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Compassion or speed, which is a more accurate indicator of healthcare quality in the emergency department from the patients’ perspective?

Michelle Beattie, Iain Atherton, Beverley McLennan, William Lauder

Abstract


Rationale, aims and objectives: Devising indicators to measure quality of care is challenging in Emergency Departments (ED).  It is difficult to measure aspects of quality which are less amenable to measurement; hence waiting time has often been relied on. This study aimed to determine whether patients’ perceptions of empathy are a measurable indicator of quality of care in comparison to waiting time within the ED. 

Method: A cross sectional survey of patients who attended an ED during a 10 day period was conducted to assess correlation between a measure of empathy (the CARE measure), waiting times  and perception of care quality.  Data other than waiting times were obtained using a questionnaire completed by patients immediately on completion of treatment. Waiting times were obtained from an existing database.  Both waiting times and CARE scores were correlated with responses to a patient satisfaction question using Spearman’s rho.

Results: Of the 81 patients who participated the majority reported care to be good (21%) or very good (75%).  Waiting times varied between 11 minutes and 5 hours 17 minutes. CARE scores ranged from 12 to 50 (mean 41.1).  Analysis showed a statistically significant relationship (p<0.001) between ratings of patient satisfaction and CARE measure scores with a moderate correlation (Spearman’s rho = 0.55), whereas no correlation was found between satisfaction and waiting time (Spearman’s rho = -0.07, p=0.56). 

Conclusions: Length of time was not associated with patients’ perceptions of care quality and hence would have been of limited value as a current measure of quality in the ED. Conversely, empathy was associated with care quality and thus should be considered as a means for assessing quality from the patients’ perspective in the context of ED departments.


Keywords


Emergency department, empathy, quality measurement, quality of healthcare, waiting time

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References


Institute of Medicine (IOM). (2001). Crossing the Quality Chasm: A New Health System for 21st Century. Washington DC: National Academy Press. http://books.nap.edu/openbook.php?record_id=10027&page=R1 (accessed 5th April 2012).

Scottish Government. (2010). The Healthcare Quality Strategy for NHS Scotland. http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf (accessed 5th April 2012).

Quality, Innovation, Productivity and Prevention (QIPP) Right Care. (2011). The NHS Atlas of Variation in Healthcare: reducing unwarranted variation to increase value and improve quality. http://www.rightcare.nhs.uk/index.php/nhs-atlas/ (accessed 11th April 2012).

Raleigh, V,S. & Foot, C. (2010). Getting the measure of quality; opportunities and challenges. London: The Kings Fund.

Cameron, P., Schull, M.J. & Cooke, M.W. (2011). A framework for measuring quality in the emergency department. Emergency Medicine Journal 28, 735-740.

Department of Health. (2011). A&E Clinical Quality Indicators: best practice guidance for local publication. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_127776 (accessed 11th April 2012).

The College of Emergency Medicine. (2011). Emergency Department Clinical Quality Indicators: A CEM guide to implementation.

Beattie, E. & Mackway-Jones, K. (2004). A Delphi study to identify performance indicators for emergency medicine. Emergency Medicine Journal 21, 47-50.

Scottish Government. (2011). Information Services Division, Accident & Emergency Waiting Times. http://isd.scot.nhs.uk/isd/4024.html (accessed 9th May 2012).

Department of Health. (2011). Accident and Emergency: Total Time Spent in A&E. http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/AccidentandEmergency/index.htm (accessed 9th May 2012).

Alberti G. (2004). Transforming emergency care in England: Department of Health. 1–48. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4091775. (accessed 9th May 2012).

Jones, P. & Schimanski, K. (2010). The four hour target to reduce emergency department ‘waiting time’: a systematic review of clinical outcomes. Emergency Medicine Australia 22, 391-298.

Kelman, S. & Friedman, J.N. (2009). Performance improvement and performance dysfunction: an empirical examination of distortionary impacts of the emergency room wait-time target in the English National Health Service. Journal of Public Administration Research Theory 19 (4) 917–946.

Beattie, M., Shepherd, A. & Howieson, B. (2012). Do the Institute of Medicines’ (IOM) dimensions of quality capture the current meaning of quality in health care? – An integrative review. Journal of Research in Nursing. 25th April. http://jrn.sagepub.com/content/early/recent

Jolly, E. & Clancy, M. (2009). Waiting times are they that important? A patient survey. Emergency Medicine Journal 26, 726.

Nystrom, M., Dahlberg, K. & Carlsson, G. (2003). Non-caring encounters at an emergency care unit – a life-world hermeneutic analysis of an efficiency-driven organisation. International Journal of Nursing Studies 40, 761-769.

Donabedian, A. (1980). Explorations in Quality Assessment and Monitoring, Vol.1, The Definition of Quality and Approaches to its Assessment. Ann Arbour, MI: Health Admin Press.

Watson, J. (2009). Measuring caring. In: Assessing and Measuring Caring in Nursing and Health Sciences, p10. New York: Springer.

Reynolds, W. & Scott, P.A. (2000). Do nurses and other professional helpers normally display much empathy? Journal of Advanced Nursing Studies 31 (1) 226- 234.

Paley, J. (2001). An archaeology of caring knowledge. Journal of Advanced Nursing 36 (2) 190.

Wolf, Z, R. (1986). The caring concept and nurse identified caring behaviours. Topics in Clinical Nursing 8 (2) 84-93.

Larsen, P. (1984). Important nurse caring behaviours perceived by patients with cancer. Oncology Nursing Forum 11 (6) 46-50.

Mercer, S., Watt, G., Maxwell, M. & Heaney, D. (2004). The development and preliminary validation of the Consultation and Relational Empathy (CARE) Measure: an empathy-based consultation process measure. Family Practice 21 (6) 699-705.

