Determinants of Patient Experience—translating qualitative research findings to the real world context of the ED using meta-synthesis.

Laura Cottey2, Dr Blair Graham1.2, Jos Latour1, Mark Mills1
1University of Plymouth, 2University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom

Background: Patient Experience (PEx) is associated with clinical effectiveness and patient safety and should be a priority for emergency care providers. Whilst both quantitative and qualitative approaches have been used to understand PEx in ED, the latter is well aligned to developing detailed understanding of features influencing the lived-experience of ED patients.
Aim: To conduct a systematic literature review of qualitative studies to identify key determinants of PEx in the ED and to construct a conceptual framework  for clinical practice.
Methods: A PRISMA compliant systematic review was conducted using PubMed, CINAHL, EMBASE, BNI and bibliography searches to identify qualitative studies in English between 1997-2017. Quality assessment was undertaken using a CASP checklist. Descriptive text and quotations relating to PEx were extracted from included studies using QSR NVivo (V11) and the meta-synthesis was subjected to thematic analysis.
Results: A total of 148 potentially relevant titles were identified from which 57 underwent full review and 21 were included. Meta-synthesis: Results were coded by two researchers (BG, JML). A total of 198 units of analysis were identified. In total, 11 descriptive and 5 analytical themes—based on the ‘needs’ of patients—resulted. These were Communication, Emotional, Competent Care, Waiting and Physical needs. Findings were translated into a conceptual framework (Fig.1) for optimising patient experience in the ED, including pragmatic recommendations.
Conclusion: This meta-synthesis provides an framework for understanding determinants of patient experience in the ED. The derivation of pragmatic recommendations to guide practice and improve PEx is an example of knowledge translation of qualitative research findings to the real-world context of the ED. Further validation of the framework and recommendations is planned.

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