Article Text

Download PDFPDF
A systematic mixed studies review of patient experiences in the ED
  1. Claudia Bull1,
  2. Sharon Latimer1,2,3,
  3. Julia Crilly1,3,4,
  4. Brigid M Gillespie1,2,3
  1. 1School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
  2. 2Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Southport, Queensland, Australia
  3. 3Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
  4. 4Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
  1. Correspondence to Claudia Bull, Griffith University School of Nursing and Midwifery, Southport, QLD 4215, Australia; claudia.bull{at}


Background Understanding patient experiences is crucial to evaluating care quality in EDs. However, while previous reviews describe the determinants of ED patient experiences (ie, factors that influence patient experiences), few have described actual patient experiences. The aim of this systematic mixed studies review was to describe patient experiences in the ED from the patient’s perspective.

Methods Embase, Medline, ProQuest Nursing and Allied Health, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library electronic databases were searched, with publication dates limited between 1 January 2001 and 16 September 2019. Studies describing adult patient experiences in the ED were included. Studies describing patient satisfaction, proxy-reported experiences or child/adolescent experiences were excluded. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (2018 version). An inductive, convergent qualitative synthesis of the extracted data was undertaken following Thomas and Harden’s (2008) methods.

Results Fifty-four studies were included and of those, only five (9%) studies included a standardised definition of patient experience. Two inter-related themes emerged: Relationships between ED patients and care providers; and Spending time in the ED environment. The first theme included four subthemes regarding respect, communication, caring behaviours and optimising patient confidence. A key finding related to the potential for power imbalances between patients and their care providers. The second theme included two subthemes regarding physical aspects of the ED environment and patients’ waiting experience. Patients attributed more importance to the waiting experience itself rather than the duration they had to wait.

Conclusions Patients in the ED have unique and complex experiences. Greater research is needed to understand the relational and environmental factors that contribute to power imbalances between patients and care providers, how to support more positive waiting experiences, and developing a standardised definition of patient experience in the ED.

PROSPERO registration number CRD42020150154.

  • emergency department
  • interpersonal
  • quality

Statistics from


  • Handling editor Margaret Samuels-Kalow

  • Twitter @ClaudiaBull3

  • Contributors All authors contributed to the conceptualisation of the research. The conduct of the research was primarily undertaken by CB and supported by SL, JC and BMG. The reporting of the research was primarily undertaken by CB and supported by SL, JC and BMG. All authors contributed to the development of the manuscript, have approved the final version of the manuscript and are responsible for its overall content.

  • Funding CB is supported by funding from an Australian Government Research Training Program (RTP) scholarship and a Griffith University Health Group top-up scholarship.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.

  • Author note Supplementary file 5 contains additional references for this article.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.