Mercer, S., McConnachie, A., Maxwell, M., Heaney, D. & Watt, G. (2005). Relevance and performance of the Consultation and Relational Empathy (CARE) Measure in general practice. Family Practice 22 (3) 328-334.

Mercer, S. & Murphy, D. (2008). Validity and reliability of the CARE Measure in secondary care. Clinical Governance: An International Journal 13, 261-283.

Mercer, S., Hatch, D., Murray, A., Murphy, D. & Eva, H. (2008). Capturing patients’ views on communication with anaesthetists: the CARE Measure. Clinical Governance: An International Journal 13, 128-137.

Mercer, S. & Reynolds, W. (2002). Empathy and quality of care. British Journal of General Practitioners 52 (Supplement) S9-12.

Goldwag, R., Berg, A., Yuval, D. & Benbassat, J. (2002). Predictors of patient satisfaction with emergency care. Israel Medical Association Journal 4, 603-606.

Perez-Carceles, M., Gironda, J., Osuna, E., Falcon, M. & Luna, A. (2010). Is the right to information fulfilled in an emergency department? Patients’ perceptions of the care provided. Journal of Evaluation in Clinical Practice 16, 456-463.

Raleigh, V., Frosini, F., Sizmur, S. & Graham, C. (2012). Do some trusts deliver a consistently better experience for patients? An analysis of patient experience across acute care surveys in English NHS trusts? British Medical Journal Quality and Safety, online first, March. http://qualitysafety.bmj.com/content/early/2012/03/01/bmjqs-2011-000588.abstract

Thiedke, C.C. (2007). What Do We Really Know About Patient Satisfaction? Family Practice Management 14 (1) 33-36.

Ware, J. & Hays, R. (1988). Methods for measuring patient satisfaction with specific medical encounters. Medical Care 26 (4) 393-402.

Kaplan, S. & Ware, J. (1995). The patient’s role in health care and quality assessment. In: Providing Quality of Care: Future Challenges. 2nd edition, pp. 25-52. (Goldfield N. & Nash D., eds.). Ann Arbor, MI: Health Administration Press.

Jenkinson, C., Coulter, A., Bruster, S., Richards, N. & Chandola, T. (2002). Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Quality and Safety in Healthcare 11, 335-339.

Nerney, M., Chin, M., Jin, L., Karrison, T., Walter, J., Mulliken, R., Miller, A., Hayley, D. & Friedman, P. (2001). Factors associated with older patients’ satisfaction with care in an inner city emergency department. Annals of Emergency Medicine 38 (2) 140-145.

Boudreaux, E., Ary, R., Mandry, C. & McCabe, B. (2000). Determinants of patient satisfaction in a large, municipal ED: the role of demographic variables, visit characteristics, and patient perceptions. American Journal of Emergency Medicine 18 (4) 394-400.

Williams, B., Coyle, J. & Healy, D. (1998). The meaning of patient satisfaction: An explanation of high reported levels. Social Science and Medicine 47 (9) 1351–1359.

Erikson, L. (1986). Patient satisfaction: an indicator of nursing care quality. Nursing Management 18 (7) 31–35.

Leonard, K.L. (2008). Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect. Journal of Health Economics 27 (2) 444-459.

Coyle, J. & Williams, B. (1999). Seeing the wood for the trees: defining the forgotten concept of patient dissatisfaction in the light of patient satisfaction research. Leadership in Health Services 12 (4) 1-9.

Wiman, E. & Wikbladm, K. (2004). Caring and uncaring encounters in nursing in the emergency department. Journal of Clinical Nursing 13, 422–429.

Coughlan, M. & Corry, M. (2007). The experiences of patients and relatives/significant others of overcrowding in accident and emergency in Ireland: A qualitative descriptive study. Accident and Emergency Nursing 15 (4) 201–209.

Pitrou, I., Lecourt, A., Bailly, L., Brousse, B., Dauchet, L. & Ladner, J. (2009). Waiting time and assessment of patient satisfaction in a large reference emergency department: prospective cohort study, France. European Journal of Emergency Medicine 16 (4) 177-182.

Boudreaux, E. & O’Hea, E. (2004). Patient satisfaction in the emergency department: a review of the literature and implications for practice. Journal of Emergency Medicine 26 (1) 13-26.

Toma, G., Triner, W. & McNutt, L. (2009). Patient satisfaction as a function of emergency department previsit expectations. Annals of Emergency Medicine 54 (3) 360-367e.

Cassidy-Smith, T., Baumann, B. & Boudreaux, E. (2007). The disconfirmation paradigm: throughput times and emergency department patient satisfaction. Journal of Emergency Medicine 32 (1) 7-13.

Booth, A.J., Harrison, C.J. & Gardener, G.J. (1992). Waiting times and patient satisfaction in the accident and emergency department. Archives of Emergency Medicine 9 (2) 162-168.

Ariba, A.J., Thanni, L.O. & Adebayo, E.O. (2007). Patients’ perceptions of quality of emergency care in a Nigerian teaching hospital: the influence of patient-provider interactions. Nigerian Postgraduate Medical Journal 14 (4) 296-301.

Oluwadiya, K., Olatoke, S., Ariba, A., Omotosho, O. & Olakulehin, O. (2010). Patients’ satisfaction with emergency care and priorities for change in a university teaching hospital in Nigeria. International Emergency Nursing 18, 203-209.

Brown, A., Sandoval, G., Levinton, C. & Blackstien-Hirsch, P. (2005). Developing an efficient model to select emergency department patient satisfaction improvement strategies. Annals of Emergency Medicine 46 (1) 3-10.




DOI: http://dx.doi.org/10.5750/ijpcm.v2i4.306

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