title: Patients' perceptions of quality of care at an emergency department and identification of areas for quality improvement.
abstract: OBJECTIVE
  This paper reports a study to identify patient's perceptions of quality of care at an emergency department and areas for quality improvement.
  
  
  BACKGROUND
  Patients are not always satisfied with the care received at emergency departments. More attention needs to be paid to the specific needs and expectations of the non-urgent group of patients, who make up the majority of attenders at many emergency departments. Nurses' and physicians' perceptions about good quality of care do not always agree with patients' perceptions. Instruments measuring patient satisfaction have often been focused on inpatient treatment.
  
  
  METHODS
  A prospective, descriptive survey design was adopted and the study took place in one emergency department at a Swedish university hospital in 2002. The participants were 99 women and 101 men, with an average age of 51 years. The emergency department version of the questionnaire Quality from the Patient's Perspective was used for data collection.
  
  
  RESULTS
  Patients estimated quality of care at the emergency department as fairly good, but there were areas in need of improvement. A high percent of inadequate quality was related to the environment in the emergency department. About 20% of patients reported that they did not receive effective pain relief. More than 20% estimated that nurses did not show an interest in their life situation and patients did not receive useful information on self-care and about which physician was responsible for their medical care.
  
  
  CONCLUSIONS
  The use of a research-based instrument gave valuable information for quality improvement in clinical practice. Many of the identified areas for quality improvement are related to nursing care. Therefore, the importance of nursing care in the emergency department should be highlighted to nurses and physicians and they also need to be more attentive to the need of the individual patient.
  
  
  CONCLUSIONS
  Identifying areas for quality improvements are important, to know where to take action. These findings may facilitate the work with changing attitudes and working routines, which are needed to deliver effective care and to improve patients' perceptions of quality of care at emergency departments.
authors.affiliation: Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Sweden. asa.muntlin@pubcare.uu.se
authors.forename: Asa
authors.initials: A
authors.lastname: Muntlin
authors.forename: Lena
authors.initials: L
authors.lastname: Gunningberg
authors.forename: Marianne
authors.initials: M
authors.lastname: Carlsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D016529:Emergency Nursing / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards*; D004645:Empathy; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology / Q000592:standards; D010353:Patient Education as Topic / Q000592:standards; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D013548:Sweden; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration*