A META-SYNTHESIS OF PATIENTS' EXPERIENCES IN CROWDED EMERGENCY DEPARTMENTS IN ACUTE HOSPITALS

Abstract

Background. The phenomenon of crowded emergency departments has been widely studied worldwide as a persistent challenge. Patients have reported negative experiences; however, current interventions have not been proved to be effective in solving the problem. Thus, the patient experience should be reviewed to construct more effective interventions. Aim. To synthesise the best available evidence of patients’ experiences in crowded emergency departments in acute hospitals. Design. A meta-synthesis was conducted. Methods. Seven databases of PubMed, Cochrane, CINAHL, Embase, Scopus, Web of Science and ProQuest were searched for published and unpublished studies in English using qualitative designs exploring adult patients’ experiences in crowded emergency departments with no year limit. Databases search, data extraction and methodological quality appraisal were performed. Thematic analysis was first conducted, followed by meta-synthesis, to form a new, comprehensive understanding of the topic. Findings. Thirteen studies were included. Three major domains emerged: (i) lack of interpersonal touch, (ii) insufficient information and care and (iii) logistic and environmental challenges. Patients’ experiences were shaped and affected by these domains and consisted of largely negative encounters. The interpersonal relationships formed were essential to the patient experience. Information sharing was scarce. Views of the standard of care differed between patients, with some positive experiences. Patients felt unhappy with the long waiting time, poor maintenance of the physical ED environment and lack of privacy. Conclusions and Implications. Improvement and adoption of better care processes that relate to the three identified domains are needed to enhance the patient experience as a whole. Recommendations that aim to tackle all three aspects range from simple deliverables to bigger systemic and behavioural changes from additional staff training, to even the introduction of a new overcrowding standard of practice for EDs. This would improve patient experience and tackle the overcrowding problem in EDs.