Patient and Caregiver Expectations of Emergency Department Care: A Scoping Literature Review

Curran, J. et al. Internantional Emergency Nursing. Published online: 13 July 2016


  • 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.


10998-2Background: 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.

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A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department

Douma, M.J. et al. Annals of Emergency Medicine. Published online: July 29, 2016
B0005922 Cost of long term care
Image source: Rowena Dugdale – Wellcome Images // CC BY-NC-ND 4.0

Study objective: Emergency department (ED) crowding is a common and complicated problem challenging EDs worldwide. Nurse-initiated protocols, diagnostics, or treatments implemented by nurses before patients are treated by a physician or nurse practitioner have been suggested as a potential strategy to improve patient flow.

Methods: This is a computer-randomized, pragmatic, controlled evaluation of 6 nurse-initiated protocols in a busy, crowded, inner-city ED. The primary outcomes included time to diagnostic test, time to treatment, time to consultation, or ED length of stay.

Results: Protocols decreased the median time to acetaminophen for patients presenting with pain or fever by 186 minutes (95% confidence interval [CI] 76 to 296 minutes) and the median time to troponin for patients presenting with suspected ischemic chest pain by 79 minutes (95% CI 21 to 179 minutes). Median ED length of stay was reduced by 224 minutes (95% CI –19 to 467 minutes) by implementing a suspected fractured hip protocol. A vaginal bleeding during pregnancy protocol reduced median ED length of stay by 232 minutes (95% CI 26 to 438 minutes).

Conclusion: Targeting specific patient groups with carefully written protocols can result in improved time to test or medication and, in some cases, reduce ED length of stay. A cooperative and collaborative interdisciplinary group is essential to success.

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Reducing Suicide Risk: Challenges and Opportunities in the Emergency Department

Betz, M.E. et al. Annals of Emergency Medicine. Published online: 20 July 2016

B0003566 Depression - artist's interpretation
Image source: Adrian Cousins – Wellcome Images // CC BY-NC-ND 4.0

Emergency physicians, sometimes cast as a significant source of the opioid overdose problem, are seeking more nuanced pain control in the emergency department (ED) and better methods to identify patients who shouldn’t receive opioids. Although the question of just how much emergency physicians are actually prescribing opioids remains under debate, innovators are moving ahead with ways to keep it to a minimum.

The Alternatives to Opiates Program at St. Joseph’s Regional Medical Center in Paterson, NJ, has gotten a lot of attention, not all of it particularly accurate. Some media reports said the hospital would have the first “no opioids” ED in the country. Not quite, explained Mark Rosenberg, DO, chairman of emergency services at St. Joseph’s.

“What we’re doing is clearly more complex and comprehensive than that,” Dr. Rosenberg said. “It is really a multidisciplinary program focused on acute pain and acute pain syndromes that present to the emergency department. The idea is to treat pain effectively, and when opioids are needed, they are given appropriately.”

The department, which says it is the busiest in New Jersey, with more than 158,000 patient visits in 2015, brought on a pain specialty fellow in 2014 to pull together evidence-based best practices on managing pain while avoiding the use of opioids.

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A Comprehensive Review of Common Respiratory Infections Encountered in Urgent and Primary Care

Beam, C. et al. Journal of Emergency Nursing. Published online: July 21 2016


Image shows digitally colorized electron micograph of influenza virions 

Concern about antibiotic overuse has become heightened as bacterial resistance to antibiotics continues to increase. Patients experiencing respiratory symptoms frequently present to urgent/emergent care settings such as fast-track emergency care departments and primary care retail settings with the expectation that they will be prescribed antibiotics.

The Centers for Disease Control and Prevention (CDC) reports that approximately 2 million people will become ill with bacteria that are resistant to at least one antibiotic, approximately 23,000 people die as a direct result of these infections, and many others die as a result of complications related to antibiotic-resistant infections.

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