title: The accident and emergency department questionnaire: a measure for patients' experiences in the accident and emergency department.
abstract: BACKGROUND
  The National Health Service National Patient Survey Programme systematically gathers patients' experiences about the care they have recently received. Prioritising quality improvement activities in the accident and emergency (A&E) department requires that survey outcomes are meaningful and reliable. We aimed to determine which method of obtaining summary scores for the A&E department questionnaire optimally combined good interpretability with robust psychometric characteristics.
  
  
  METHODS
  A&E department questionnaire data from 151 hospital trusts were analysed, covering 49 646 patients. Three methods of grouping and summarising items of the questionnaire were compared: principal components analysis (PCA); Department of Health dimensions; sections according to the patient's journey through the A&E department. The patient-level reliability of summary scores was determined by Cronbach's α coefficients (threshold: α>0.70), construct validity by Pearson's correlation coefficients, and the discriminative capacity by intra-class correlation coefficients (ICCs) and reliability of A&E-level mean scores.
  
  
  RESULTS
  The PCA provided the best score reliability on six clear and interpretable composites: waiting time; doctors and nurses; your care and treatment; hygiene; information before discharge; overall. The discriminative power of the concepts was comparable for the three methods, with ICCs between 0.010 and 0.061. A&E sample sizes were adequate to obtain good to excellent reliability of A&E-level mean scores.
  
  
  CONCLUSIONS
  The A&E department questionnaire is a valid and reliable questionnaire to assess patients' experiences with the A&E. The discriminative power of six summary scores offers a reliable comparison of healthcare performance between A&Es to increase patient centredness and quality of care.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands. n.bos-2@umcutrecht.nl
authors.forename: Nanne
authors.initials: N
authors.lastname: Bos
authors.forename: Steve
authors.initials: S
authors.lastname: Sizmur
authors.forename: Chris
authors.initials: C
authors.lastname: Graham
authors.forename: Henk F
authors.initials: HF
authors.lastname: van Stel
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D004777:Environment; D005260:Female; D019538:Health Care Surveys / Q000592:standards* / Q000706:statistics & numerical data; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000592:standards*; D025341:Principal Component Analysis; D011369:Professional-Patient Relations; D011594:Psychometrics; D012042:Registries; D015203:Reproducibility of Results; D012107:Research Design; D011795:Surveys and Questionnaires / Q000592:standards