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

Evaluation method for public guidance service interface design based on improved grey H-Convex correlation model: integrating layout aesthetics and user visual cognition

The development of scientifically rigorous evaluation methods is essential to overcome three persistent challenges in public navigation interfaces: inadequate guidance, low usability, and suboptimal user experience. Focusing on intelligent medical guidance systems, this study establishes a dual-dimensional analytical framework encompassing layout aesthetics (spatial composition principles) and visual cognition (information processing patterns). We propose an enhanced grey H-convex correlation model integrating Bayesian Best Worst Method (BBWM) and modified CRITIC with reference point (M-CRITIC-RP) to address weight determination limitations in existing models. Our experimental analysis reveals two key findings: First, the synergistic integration of layout aesthetics (e.g., visual hierarchy balance) and visual cognition characteristics (e.g., attention distribution patterns) significantly improves interface usability for medical service navigation. Second, the proposed BBWM-M-CRITIC-RP hybrid model demonstrates superior performance in quantifying aesthetic-cognition relationships, achieving 88% prediction accuracy compared to conventional methods. In a word, our research provides a new theoretical method for traditional visual display design and a new evaluation criterion for interface design, aiming at improving the user experience.

Human-Building-Technology Interactions in Healthcare Environments: A Guiding Analytical Framework Based on Mediation Theory

Objective: There is a need for a more theoretical understanding of human behavior to inform the decision-making related to how technology should be integrated into healthcare environments. Background: Healthcare systems are transforming with more technology embedded within the built environment of healthcare facilities. The placement of these technologies, however, only sometimes considers the needs or workflow of patients, visitors or staff. Despite similarities, evidence-based design, smart building design and human-building interaction research rarely intersect. However, each relies on multi-disciplinary insights to enhance these fields. In this paper, we contextualize human-building interaction with building technology through an analytical framework inspired by mediation theory. Methods: Based on five case examples from previous studies and site visits, we present the interaction and explain how mediation theory provides insight into the interaction. Results and Conclusions: Looking at human-building technology interaction from the lens of mediation theory, it is apparent that the specific decisions taken in spatial and technological design impact the behaviors of building occupants. This paper provides examples of how technology in healthcare environments is used unintendedly, resulting in adapting the use to meet the user's needs. Mediation theory provides a framework to contextualize such encounters which will allow researchers to anticipate user needs and avoid disruptive building technologies in the future.

Use of the structured emergency nursing framework HIRAID® improves patient experience: A stepped-wedge cluster randomised control trial in rural, regional and metropolitan Australia

BACKGROUND

Emergency departments have high levels of uncertainty, long wait times, resource shortages, overcrowding and a constantly changing environment. Patient experience and patient safety are directly linked, yet levels of patient experience are stagnant. To improve emergency nursing care and patient experience, an emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) was implemented in 29 Australian emergency departments.

OBJECTIVES

To evaluate HIRAID® on patient experience in the emergency department.

METHODS

This modified stepped-wedge cluster randomised control trial was conducted in 29 Australian rural, regional and metropolitan emergency departments and involved over 1300 emergency nurses. A total 2704 (1456 control, 1248 intervention) surveys were completed. We hypothesised implementation of HIRAID® would result in an at least 5% increase in patient experience per Schmidt's Perceptions of Nursing Care Survey and Australian Hospital Patient Experience Question Set. Patients (of all ages) and/or their carers completed a phone interview. Data were analysed using descriptive statistics and Generalized Estimating Equations approaches.

RESULTS

Median (IQR) participant age was 54 (31-67) years. The most common presenting problems were abdominal, chest and respiratory issues. Greater than 5% improvement in all categories of the Schmidt's Perceptions of Nursing Care Survey, and 10 out of 12 Australian Hospital Patient Experience Question Set was achieved.

CONCLUSIONS

The implementation of the HIRAID® emergency nursing framework in Australian emergency departments significantly improved patient experience with emergency care.

IMPLICATIONS

Demand for emergency care is increasing. Evaluating what methods work to effectively translate evidence to emergency practice, improve patient experience in the complex emergency setting is crucial. We present how a behaviour change informed implementation strategy enabled maximum, sustained uptake of an intervention that improved patient experience in a variety of emergency settings despite the COVID-19 pandemic and catastrophic flooding.

