Patient and caregiver expectations of emergency department care: A scoping literature review

Highlights

• Literature related to patient and caregiver ED expectations is discussed.

• Paucity of research literature related to patient/caregiver expectations.

• Majority of studies do not communicate expectations to nurses or other health care providers.

• Experimental research needed to evaluate strategies for obtaining ED expectations.

Abstract

Background

Communication between health care providers (HCPs) and patients and/or their caregivers in the chaotic emergency department (ED) context can be challenging and potentially impact health outcomes and patient satisfaction. Studies examining strategies to improve communication of patient and caregivers expectations of care in an ED are widely dispersed.

Methods

We conducted a scoping review of the published and grey literature to examine the extent, range and nature of existing research evidence regarding strategies to enhance communication of patient and caregiver expectations of care in an ED.

Results

Of the 599 articles retrieved, 24 met the inclusion criteria. Most of the studies identified included patients (n = 9) or caregivers (n = 8) as the population of interest, while the remainder examined the expectations of a mix of patients, parents/caregivers, and/or HCPs (n = 7). The majority (n = 21) of the studies did not communicate patient/caregiver expectations to HCPs.

Conclusion

This scoping review highlights the paucity of available research literature evaluating strategies to communicate patient and caregiver ED expectations. Our findings identify the need for experimental designs in future studies to evaluate implementation strategies for ED expectation tools with a particular emphasis on measuring the impact of sharing patient expectations with HCPs.

Introduction

The emergency department (ED) can be a chaotic environment characterized by frequent interruptions in important communication between patients and nurses and other health care providers (Dean and Oetzel, 2014). Previous research has shown that effective communication between health care providers and patients can improve patient satisfaction (Clever et al., 2008), while a failure in communication may result in adverse events and patient harm (Committee on Pediatric Emergency Medicine et al., 2010, Lingard et al., 2004). In a pediatric ED context, parents identify good communication as a vital element of quality care (Byczkowski et al., 2013). Furthermore, a child’s active involvement in their care in the ED also important (Hemingway and Redsell, 2011). Interventions that improve a patient-centred approach to care can improve quality in an ED (Dahl et al., 2015, Hoppa and Porter, 2011).

Patient-centred care is defined by the active involvement of patients and their families or caregivers (parents of pediatric patients) in their care including participation in decision-making about management and treatment options (Gill, 2013). Patient-centred care entails attending to patients’ preferences, needs and expectations for care and is central in the delivery of quality care (American Academy of Pediatrics Committee on Pediatric Emergency, 2006, Hoppa and Porter, 2011). However, communication of patient preferences and expectations is a dimension of patient-centred care that can be compromised in a stressful ED environment (Kilaru et al., 2016). Opportunities to enhance the communication of patient expectations for care in an ED are not well understood.

Patients and caregivers come to the ED with expectations about the care and the services they will receive. Unmet expectations can have a negative impact on patient satisfaction and possibly influence return for follow-up care. Understanding and addressing patient and caregiver expectations during a clinical encounter in the ED can be challenging amid competing priorities. However, there is an increasing body of literature focused on determining the value of obtaining patient expectations in a written format prior to receiving care in the ED. For example, in a pediatric emergency care setting, studies have shown that obtaining caregiver expectations leads to improved communication and overall satisfaction with care (Spahr et al., 2006). The ‘Clear and Concise Communication Campaign’ or ‘3C Campaign”, a quality improvement (QI) initiative to share parents’/caregivers’ worries, questions, and expectations for care with health care providers in an urban Canadian pediatric ED, was also successful in improving parent-provider communication (Porter et al., 2011). Obtaining patient/caregiver expectations early in the patient encounter has been shown to provide an opportunity to create a mutually agreed upon agenda for discussing patient problems and expectations of care (Hoppa and Porter, 2011). To date, the literature examining patient and caregiver expectations of the ED has not been systematically reviewed. It is unclear how this body of literature is positioned in the field of emergency medicine and how ED expectations are defined and measured. As such, this scoping review will address the following research objectives: 1. To describe the extent, range and nature of current research evidence related to patient and caregiver ED expectations, 2. To describe the tools and measures used to capture patient and caregiver ED expectations and 3. To identify the quality of available evidence.