Focusing on families in the emergency department

Usability and Evaluation of a Health Information System in the Emergency Department: Mixed Methods Study

BACKGROUND

A lack of information during an emergency visit leads to the experience of powerlessness for patients and their family members, who may also feel unprepared to cope with acute symptoms. The ever-changing nature and fast-paced workflow in the emergency department (ED) often affect how health care professionals can tailor information and communication to the needs of the patient.

OBJECTIVE

This study aimed to evaluate the usability and experience of a newly developed information system. The system was developed together with patients and their family members to help provide the information needed in the ED.

METHODS

We conducted a mixed methods study consisting of quantitative data obtained from the System Usability Scale questionnaire and qualitative interview data obtained from purposively selected participants included in the quantitative part of the study.

RESULTS

A total of 106 patients and 14 family members (N=120) answered the questionnaire. A total of 10 patients and 3 family members participated in the interviews. Based on the System Usability Scale score, the information system was rated close to excellent, with a mean score of 83.6 (SD 12.8). Most of the participants found the information system easy to use and would like to use it again. The participants reported that the system helped them feel in control, and the information was useful. Simplifications were needed to improve the user experience for the older individuals.

CONCLUSIONS

This study demonstrates that the usability of the information system is rated close to excellent. It was perceived to be useful as it enabled understanding and predictability of the patient's trajectory in the ED. Areas for improvement include making the system more usable by older individuals. The study provides an example of how a technological solution can be used to diminish the information gap in an ED context.

The Impact of the Healthcare Environment on Patient Experience in the Emergency Department: A Systematic Review to Understand the Implications for Patient-Centered Design

Background:

The emergency department (ED) is a complex, volatile, and limited-resource healthcare setting. Many environmental factors, including high patient volumes, overburdened staff, long waits, and a tense atmosphere, converge in the ED. The objective of this study was to perform a systematic review of extant literature to understand how the ED environment drives patient experience and identify methodological or empirical insights for patient-centered ED design.

Methods:

We searched eight academic databases (Web of Science, PubMed, Scopus, Medline [Ovid], CINAHL, PyscInfo, Compendex, and IEEE Explore) to identify studies that employed observational (descriptive) or interventional (evaluative) methodology. We performed a co-citation analysis of potentially eligible articles and a qualitative synthesis of findings from studies included in our final sample.

Results:

Our search yielded 117 records. Of the 35 potentially relevant articles, 18 were published in the last 5 years, and 50% were authored by investigators in the United States. We used 33 articles for a co-citation analysis, revealing three interdisciplinary clusters and promising potential for collaboration across fields. Thirty articles were subjected to a full-text analysis, resulting in the identification of three overarching dimensions linking the ED environment to patient experience.

Conclusion:

The most commonly identified factors influencing patient experience in the ED included overcrowding and wait times, privacy, and communication; however, existing literature is limited. More research is needed to understand how ED environments configure patient experience and can be improved through design. Particularly, there is little research on participatory interventional strategies in the ED, despite strong evidence suggesting a need for stakeholder participation.

Graph Network Techniques to Model and Analyze Emergency Department Patient Flow

This article moves beyond analysis methods related to a traditional relational database or network analysis and offers a novel graph network technique to yield insights from a hospital’s emergency department work model. The modeled data were saved in a Neo4j graphing database as a time-varying graph (TVG), and related metrics, including degree centrality and shortest paths, were calculated and used to obtain time-related insights from the overall system. This study demonstrated the value of using a TVG method to model patient flows during emergency department stays. It illustrated dynamic relationships among hospital and consulting units that could not be shown with traditional analyses. The TVG approach augments traditional network analysis with temporal-related outcomes including time-related patient flows, temporal congestion points details, and periodic resource constraints. The TVG approach is crucial in health analytics to understand both general factors and unique influences that define relationships between time-influenced events. The resulting insights are useful to administrators for making decisions related to resource allocation and offer promise for understanding impacts of physicians and nurses engaged in specific patient emergency department experiences. We also analyzed customer ratings and reviews to better understand overall patient satisfaction during their journey through the emergency department.

Orienting child- and family-centered care toward equity

Child- and family-centered care (CFCC) is being increasingly adopted internationally as a fundamental philosophical approach to the design, delivery, and evaluation of children's services in diverse primary and acute health care contexts. CFCC has yet to be explored in the context of families and children whose health and health care is likely to be compromised by multifaceted social and structural factors, including racialization, material deprivation, and historically entrenched power imbalances. To date, an equity orientation for CFCC has not been examined or developed. This is a critical area of inquiry, given the increasing evidence that children in families who face such inequities have poor health outcomes. This article examines dominant discourses on CFCC in the context of families and children who are at greater risk of health inequities in wealthy countries, drawing on Canada as a useful example. It outlines an evidence-based approach to equity-oriented care that the authors contend has the potential to orient CFCC toward equity and provide greater clarity in the conceptualization, implementation, measurement, and evaluation of CFCC in ways that can benefit all families and children including those who have typically been excluded from research.

Measuring patient experience in the emergency department: A scoping review

INTRODUCTION

Measuring patients' experience in the emergency department can be an avenue through which the patients are able to evaluate their own care experience, and this may provide guidance for healthcare professionals in addressing quality improvement. This scoping review aimed to identify and examine existing tools that measure patients' experience in the emergency department.

METHODS

A scoping review was carried out to synthesize evidence from a range of studies in order to describe the characteristics of each study and their sample, and to describe the tools used to measure patients' experience in the emergency department.

RESULTS

Out of the 308 articles retrieved, results of the first and second level screening yielded 10 articles for inclusion using 9 different experience tools/questionnaire in the emergency department.

CONCLUSION

Measuring patients' experience in the emergency department is a global concern, however research conducted in low-to-middle-income countries is very limited and such research in Africa appears to be absent. Getting consumers of care to evaluate their experience may help healthcare professionals to identify discrepancies in care and plan possible strategies to address them.