699 - Diagnosis-Specific Themes in ED Patient Experience Surveys

Publication Number: 3676.699

Emily M. Hogikyan, Medical College of Wisconsin, Milwaukee, WI, United States; Lindsay H. Boles, Medical College of Wisconsin, Milwaukee, WI, United States; Jessica Schnell, Medical College of Wisconsin, Milwaukee, WI, United States; Sarah Thill, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Communication is paramount for ensuring appropriate diagnosis, treatment and adherence to indicated follow-up care in the Pediatric Emergency Department (PED). In a prior qualitative study of patient and family experience (PFE) comments, our group identified 5 main themes of ED communication: complete, consistent, compassionate, non-verbal, and informative. Within each theme, there were positive and negative comments. These broad areas reflect what patients and families value in ED communication, but they do not provide specific areas of intervention.

Objective: In this secondary analysis, we seek to characterize the patient and family experience of feeling informed based on their discharge diagnosis through qualitative analysis of PFE survey comments.

Design/Methods: This was a single-center, qualitative study of PED PFE surveys from a subset of discharged patients. Surveys include Likert-scale questions and an option for additional narrative comments. Narrative comments were included in 1440 surveys (28.4% of total surveys). Qualitative analysis was performed on the full data set to determine themes about communication in the PED. This secondary analysis specifically examines the "informative" subgroup of communication-related comments. A second iteration of qualitative coding was performed looking for associations between these comments and the patient's discharge diagnosis. Subsequently, the diagnoses were coded into broader groups.

Results: Table 1 summarizes the demographics of the survey respondents compared to the total ED population. On initial review, 596 (41%) of all comments were classified as communication-related. Of these, 242 (40%) were coded as "informative" with 160 (66%) being negative comments. Diagnosis-related themes and representative quotes can be found in Table 2.

Within positive comments, themes emerged around having questions addressed and having a clear diagnosis and plan of care. Diagnoses associated with these themes had well-defined treatment plans and opportunities for immediate intervention. Within negative comments, themes emerged around lack of work-up, inconclusive ED visits, uncertainty around discharge care, and residual concerns. Diagnoses associated with these themes included: symptom-based diagnoses, viral illness diagnoses, and acute events.

Conclusion(s): PFE comments show generalizable themes about the informative nature of the PED visit that are related to discharge diagnosis category. These findings allow for targeted interventions in PED communication to improve patient and family satisfaction as well as understanding of and adherence to their medical care.

Table 1
Demographics of survey respondents compared with total ED visits, July 2023-June 2024

Table 2
Themes, representative quotes, discharge diagnosis, and diagnosis categories