TRIAL REGISTRATION

ANZCTR, ACTRN12621001456842. 25.10.2021.

The experiences of patients attending the emergency department who were managed by physiotherapists: a person-centred perspective

PURPOSE

The expectation for all clinicians to deliver person-centred practices extends to the growing number of primary contact physiotherapists based in United Kingdom emergency departments (ED). Research on ED patients' experience of this physiotherapy role has yet to consider this through the lens of person-centredness. A qualitative exploration of person-centredness among ED physiotherapists through the experiences of attending patients targeted this knowledge gap to inform future clinical practice.

METHODS

Semi-structured interviews with thematic analysis.

RESULTS

13 interviews were completed with four overarching themes generated: (1) patient experience of the ED; (2) the importance of connection, competence, and time; (3) recognising the benefits of being seen by a physiotherapist in ED; and (4) patient experience of the ED physical environment.

CONCLUSION

Novel contributions from the patient perspective, here, reflected a cognisance of certain environment limitations to PCP, as well as institutional challenges to their personhood, with a suggestion that ED patients anticipated a validation of their visit and valued the educational aspects that the physiotherapists provided. Considering this new knowledge can help ED physiotherapists to be more person-centred.

Screening and Response for Adverse Social Determinants of Health in US Emergency Departments

Importance

Regulatory agencies have begun incentivizing screening for adverse social determinants of health (SDOH) and responses in inpatient settings, missing a crucial safety net: the emergency department (ED). Little is known about the prevalence of ED-based adverse SDOH screening and response practices nationally.

Objective

To describe the prevalence of ED-based adverse SDOH screening and response policies and to identify associated hospital characteristics.

Design, Setting, and Participants

This survey study utilized a 5% random sample from the National Emergency Department Inventory-USA, including EDs stratified by geography, urbanicity, and practice setting (academic vs community). Data regarding 2022 policies were collected in 2023.

Exposures

Practice setting, urbanicity, visit volume, and availability of social work.

Main Outcomes and Measures

The presence of written policies for any adverse SDOH (housing, food, transportation, and utility payment difficulties) screening and responses, as well as other requirement-driven screening for SDOH risk factors (intimate partner violence, substance use, and mental health conditions). Responses were categorized as consultations (eg, social work), standardized information sheets, individualized resource information, or other.

Results

Of a total of 280 EDs, 232 responded (83% response rate). Among 232 EDs, 28.4% (survey-weighted proportion; 95% CI, 21.0%-37.2%) had screening policies for at least 1 adverse SDOH domain, and 93.1% (95% CI, 89.2%-95.7%) performed at least 1 other requirement-driven screening (eg, intimate partner violence). Of EDs performing any screening (adverse SDOH or other), 81.6% (95% CI, 73.4%-87.7%) had response policies, primarily involving consultations (78.2%; 95% CI, 67.2%-86.3%), standardized information sheets (43.0%; 95% CI, 32.5%-54.3%), and individualized resource information (12.9%; 95% CI, 7.2%-21.8%). Among all responding EDs, only 23.4% (95% CI, 17.1%-31.2%) had around-the-clock social work availability, and 20.5% (95% CI, 14.2%-28.6%) had an ED-based social worker. There was no association between practice setting, urbanicity, visit volume, or around-the-clock social work with adverse SDOH screening or response policies.

Conclusions and Relevance

Despite the high prevalence of adverse SDOH in ED populations, in this survey study of 232 EDs, less than one-third performed screening, and one-fifth did not have policies requiring a response to positive screens. Bridging this gap may require expanding adverse SDOH screening practices while also ensuring that EDs have the resources and infrastructure to respond appropriately to identified social needs. Future research might explore advanced technological solutions to enhance screening and responses in these resource-constrained settings.

