Patients’ Perspectives on Outcomes of Care After Discharge From the Emergency Department: A Qualitative Study

• Published in: Annals of emergency medicine 2017-11, Vol.70 (5), p.648-658.e2
• Main Authors: Vaillancourt, Samuel, Seaton, M. Bianca, Schull, Michael J., Cheng, Amy H.Y., Beaton, Dorcas E., Laupacis, Andreas, Dainty, Katie N.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Disease Management; Emergency Service, Hospital - standards; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Interviews as Topic - methods; Male; Middle Aged; Ontario - epidemiology; Patient Discharge - statistics & numerical data; Patient Reported Outcome Measures; Qualitative Research; Surveys and Questionnaires; Young Adult
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2017.05.034

Much effort has been expended to understand what care experiences patients value in the emergency department (ED), yet little is known about which outcomes patients value after ED care. Our goal is to define outcomes of ED care that are valued by patients discharged from the ED, with the goal of informing the development of a patient-reported outcome measure for ED care. We conducted qualitative semistructured interviews with patients recruited during their care at 1 of 2 EDs and interviewed in either English or French 1 to 9 days after their visit. Patients who were hospitalized were excluded. Interviews focused on perceived outcomes of care since the ED visit and expectations of care before the ED visit. We identified themes with standard descriptive content analysis techniques and a modified version of the constant comparative method, drawing on grounded theory methods. We interviewed 46 patients in English (n=38) or French (n=8). Participants with diverse reasons for seeking care appeared to value common outcomes from ED care that centered around 4 themes: understanding the cause and expected trajectory of their symptoms; reassurance; symptom relief; and having a plan to manage their symptoms, resolve their issue, or pursue further medical care. These themes were also reflected in the expectations participants recalled having when they decided to seek care in the ED. The 4 outcomes defined constitute areas for improvement and will inform the development of an ED patient-reported outcome questionnaire. Consideration should be given to measuring patient-reported outcomes separately from patient experience.