Urgent and Emergency Care Research (CURE), The University of Sheffield, Sheffield, UK Correspondence to Dr James David van Oppen; james.vanoppen@d octors. org.u k
healthcare resource use) rather than appreciating their experience once there. 9 Experience, though, is a key measure of emergency care and contributes to any outcomes attained to subsequent satisfaction. 10 ED crowding is an issue with complex causes; there is no single solution for its prevention that departments can implement, and instead, a whole- system response will be required. 11 This study aimed to improve understanding of ED crowding and its emotional, psychological and experiential impacts from the patient perspective and thereby identify potential local interventions for alleviation. A qualitative service evaluation was undertaken. The methodology used semi-structured interviews with interpretative phenomenological analysis to elicit in detail and make sense of participants’ perspectives. This method extends beyond the narration of participants’ experiences and insights to double hermeneutic interpretation of their perspectives. 12 13 This uses a relatively small number of in-depth interviews and focuses on appreciating the essence of experience rather than necessarily deriving generalisable theory. METHODS Study design experiences of receiving healthcare in a crowded emergency department and identified potential mitigating interventions for improvement. Crowding contributed to uncertainty, helplessness and discomfort for these participants, who suggested process and environmental adjustments for amelioration. HOW THIS STUDY MIGHT AFFECT RESEARCH, POLICY OR PRACTICE ⇒ Evaluating crowding impacts from the patient perspective can identify interventions for experience improvement. Reinforcement of information and orientation may help to relieve negative healthcare experience when our emergency department is crowded. WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Crowding in emergency departments is associated with poorer outcomes for patients and poorer working conditions for professionals. WHAT THIS STUDY ADDS ⇒ This qualitative evaluation studied patients’
AIPC, HS-M and MTO contributed equally.
Received 9 November 2023 Accepted 13 July 2024
© Author(s) (or their employer(s)) 2024. No
To cite: Craston AIP, Scott- Murfitt H, Omar MT, et al . Emerg Med J Epub ahead of print: [ please include Day Month Year]. doi:10.1136/ emermed-2023-213751 commercial re-use. See rights and permissions. Published by BMJ.
Craston AIP, et al . Emerg Med J 2024; 0 :1–6. doi:10.1136/emermed-2023-213751
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