Implementing a re-structured response to behavioural disturbance in the emergency Department - A mixed methods evaluation

BACKGROUND

The increasing prevalence of violence in Emergency Departments (EDs) globally emphasises that the early detection of behavioural disturbance, the skilful application of de-escalation techniques and as a last resort, patient restraint, are vital to the safety and wellbeing of staff and patients. The findings from our previous research led four EDs across three sites to form a working party consisting of clinicians, educators, IT specialists, researchers, and security officers to design and implement a restructured approach to managing behavioural emergencies.

METHODS

This mixed methods study used surveys and interviews and the Theoretical Domains Framework (TDF) to evaluate the barriers and facilitators to implementing an intervention designed to manage behavioural emergencies. We collected 61 surveys and conducted 12 interviews with nurses, physicians and security staff.

RESULTS

The qualitative and quantitative data collected using the TDF pinpointed six facilitators and nine barriers for the implementation of the Code Black intervention. We were able to identify environmental, systemic and cultural factors that inhibited its implementation. Staff felt confident in their ability to apply the Code Black knowledge and skills and appreciative of efforts being made to improve safety. However, some remain unconvinced that behavioural change of staff will lead to safer outcomes.

CONCLUSION

The restructured approach is an effective containment of escalating aggression which ensures greater safety of patients and staff. However, the implementation of interventions in emergency care settings is complex. EDs have unique characteristics that influence sustainability and that need to be explored further to ensure the ongoing uptake of new practices. This paper demonstrates how to identify facilitators and barriers to change and provide evidence that may be used to drive implementation in the emergency care setting.

Evaluating perceived advantages and funding needs to enhance emergency medical services: insights from patients and staff

INTRODUCTION

The University Hospital for Active Treatment and Emergency Medicine (UHATEM) "N. I. Pirogov" LTD is a pivotal institution in Bulgaria's emergency medical services (EMS). However, funding challenges adversely affect its operational efficiency and quality of care.

Privacy Matters: Experiences of Rural and Remote Emergency Department Patients - A Mixed-Methods Research Conducted in Newfoundland and Labrador, Canada

Objectives

This study aims to investigate patients' privacy experience when receiving care in emergency departments (EDs) in Newfoundland and Labrador, Canada. We aim to assess the level of satisfaction with privacy and to assess for factors that improve or worsen the privacy experience, not limited to patient demographics, length of stay, and hospital location.

Methods

This study used a mixed-methods design, gathering quantitative and qualitative data using a telephone survey and semi-structured interviews. Our primary outcome measure was patients' privacy experience in the ED. The independent variables in our study were age, gender, ED location, patient-reported wait times, reason for ED visit, and healthcare provider involved in care.

Results

Among the 821 patients who participated in the interviews, 1 in 4 patients (24%) did not have satisfactory ED privacy experiences. Multinominal logistic regression showed patients who waited 4+ hours before being examined by a provider [aOR = 0.34, 95% CI: 0.17-0.69] and those who visited the urban EDs [aOR = 0.17, 95% CI: 0.09-0.35] reported low levels of privacy. Furthermore, those whose overall length of stay was 4 to 8 hours [aOR = 0.44, 95% CI: 0.23-0.84] and 8+ hours [aOR = 0.36, 95% CI: 0.17-0.78] also reported dissatisfaction with ED privacy experience. Our qualitative analysis found privacy concerns in waiting rooms, triage areas, and curtain rooms, with females voicing more concerns than males.

Conclusion

Patients with longer wait times and who have been seen in urban EDs experience less privacy. Our qualitative data shows that women also raised more privacy concerns than men and that waiting rooms and triage areas are the locations with the most reported privacy concerns. Patient experience and outcomes would benefit from improving patient privacy when receiving care in EDs.

Practice and Impact of Using Fall Screening Tools in Emergency Medicine for Older Adults: A Scoping Review

Falls are a leading cause of injury among older adults in the United States which leads to significant morbidity and mortality. Though screening for fall risk is an important preventative measure in the emergency department (ED), fall screening tools' feasibility and utility remain a challenge in EDs. This scoping review aimed to identify the fall screening tools, their psychometric properties, their best practices, and their impact in the ED among patients aged 60 years and older. In the 25 publications included in this review, 6 functional assessments and 10 screening questionnaires were used. Even though this review found several tools that are easy to apply and have good psychometric properties in the ED setting, there is a need for increased feasibility, support, and effectiveness. Consistent education and resource allocation remains a challenge for fall screening. Future research needs to focus on optimizing fall screening tools and practices to improve fall prevention measures in ED.

