Table 1

Characteristics of the 22 included studies and contributions to meta-synthesis

(a) Characteristics of individual studies						(b) Principal contribution(s) of individual studies to each analytical theme (‘need’)
First author (year) country	Setting	Summary of aims	Approach Methods Sampling	Patient population	Key findings	C=Communication; E=Emotional; CA=Care W=Waiting P=Physical/ Environ.
First author (year) country	Setting	Summary of aims	Approach Methods Sampling	Patient population	Key findings	C	E	CA	W	P
Burström (2013)30 Sweden	3 EDs	To explore waiting in the ED	Grounded Theory Staff interviews and patient observation Theoretical sampling	Observation of patients in the waiting room	Indicators of ‘non-acceptable’ waiting included physical densification, contact seeking and emergence of critical situations. Staff were ashamed and frustrated with non-acceptable waiting. Waiting management may be achieved by changing the patient experience	•	•		•	•
Caldicott (2005)21 USA	1 ED	To compare the experiences of ED patients in the context of those ‘turfed’ to other specialities vs deemed appropriate	Descriptive approach Semi-structured interviews Convenience sampling	26 adult patients	10 themes divided between two main categories, which were (i) interpersonal issues’ and (ii) technical/systems issues. Themes classified as either ‘favourable’ or ‘unfavourable’ Global experience was negative for ‘turfed’ patients	•	•		•	•
Clarke (2007)32 Canada	1 ED	To determine satisfaction with mental healthcare in ED	Descriptive approach Focus groups Convenience sampling	27 adult mental health service users	Themes included: ‘waiting in the ED’, ‘attitudes of treatment staff’, ‘diagnostic overshadowing’, ‘nowhere else to go’, and ‘family needs’ Devised a list for ideal services	•	•
Cypress (2014)24 USA	1 ED	Experiences of patients triaged as ‘critically ill’	Phenomenology Interviews Purposive sampling	23 participants including 10 patients	Patients and relatives valued ‘critical thinking’, ‘communication’ and ‘sensitivity and caring’ behaviours in nurses. Desirable aspects of communication included listening, identifying, greeting and interacting with patients. ‘Sensitivity and caring’ included advocating for critically unwell patients and empathy	•		•		•
Hillman (2014)44 UK	1 ED	To examine the concept of legitimacy and processes of negotiation between patients and staff in the ED	Ethnography Observation with follow-up interviews Thematic analysis Convenience sampling	50y older adult patients	Patients were compelled to legitimise their reasons for attendance and justify these in order to be perceived positively by staff, which shaped their access to resources and determined their ED experience	•			•
Kihlgren (2004)25 Sweden	1 ED	To explore the experience of waiting in the ED	Grounded theory Observation Convenience sampling	20 patients aged >25 years	6 core variables emerged, which were (i) unpleasant waiting, (ii) unnecessary waiting, (iii) lack of good routines during the waiting stage, (iv) suffering during the waiting stage, (v) bad feelings during the waiting stage and (vi) nursing care during the waiting stage	•	•		•	•
Lin (2008)26 Taiwan	1 ED	To investigate the patient experience of empathy	Descriptive In-depth interviews Convenience sampling	28 participants including 7 patients	4 themes emerged. These were (i) when patients expressed their feelings, physicians did not resonate with concerns, (ii) patient required psychological comfort, (iii) patients needed feedback from physicians but did not always get this and (iv) physicians found the physical environment difficult to overcome	•	•
MacWilliams (2016)20 Canada	3 EDs 1 Tertiary 2 Local	To explore the experiences of women attending the ED to get care for a miscarriage	Interpretive Phenomenology Semi-structured interviews Convenience sampling	8 female patients (suspected miscarriage)	5 themes resulted, which were: (i) pregnant=life vs miscarriage=death, (ii) deciding to go to the ED, (iii) not an illness—a different type of trauma, (iv) need for acknowledgement and (v) leaving the ED: What now?. Patients felt that staff were dismissive of their loss	•	•
Nyden (2003)31 Sweden	1 ED	To examine older peoples’ basic needs in ED	Interpretive approach Interviews Convenience sampling	7 participants between 65 and 88 years	Needs of older adults attending the ED were interpreted according to Maslow’s Hierarchy of Needs. Basic needs at the lower tiers of the hierarchy were well represented. Higher needs tended to be neglected, including the need to know and understand. Patients needed to feel safe	•	•		•
Nystrom (2003)27 Sweden	1 ED	To analyse and describe experiences of being a ‘non-urgent’ patient in ED	Descriptive approach Interviews Convenience sampling	11 patients	The non-urgent patient experience was interpreted as fragmented. Patients had difficulty being ‘seen or heard’, and were cognizant of the effect of non-urgent problems on nurses’ workloads and perceptions. Patients strived to maintain their own integrity	•			•
