Patient and staff experience of ambulatory emergency care on the surgical assessment unit

Abstract

Introduction Ambulatory emergency care has been widely adopted in acute medicine in the last two decades and more recently there has been rapid expansion of this service in general surgery. There are challenges when trying to deliver this care for surgical patients including uncertainty about the role of protocols, need for dedicated staff and the ability to deliver the care in a timescale that is acceptable to patients. My research explores what factors affect patient and staff experience of this service and what would need to be considered prior to planned expansion.

Methods My research is a pragmatic qualitative study which was conducted in an NHS hospital. The components are: 1. Systematic scoping review of ambulatory emergency care in general surgery 2. In-depth telephone interviews with patients about their experience, interpreted using thematic analysis 3. In-depth interviews with staff about their experience, interpreted using an implementation framework and thematic analysis 4. Findings interpreted in the context of the literature and theory

Results There is little data in the literature examining the experience of patients and staff. Patient experience is affected by their illness perception, expectations and perceptions of the relative safety of the home and hospital environment. Many find it difficult to understand a lengthy process with several different steps. Front-line staff are frustrated by lack of resources and an inadequate physical environment but are engaged with the service as they perceive a benefit to patients. Engagement by senior medical staff and those in leadership positions is variable.

Conclusion Patients and staff see the value of ambulatory emergency care when it can be delivered within a reasonable timescale. It may be possible to modify factors such as the physical environment, patients’ perceptions of their illness and staff resourcing to allow it to be successfully expanded.