Staff and patient experiences of crowding, corridor care and boarding: a rapid review

The increasing use of healthcare services is leading to issues with hospital overcrowding and this is particularly apparent in emergency departments (EDs). Consequently, patients are being cared for in areas that were not designed for that purpose, such as waiting areas and corridors. This negatively affects nurses' and patients' experiences of care. This article provides a rapid review of the evidence on nurses' and patients' experiences of crowding, corridor care and boarding. The findings highlight three main elements experienced by staff and patients when caring or being cared for in such contexts: stress and frustration; dissatisfaction with care; and safety and coping mechanisms. Enhancing nurse autonomy and improving communication with patients could mitigate some of these negative experiences and thereby improve staff retention, reduce staff-patient conflict and reduce the likelihood of patients leaving the ED without being seen.

Parents' Experiences of Accessing Mental Health Services for Their Adolescents With Mental Health Challenges: A Scoping Review

AIM

To analyse the literature on parents' experiences of accessing mental health services with their adolescents for mental health challenges in Ireland.

BACKGROUND

Health systems globally have inadequately addressed mental health service needs resulting in notable gaps between population needs and access to adolescent mental health services.

METHODS

This scoping review followed Arksey and O'Malley's six-stage framework and PRISMA-ScR reporting guidelines. Five electronic databases SocINDEX, MEDLINE, CINHAL, Scopus and EBSCO were searched and reference lists screened 2015-2024.

RESULTS

Twenty-three studies were included. Applying Braun and Clarke's thematic analysis identified three themes: adolescent community mental health services for adolescents with mental health challenges, accessing mental healthcare services via emergeny departments for adolescents with mental health challenges and parents' experiences of accessing mental health services for their adolescents with mental health challenges.

CONCLUSION

Parents' experiences of accessing mental health services for their adolescents are not fully understood, and further research is required to map key concepts to inform practice and policymaking.

RELEVANCE TO CLINICAL PRACTICE

The findings from this scoping review highlight challenges for adolescent mental health services in Ireland and internationally. Heightening awareness of these issues is necessary to improve the clinical practice of nurses.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a scoping review study.

Feasibility of a Web-Based and Mobile-Supported Follow-Up Treatment Pathway for Adult Patients With Orthopedic Trauma in the Netherlands: Concurrent Mixed Methods Study

Background

Orthopedic trauma care encounters challenges in follow-up treatment due to limited patient information provision, treatment variation, and the chaotic settings in which it is provided. Additionally, pressure on health care resources is rising worldwide. In response, digital follow-up treatment pathways were implemented for patients with orthopedic trauma, aiming to optimize health care resource use and enhance patient experiences.

Objective

We aim to assess digital follow-up treatment pathway feasibility from the patient's perspective and its impact on health care resource use.

Methods

A concurrent mixed methods study was conducted parallel to implementation of digital follow-up treatment pathways in an urban level-2 trauma center. Inclusion criteria were (1) minimum age of 18 years, (2) an active web-based patient portal account, (3) ability to read and write in Dutch, and (4) no cognitive or preexisting motor impairment. Data were collected via electronic patient records, and surveys at three time points: day 1-3, 4-6 weeks, and 10-12 weeks after an initial emergency department visit. Semistructured interviews were performed at 10-12 weeks post injury. Anonymous data from a pre-existing database were used to compare health care resource use between the digital treatment pathways and traditional treatment. Quantitative data were reported descriptively. A thematic analysis was used for qualitative data. All outcomes were categorized according to the Bowen feasibility parameters: acceptability, demand, implementation, integration, and limited efficacy.

