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Abstract
Introduction Optimising emergency department (ED) patient experience is vital to ensure care quality. However, there are few validated instruments to measure the experiences of specific patient groups, including older adults. We previously developed a draft 82-item Patient Reported Experience Measure (PREM-ED 65) for adults ≥65 attending the ED. This study aimed to derive a final item list and provide initial validation of the PREM-ED 65 survey.
Methods A cross-sectional study involving patients in 18 EDs in England. Adults aged 65 years or over, deemed eligible for ED discharge, were recruited between May and August 2021 and asked to complete the 82-item PREM at the end of the ED visit and 7–10 days post discharge. Test–retest reliability was assessed 7—10 days following initial attendance. Analysis included descriptive statistics, including per-item proportions of responses, hierarchical item reduction, exploratory factor analysis (EFA), reliability testing and assessment of criterion validity.
Results Five hundred and ten initial surveys and 52 retest surveys were completed. The median respondent age was 76. A similar gender mix (men 47.5% vs women 50.7%) and reason for attendance (40.3% injury vs 49.0% illness) was observed. Most participants self-reported their ethnicity as white (88.6%).
Hierarchical item reduction identified 53/82 (64.6%) items for exclusion, due to inadequate engagement (n=33), ceiling effects (n=5), excessive inter-item correlation (n=12) or significant differential validity (n=3). Twenty-nine items were retained.
EFA revealed 25 out of the 29 items demonstrating high factor loadings (>0.4) across four scales with an Eigenvalue >1. These scales were interpreted as measuring ‘relational care’, ‘the ED environment’, ‘staying informed’ and ‘pain assessment’. Cronbach alpha for the scales ranged from 0.786 to 0.944, indicating good internal consistency. Test–retest reliability was adequate (intraclass correlation coefficient 0.67). Criterion validity was fair (r=0.397) when measured against the Friends and Families Test question.
Conclusions Psychometric testing demonstrates that the 25-item PREM-ED 65 is suitable for administration to adults ≥65 years old up to 10 days following ED discharge.
- Health Services for the Aged
- quality assurance
- geriatrics
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.
Footnotes
Handling editor Liza Keating
X @DrBlairGraham, @JosLatour1
Collaborators PREM-ED 65 Validation Study Group: Co-authors: Blair Graham, Jason E Smith, Yinghui Wei, Pamela Nelmes, Jos M Latour. Non-author contributors: Usama Abrar (Royal Blackpool Hospital) ‡ Omar Almousa (Bristol Royal Infirmary)† Arslan Ahmed (Whiston Hospital)* Desislava Baramova (St George’s Hospital)† Grace Bartlett (Aintree Hospital)* Wayne Battishill (Musgrove Park Hospital)‡ Bethany Bashford-Chucla (St George’s Hospital) Jonathan Benger (Bristol Royal Infirmary)‡ Craig Buddery-Davidson (St George’s Hospital)† Amy Bullock (Aintree Hospital)* Julia Charsley (St George’s Hospital)† Noemi Caponi (Royal London Hospital)† Alice Capper (Manchester Royal Infirmary)* Maddalena Caprotti (Derriford Hospital)* Kirsty Challen (Royal Preston Hospital)‡ Raine Astin-Chamberlain (Royal London Hospital)†, Steven Crane (York Hospital)†, Hugh Dalton (Manchester Royal Infirmary)*, Helena Dunn (St George’s Hospital)*, Julia Egierszdorff (Royal Devon and Exeter Hospital)*, Jayne Foote (Musgrove Park Hospital)†, Daniel Horner (Salford Royal Hospital)‡, Zac Houghton (Royal Liverpool Hospital)*, Stephanie Howard (Salford Royal Hospital)*, Willian Hurst (Bristol Royal Infirmary)†, Thomas Huxley (Royal Blackpool Hospital)*, Jacques Hyde Tissier (Whiston Hospital)*, Lucy Jackson (Derriford Hospital)†, Dominique Jones (Manchester Royal Infirmary) †, Heather Jarman (St George’s Hospital) ‡, Steve Jones (Manchester Royal Infirmary)‡, Padrig Kelly (Preston Royal Hospital)*, Rebecca Kidd (Derriford Hospital)*, Ruth Kinston (Royal Stoke Hospital)‡, Helen Laird (Royal United Hospital Bath)‡, Hannah Lidbetter (St George’s Hospital London)*, Caitlin McConnell (Royal Cornwall Hospital)*, Holly Mould (Royal United Hospital Bath)*, Nuria Moramorell (Royal London Hospital)†, Philip Moss (St George’s Hospital)†, Nimca Omer (Royal London Hospital)†, Deborah Paripoorani (Manchester Royal Infirmary)†, Thomas Parker (York Hospital)*, Kirsten Parkin (Royal London Hospital)†, Ashleigh Pestridge (Royal Stoke Hospital)*, Ray Raj (Royal Liverpool Hospital)‡, Peter Riou (Royal Devon & Exeter Hospital)‡, Gianluca Risolvo (St George’s Hospital)†, Georgina Roberts (Derriford Hospital)*, Abdo Sattout (Aintree Hospital)‡, Imogen Skene (Royal London Hospital)‡, Megan Sugarman (Whiston Hospital)*, Anila Sukumaran (Manchester Royal Infirmary)†, Emily Taylor (Gloucester Royal Hospital)*, Grace Tunesi (Royal London Hospital)†, Olivia Webster (Royal Liverpool Hospital)*, Leanne Welch (Royal Cornwall Hospital)‡.---Legend (if applicable). Student researchers (Faculty of Health, University of Plymouth) (*), site principal investigators (‡) and other site researchers (†).
Contributors BG conceived the study and led the development, study design, recruitment of student researchers, data collection, analysis, and writing of the first draft of the manuscript and all subsequent versions. JS and JML contributed to the study design, data collection and analysis and reviewed the first draft of the manuscript and all subsequent versions. YW provided a review of data analysis and results, the first draft of the manuscript and all subsequent versions. PN contributed to the study design and student researcher recruitment and approved the manuscript’s final version. All authors approved the final version of the manuscript. Non-author contributors (collaborators) included site principal Investigators, who were responsible for local study conduct and site investigators, who performed screening, recruitment, data collection and data entry. Grammarly (Grammarly Inc., San Francisco) was used to detect spelling and grammar errors while proofreading the final manuscript. BG is the guarantor.
Funding BG received a doctoral research fellowship grant from the Royal College of Emergency Medicine to support the development of PREM-ED 65 (October 2017).
Competing interests BG and PN were employed as programme faculty for the BSc (Hons) Urgent and Emergency Care programme during the study period. The authors have no other conflicts of interest to declare.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer-reviewed.
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