O’Brien (2004)17 Canada	1 ED Level 1 trauma centre	To examine patient perceptions of trauma resuscitation in ED	Interpretive Phenomenology Semi-structured interviews Purposive sampling	7 adult patients with major trauma as the presenting complaint.	4 themes results, which were (i) ‘I was scared’, (ii) ‘I felt safe’, (iii) ‘I will be okay’ and (iv) ‘I remember’. System factors were contributed to a positive overall experience	•		•
Olsson (2001)33 Sweden	1 ED	To explore patients experience of repeat ED attendance	Inductive Interviews Purposive sampling	10 adult participants Frequent users of ED	Experience of repeat attenders was adversely affected when the patient perceives that use of the ED is inappropriate or when symptoms are belittled		•		•
Olthuis (2014)28 Netherlands	1 ED	To determine the actual experiences of patients who received ED care	Ethnography Direct observation Convenience sampling	55 patients in ED	Patients’ ‘concerns’ related to anxiety, expectations, care provision, endurance of symptoms and need to receive or express recognition		•		•	•
Revell (2017)16 New Zealand	1 ED tertiary centre	To determine the information needs of patients receiving procedural sedation in the ED	Descriptive Interviews Convenience sampling	8 adult patients who had received procedural sedation	Major themes included (i) safety and trust, (ii) competence and efficiency of staff, (iii) explanations of procedures and progress, (iv) supporting person presence, (v) medico-legal implications and (v) written information	•	•	•	•
Rising (2015)22 USA	2 related EDs	To examine the experience of ED discharge processes through return attenders	Descriptive Semi-structured interviews Convenience sampling	60 patients who returned within 9 days	Themes included (i) discharge process (wanted more tests/wanted admission/complaint unaddressed), (ii) discharge process (no problem/problem understanding/rushed out/limited explanation) and (ii) prescriptions (did not receive what was wanted)	•		•	•
Shearer (2015)36 Australia	1 ED	To explore why patient choose to attend a private ED in Australia	Content analysis Semi-structured interviews Purposive sampling	Thirty adult patients	Themes included (i) prior experience of the hospital, (ii) convenient location, (iii) anticipated high-quality care and (iv) anticipated short wait times			•	•
Stuart (2003)23 Australia	1 ED	To identify ‘consumer expectations’ with respect to the ED	Ethnography Focus groups Purposive sampling	98 adults including minority ethnic and disabled groups	Major themes were communication triage, waiting area, cultural issues and carers	•		•	•
Vaillancourt (2017)29 Canada	2 EDs	To define outcomes of ED care that are valued by patients discharged from the ED	Descriptive Semi-structured interviews Convenience sample	46 adults	Patients valued outcomes that related to 4 themes. These were: (i) understanding the cause and expected trajectory of symptoms, (ii) reassurance, (iii) symptom relief and (iv) having a plan to manage symptoms, resolve the problem or pursue further medical care	•	•	•
Watson (1999)18 USA	3 EDs	To describe elderly patients’ perceptions of care in the ED	Descriptive In-depth interviews Convenience sampling	12 elderly patients	5 themes emerged, which were ‘needs for information’, ‘observations of waiting time’, ‘perceptions of professional competency’, ‘concerns about process and facility design’ and ‘personal tolerance’	•		•	•	•
Watt (2005)34 Canada	Calgary region	To compare public expectations of ED care with healthcare professionals	Descriptive Focus groups and interviews Purposive sampling	87 adults including 34 recent ED users	6 themes emerged which included: (i) staff communication with patients, (ii) appropriate waiting times, (iii) the triage process, (iv) information management, (v) quality of care and (vi) improvements to existing services	•		•
Wellstood (2005)35 Canada	4 EDs across one health system	To gain an understanding of patient perceptions of ED care	Descriptive In-depth interviews Pseudorandomised sampling	41 adults	Aspects of care most commonly negatively associated with experience were waiting times, patient perceptions of quality of care and staff–patient interactions	•	•		•
Wiman (2007)19 Sweden	Two EDs (1 trauma centre; 1 rural)	To explore trauma patients conceptions of their encounter with the ED team	Inductive Semi-structured interviews Purposive sampling	23 adult patients with a presenting complaint of trauma	Three phases of trauma patient reception, which were: (i) the instrumental mode, (ii) the attentive mode and (iii) the uncommitted mode. The uncommitted mode could generate emotions of abandonment and dissatisfaction	•

ED,emergency department.