Measuring patients' experiences in the Accident and Emergency department

Two questionnaires were used to measure patients’ experiences in the Accident and Emergency department (A&E). First, the English A&E department questionnaire used in the English National Survey Programme, and after translation in Dutch used in the Netherlands. The second questionnaire concerned the newly developed Consumer Quality Index for the A&E (CQI A&E). Both questionnaires showed to be valid and reliable questionnaires to assess patients’ experiences with the A&E. Presenting survey data according to respectively, six and seven quality domains increases the usefulness of measuring patients’ experiences. The discriminative power of these domains enables a reliable comparison of healthcare performance between A&Es from the patient’s perspective. Domains scores were constructed for both questionnaires based on Principal Components Analysis. The six domains of the English A&E department questionnaire (50 items) were: 1. Waiting time; 2. Nurses and doctors; 3. Your care and treatment; 4. Hygiene; 5. Information before discharge; 6. Overall performance. The CQI A&E was developed in line with the Dutch family of CQIs, which measure patients’ experiences in healthcare.The seven domains of the CQI A&E (78 items) were: 1. Information before treatment; 2.Timeliness; 3. Attitude of healthcare professionals; 4. Professionalism of received care; 5. Information during treatment; 6. Environment and facilities; 7. Discharge management. Measures based on the English A&E department questionnaire, which were performed in England and the Netherlands, showed that Dutch patients reported significantly better mean scores than English patients on three domains (range: 0-100): 1. Waiting time (mean scores: 73.8 (NL) versus 67.2 (EN)); 2. Doctors and nurses (mean scores: 85.7 (NL) versus 80.6 (EN)); 3. Your care and treatment (mean scores: 82.6 (NL) and 80.2 (EN)). However, differences and effect sizes were small. Despite the fact that overall Dutch A&Es had higher mean scores, plots of individual A&Es, showed that on all domains the best performing A&E concerned English A&Es. Thus, healthcare performance in the A&E can be compared between countries by surveying patients’ experiences, and there is much to learn across A&Es both within and among countries. A priority study among Dutch A&E patients was performed. The most important quality aspects of emergency care in the A&E were (range: 1-4): hygiene (3.65), whether professionals treat their patients seriously (3.61), and whether patients receive the care they need (3.61). It has not been studied before if prioritization of care aspects differs between populations - the development of a CQI requires a single assessment of priorities. Patient’s priorities across different Dutch A&E populations showed to be stable, and indifferent of patients’ characteristics. Longer perceived waiting time was associated with a decrease in global quality ratings, and an increase of problematic experiences. Problematic experiences about the perceived waiting time can be reduced by providing information before treatment (OR uninformed patients versus informed patients is 3.4 (95% CI 2.29-5.11)), controlling pain (OR 1.12; 95% CI 1.07-1.17), and acting upon patients’ perceived acuity (emergency/urgent/non-urgent ORs: 2.68; 95% CI 1.64-4.36/2.22; 95% CI 1.68-2.92 /1.0). Consequently, problematic experiences are likely to reduce, and the global quality rating is likely to increase