Results

Sixty-six patients were included for quantitative data collection. Survey response rates were 100% (66/66) at day 1-3, 92% (61/66) at 4-6 weeks, and 79% (52/66) at 10-12 weeks. For qualitative data collection, 15 semistructured interviews were performed. Patients reported median satisfaction scores of 7 (IQR 6-8) with digital treatment pathways and 8 (IQR 7-9) for overall treatment, reflecting positive experiences regarding functionality, actual and intended use, and treatment safety. Digital treatment pathways reduced secondary health care use, with fewer follow-up appointments by phone (median 0, IQR 0-0) versus the control group (median 1, IQR 0-1; P<.001). Consequently, fewer physicians were involved in follow-up treatment for the intervention group (median 2, IQR 1-2) than for the control group (median 2, IQR 1-3; P<.001). Fewer radiographs were performed for the intervention group (median 1, IQR 0-1) than for the control group (P=.01). Qualitative data highlighted positive experiences with functionalities, intended use, and safety, but also identified areas for improvement, including managing patient expectations, platform usability, and protocol adherence.

Conclusions

Use of digital follow-up treatment pathways is feasible, yielding satisfactory patient experiences and reducing health care resource use. Recommendations for improvement include early stakeholder involvement, integration of specialized digital tools within electronic health record systems, and hands-on training for health care professionals. These insights can guide clinicians and policy makers in effectively integrating similar tools into clinical practice.

Abbreviated MRI in the evaluation of dizziness: report turnaround times and impact on length of stay compared to CT, CTA, and conventional MRI

PURPOSE

Neuroimaging is often used in the emergency department (ED) to evaluate for posterior circulation strokes in patients with dizziness, commonly with CT/CTA due to speed and availability. Although MRI offers more sensitive evaluation, it is less commonly used, in part due to slower turnaround times. We assess the potential for abbreviated MRI to improve reporting times and impact on length of stay (LOS) compared to conventional MRI (as well as CT/CTA) in the evaluation of acute dizziness.

MATERIALS AND METHODS

We performed a retrospective analysis of length of stay via LASSO regression for patients presenting to the ED with dizziness and discharged directly from the ED over 4 years (1/1/2018-12/31/2021), controlling for numerous patient-level and logistical factors. We additionally assessed turnaround time between order and final report for various imaging modalities.

RESULTS

14,204 patients were included in our analysis. Turnaround time for abbreviated MRI was significantly lower than for conventional MRI (4.40 h vs. 6.14 h, p < 0.001) with decreased impact on LOS (0.58 h vs. 2.02 h). Abbreviated MRI studies had longer turnaround time (4.40 h vs. 1.41 h, p < 0.001) and was associated with greater impact on ED LOS than non-contrast CT head (0.58 h vs. 0.00 h), however there was no significant difference in turnaround time compared to CTA head and neck (4.40 h vs. 3.86 h, p = 0.06) with similar effect on LOS (0.58 h vs. 0.53 h). Ordering both CTA and conventional MRI was associated with a greater-than-linear increase in LOS (additional 0.37 h); the same trend was not seen combining CTA and abbreviated MRI (additional 0.00 h).

CONCLUSIONS

In the acute settings where MRI is available, abbreviated MRI protocols may improve turnaround times and LOS compared to conventional MRI protocols. Since recent guidelines recommend MRI over CT in the evaluation of dizziness, implementation of abbreviated MRI protocols has the potential to facilitate rapid access to preferred imaging, while minimizing impact on ED workflows.

Perceived academic anxiety and procrastination among emergency nursing students: the mediating role of cognitive emotion regulation

AIM

Explore the mediating role of cognitive emotion regulation strategies used by nursing students between academic anxiety and procrastination.

DESIGN

A descriptive correlational design was used.

SETTING

This study was carried out in the faculty of nursing at the University of Alexandria.

SAMPLE

The participants in this study were all students enrolled in emergency nursing during the second semester of the academic year 2021-2022 and a convenience sampling of 654 nursing students. The Sobel test was used as a statistical method to determine the significance of a mediation effect by assessing whether the relationship between perceived academic anxiety and procrastination was significantly reduced when cognitive emotion regulation was included, using coefficients and standard errors from regression models to calculate the test statistic.

TOOLS

Academic Anxiety Scale, Academic Procrastination Scale, and Cognitive Emotion Regulation Questionnaire were used to collect data.

