Original research We recruited only people who spoke conversational English with the capacity to consent. While we identified interventions that may help ED users locally, we cannot claim generalisability. We recruited, interviewed and analysed data from positions as healthcare professionals. This may have limited the extent and detail of discussions. Our experiences and perspectives inevitably influenced interpretations of data and the themes generated. However, participants’ expressions of negative perspectives and suggestions for mitigating improvements add confidence to the quality and openness of the interviews. Our structured debriefing and collaborative analysis strengthen findings. CONCLUSION Crowding negatively impacted on the patient experience of emergency care, summarised by themes of ‘loss of autonomy’, ‘unmet expectations’ and ‘vulnerability’. Mitigating recommen- dations centred on information provision to identify existing facilities for basic needs within the department and alleviate uncertainty around personnel and processes. X Damian Roland @damian_roland and James David van Oppen @J_vanOppen Acknowledgements The authors gratefully acknowledge Dr Mandar Marathe for advice and support with project methods and regulatory approvals. Contributors JDvO conceptualised the project. AIPC, HS-M, MTO and JDvO collected and analysed the data and wrote the first draft. RA, KK, NM and DR gave academic supervision and reviewed the first draft. All authors revised the draft manuscripts. JDvO accepts full responsibility as guarantor for the work and conduct of the study. Funding This project was not specifically funded. JDvO was funded by the National Institute for Health and Care Research (NIHR): Doctoral Research Fellowship 300901 and Clinical Lectureship. Competing interests None declared. Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting, or dissemination of this service evaluation. Patient consent for publication Not applicable. Ethics approval The study was registered with the hospital trust as a service evaluation (ref 12348). The NHS Health Research Authority confirmed that additional regulatory approvals were not required (ref 81/81). Participants gave informed consent to participate in the study before taking part. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement No data are available. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. ORCID iDs Damian Roland http://orcid.org/0000-0001-9334-5144 James David van Oppen http://orcid.org/0000-0002-2570-7112 REFERENCES 1 Higginson I, Boyle A. What should we do about crowding in emergency departments? Br J Hosp Med 2018;79:500–3.
2 Pearce S, Marchand T, Shannon T, et al . Emergency department crowding: an overview of reviews describing measures causes, and harms. Intern Emerg Med 2023;18:1137–58. 3 Jones S, Moulton C, Swift S, et al . Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emerg Med J 2022;39:168–73. 4 Carter EJ, Pouch SM, Larson EL. The relationship between emergency department crowding and patient outcomes: a systematic review. J Nurs Scholarsh 2014;46:106–15. 5 Af Ugglas B, Lindmarker P, Ekelund U, et al . Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR). PLoS One 2021;16:e0247881. 6 Eriksson J, Gellerstedt L, Hillerås P, et al . Registered nurses’ perceptions of safe care in overcrowded emergency departments. J Clin Nurs 2018;27:e1061–7. 7 Chen L-C, Lin C-C, Han C-Y, et al . An interpretative study on nurses’ perspectives of working in an overcrowded emergency department in Taiwan. Asian Nurs Res (Korean Soc Nurs Sci ) 2018;12:62–8. 8 Lovell L-M, Atherley AEN, Watson HR, et al . An exploration of burnout and resilience among emergency physicians at three teaching hospitals in the English-speaking Caribbean: a cross-sectional survey. Lancet Reg Health - Am 2022;15:100357. 9 Butun A, Lynn F, McGaughey J, et al . Exploring attendance at emergency departments for children with non-urgent conditions in Turkey: a qualitative study of parents and healthcare staff perspectives. Emerg Crit Care Med 2022;2:50–60. 10 Graham B, Endacott R, Smith JE, et al . “They do not care how much you know until they know how much you care”: a qualitative meta-synthesis of patient experience in the emergency department. Emerg Med J 2019;36:355–63. 11 Morley C, Unwin M, Peterson GM, et al . Emergency department crowding: a systematic review of causes, consequences and solutions. PLoS ONE 2018;13:e0203316. 12 Pietkiewicz I, Smith JA. Praktyczny przewodnik interpretacyjnej analizy fenomenologicznej w badaniach jakościowych w psychologii [english version]. Czas Psychol 2012;18:361–9. 13 Bull C, Latimer S, Crilly J, et al . “I knew I’d be taken care of”: exploring patient experiences in the emergency department. J Adv Nurs 2022;78:3330–44. 14 Boyle A, Coleman J, Sultan Y, et al . Initial validation of the International Crowding Measure in Emergency Departments (ICMED) to measure emergency department crowding. Emerg Med J 2015;32:105–8. 15 Graham B, Smith JE, Nelmes P, et al . Initial development of a patient reported experience measure for older adults attending the emergency department: part I-interviews with service users. Healthcare (Basel) -> Healthc (Basel ) 2023;11:717. 16 Pines JM, Iyer S, Disbot M, et al . The effect of emergency department crowding on patient satisfaction for admitted patients. Acad Emerg Med 2008;15:825–31. 17 do Nascimento Rocha HM, da Costa Farre AGM, de Santana Filho VJ. Adverse events in emergency department boarding: a systematic review. J Nurs Scholarsh 2021;53:458–67. 18 McDermid F, Mannix J, Peters K. Factors contributing to high turnover rates of emergency nurses: a review of the literature. Aust Crit Care 2020;33:390–6. 19 Jones PG, Mountain D, Forero R. Review article: emergency department crowding measures associations with quality of care: a systematic review. Emerg Med Australas 2021;33:592–600. 20 Cottey L, Shanahan TAG, Gronlund T, et al . Refreshing the emergency medicine research priorities. Emerg Med J 2023;40:666–70. 21 England N. NHS sets out plans for winter with new measures to help speed up discharge for patients and improve care. 2023. Available: https://www.england.nhs. uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up- discharge-for-patients-and-improve-care 22 Sonis JD, Aaronson EL, Lee RY, et al . Emergency department patient experience: a systematic review of the literature. J Patient Exp 2018;5:101–6. 23 Vaillancourt S, Cullen JD, Dainty KN, et al . PROM-ED: development and testing of a patient-reported outcome measure for emergency department patients who are discharged home. Ann Emerg Med 2020;76:219–29. 24 van Oppen JD, Coats TJ, Conroy SP, et al . Co-creation of a patient-reported outcome measure for older people living with frailty receiving acute care (PROM-OPAC). J Patient Exp 2023;10:237437352311589. 25 Oxley L. An examination of interpretative phenomenological analysis (IPA). Educational and Child Psychology 2016;33:55–62.
Craston AIP, et al . Emerg Med J 2024; 0 :1–6. doi:10.1136/emermed-2023-213751
6
Powered by FlippingBook