Patient experience of different regional models of urgent and emergency care: a cross-sectional survey study

Abstract

ObjectivesTo compare user experiences of 8 regional urgent and emergency care systems in the Republic of Ireland, and explore potential avenues for improvement.DesignA cross-sectional survey.SettingSeveral distinct models of urgent and emergency care operate in Ireland, as system reconfiguration has been implemented in some regions but not others. The Urgent Care System Questionnaire was used to explore service users' experiences with urgent and emergency care. Linear regression and logistic regression were used to detect regional variation in each of the 3 domains and overall ratings of care.ParticipantsA nationally representative sample (N=8002) of the general population was contacted by telephone, yielding 1205 participants who self-identified as having used urgent and emergency care services in the previous 3 months.Main outcome measuresPatient experience was assessed across 3 domains: entry into the system, progress through the system and patient convenience of the system. Participants were also asked to provide an overall rating of the care they received.ResultsService users in Dublin North East gave lower ratings on the entry into the system scale than those in Dublin South (adjusted mean difference=−0.18; 95% CI −0.35 to −0.10; p=0.038). For overall ratings of care, service users in the Mid-West were less likely than those in Dublin North East to give an excellent rating (adjusted OR 0.57; 95% CI 0.35 to 0.92; p=0.022). Survey items relating to communication, and consideration of patients' needs were comparatively poorly rated. The use of public emergency departments and out-of-hours general practice care was associated with poorer patient experiences.ConclusionsNo consistent relationship was found between the type of urgent and emergency care model in different regions and patient experience. Scale-level data may not offer a useful metric for exploring the impact of system-level service change.

The drivers and impact of emergency care reconfiguration in Ireland: Results from a large mixed-methods research programme

“…The survey found no association between the type of emergency care model adopted in different regions and self-reported care experience. 17 Overall, 36% of service users in the SIREN survey rated their care as excellent, slightly lower than figures from comparable studies conducted in the UK where ratings of 39% and 41% were reported. The only significant finding was that service users in the mid-west region, which had shut three EDs and centralised care to one tertiary hospital, reported significantly lower overall ratings of care than those in the Dublin north-east region, which has undertaken little change.…”

A systematic mixed studies review of patient experiences in the ED

“…Respect was demonstrated on a spectrum, ranging from a lack of respect to a high level of respect. Positive experiences were associated with being listened to carefully and attentively, [35-37, 40, 46, 47, 50-60] having the opportunity to talk uninterrupted, [47,50] being taken seriously, [36,45,49,51,61,62] and feeling as though care providers had the time for them. [51,53,55,59,60,63,64] Similarly, care providers that were on the same level as patients (i.e.…”

“…[64] • "I was told how long I'd have to wait." [61] • "This is not the first time I've been here and was so ill and had to sit and wait. Then, when I get to the next spot, I have to sit and wait.…”

“…confusion and fear [39,40,. 43,63,72] Patients described being uninformed as not being provided with sufficient verbal or written information about matters such as how long they might have to wait and what to do following discharge,[36,39,41,46,52,56,58,60,61,63,65,72,[81][82][83] receiving information they could not understand,[46,63,68] when information was delivered abruptly,[68,81,82] when information from multiple care providers was inconsistent or contradictory,[36,42,58,60,78] and when they were asked to repeat themselves numerous times [42,45,61,66]. Caring for patientsBeing cared for encompassed both routine/ functional aspects of care (e.g.…”

An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015

“…The analysis within this study was conducted using secondary data collected by the INMO, HSE and HIPE. However, the development of this research question was informed by public and patient experiences as identified by studies conducted by Droog et al 41 and Foley et al 42 as part of the wider Study of the Impact of Reconfiguration on Emergency and Urgent Care Networks (SIREN) project, of which this study is a part. Preliminary findings from this study were disseminated to patients and the wider public through a number of public meetings held in the regions included in this analysis.…”