RESULTS

The study found that 46.5% of students reported high anxiety levels, with 40.1% perceiving moderate anxiety and only 11.3% experiencing low anxiety. Moreover, 80.4% of nursing students showed moderate academic procrastination. There is a positive correlation between procrastination and academic anxiety, with Adaptive and maladaptive coping strategies mediating this relationship, according to the Sobel test.

CONCLUSION

Based on the results, it can be concluded that there is a complex causal and effect relationship between academic anxiety and procrastination. Nursing students may resort to academic procrastination as a means of coping. Therefore, reducing anxiety, correcting maladaptive behaviors, and enhancing adaptive cognitive and emotional regulation strategies could effectively reduce academic procrastination.

Trends and Patterns in Emergency Department Visits: A Comprehensive Analysis of Adult Data From the National Center for Health Statistics (NCHS) Database

Background Emergency department (ED) visits among adults have increased in recent years, with the United States reporting 140 million ED visits in 2021, equating to an overall rate of 43 visits per 100 people. This trend underscores challenges in accessing primary care and addressing underlying health conditions. Understanding the trends and patterns in ED utilization is essential for informing healthcare policy and practice. Objective This study aims to comprehensively analyze trends and patterns in ED visits among adults using data from the National Center for Health Statistics (NCHS) database. Methods We conducted a retrospective analysis of ED visit data from 1999 to 2019, focusing on adults aged 18 and over. The prevalence rates of ED visits were examined across demographic, socioeconomic, and geographic groups using datasets retrieved from the NCHS database. Statistical analysis included one-way ANOVA and chi-square tests to assess variations in ED visit rates. Results This study's findings revealed a consistent increase in overall ED visits among adults, from 17.2 ± 0.3% in 1999 to 21.7 ± 0.3% in 2019. Disparities in ED utilization were evident across demographic and socioeconomic groups. Females had slightly higher visit rates, and significant racial disparities were noted, with American Indian or Alaska Native and Black or African American individuals showing the highest visit rates. Age-specific variations were observed, with young adults (18-24 years) and older adults (65 years and above) exhibiting higher visit rates. Socioeconomic status and health insurance coverage emerged as significant determinants, highlighting disparities in healthcare access. Conclusion This study provides valuable insights into the trends and patterns of ED visits among adults, emphasizing the need for targeted interventions to address healthcare disparities and improve access to primary care services.

"Pain is not typically taken into consideration due to him being nonverbal"- emergency department experiences among persons with disabilities: a mixed methods study in Kingston, Ontario

Background

Persons with disabilities (PWD) are more likely to visit the emergency department (ED) and often have complex health needs when accessing care in the ED. Yet there is limited understanding of ED care experiences among PWD, especially in a Canadian context. The aim of this study was to examine the ED care experiences of PWD in contrast to a comparison group in Kingston, Ontario to better understand their health care needs.

Methods

A mixed-methods study with a community-based participatory approach examining participants' past ED care experiences (within 24 months) was conducted in Kingston, ON. Quantitative data from those with disabilities and those from the comparison group were compared using chi squared tests to identify differences between groups. An inductive and deductive thematic analysis approach was used to identify themes in the shared qualitative data. Convergence of findings across quantitative and qualitative data was undertaken.

Results

A total of 175 participants identified as having a disability. In contrast with the comparison group (N = 949), PWD were more likely to report being given too little attention to their needs (p < 0.001), that it was more important to be treated with kindness/respect than to receive the best possible medical care (p < 0.001), to report feelings of disrespect and/or judgement (p < 0.001), and that better understanding of personal identity/situation/culture and better communication would improve ED care. Qualitative analysis highlighted the following themes: poor communication between PWD and health care providers (HCP), compassionate medical care received, perceived HCP negative attitudes/beliefs related to having a disability and substance misuse, and perceived HCP lack of knowledge/skill to treat the unique health needs of PWD.

Conclusion

Findings highlight the need to improve ED care for PWD. Future quality improvement initiatives should focus on incorporating a deeper understanding of disability into medical education and emergency medicine (EM) residency education, designing curricula that emphasize cultural humility, and implementing community-based placements providing opportunities for health professionals to work with and learn from PWD.

Explore the practice and barriers of collaborative health policy and system research-priority setting exercise in Ethiopia

INTRODUCTION

Collaboration is gaining prominence in the priority setting of Health Policy And System Research (HPSR). However, its practice and challenges are not well explored in Ethiopia. Understanding the practice and barriers of collaborative Health Policy and System Research will help design approaches and platforms for setting inclusive and participatory policy and system-level health research topics. This paper explores the practice and barriers of collaborative HPSR-priority setting exercise in Ethiopia.

METHODS

This study investigates the practice and barriers of collaborative health policy and system research priority-setting exercises in Ethiopia. Utilizing a mixed-methods approach, we conducted Key Informant Interviews (KIIs) and an online self-administered survey with open-ended questionnaires to capture diverse perspectives from stakeholders involved in the research priority-setting process. Through conventional content analysis, we identified key contents related to current practices, challenges, and opportunities for enhancing collaboration in health policy and system research prioritization.

RESULTS

Our findings reveal a complex landscape characterized by varying levels of stakeholder engagement, institutional capacity constraints, and competing priorities within the health research ecosystem. Despite notable efforts to foster collaboration, stakeholders identified persistent challenges such as limited resources, institutional fragmentation, and inadequate coordination mechanisms as barriers to effective priority-setting processes. The implications of our research extend beyond academic discourse, with direct relevance to health policy and system research practice in Ethiopia. By shedding light on the dynamics of collaborative priority-setting exercises, our findings offer valuable insights for policymakers, researchers, and practitioners seeking to enhance the effectiveness and inclusivity of health research prioritization processes. Addressing the identified barriers and leveraging existing strengths in the research ecosystem can contribute to more evidence-informed health policies and programs, ultimately improving health outcomes for Ethiopian populations.

CONCLUSIONS

Most institutions do not apply health policy and system research-priority setting to conduct informed decision-making. The barriers explored were weak integration, lack of knowledge, system, and platforms for the priority setting of Health Policy and System Resreach. So, it is recommended to build skills of different actors in the Health Policy and System Research-priority setting exercise and design a system and platform to integrate different stakeholders for collaborative research topics priority setting.

Orthopaedic trauma patients' experiences with emergency department care and follow-up through Virtual Fracture Care review: a qualitative study

OBJECTIVES

This study aimed to identify factors influencing orthopaedic trauma patients' experiences and satisfaction with emergency department (ED) care and follow-up through Virtual Fracture Care (VFC) review workflow.

DESIGN

This study employed an explorative, descriptive, qualitative design using individual, semistructured interviews.

SETTING

An urban level 2 trauma centre and teaching hospital in Amsterdam, the Netherlands.

PARTICIPANTS

Eligible patients were Dutch-speaking or English-speaking orthopaedic trauma patients, aged 18 years or above, who visited the hospital's ED between June and September 2022, and were treated through VFC review workflow. Exclusion criteria were: reason for follow-up other than injury, eye/motor/verbal score <15 at ED admission, follow-up treatment in another hospital, treatment initiated in another hospital, acute hospital admission (<24 hours). Twenty-three patients were invited for participation, of whom 15 participated and were interviewed.

RESULTS

Several influential factors contributed to seven generic themes: (1) waiting times, (2) information provision, (3) healthcare professional communication, (4) care expectations, (5) care coordination, (6) care environment and (7) patient condition. Overall, participants were satisfied with received care. Interpersonal skills of healthcare professionals, and timing and content of provided information were specifically valued. Additionally, patients stated that their needs in the ED differed from those after ED discharge, and appreciated the way the VFC review workflow addressed this. Points of improvement included more active involvement of patients in the care process and prevention of inconsistent instructions by different healthcare professionals.

CONCLUSIONS

Patient experiences with ED care and VFC review follow-up are influenced by factors categorised into seven themes. The VFC review workflow effectively addresses these factors, leading to positive feedback. Recommendations for healthcare professionals include anticipating evolving post-ED information needs, engaging patients early to provide clarity about the care process, involving them in treatment decisions and expanding information provision across the entire care pathway.