Characteristics of the emergency and urgent care system important to patients: a qualitative study

Objectives: To explore patients' views and experiences of the emergency and urgent care system to inform the development of a questionnaire for routine assessment of the system's performance from the patient perspective. Methods: Qualitative research with people who had recently used the system: 47 people in eight focus groups and 13 individual interviews. Results: Recurrent themes included characteristics of the system which are rarely addressed in service-specific questionnaires, in particular, confusion over the most appropriate service to use for particular health problems, coordination between services and informational continuity across services. Other characteristics were identified which, although commonly included in service-specific questionnaires, could have system-level consequences. These included communication between health professionals and patients, and ease of access to services. For example, patients' perception of poor communication with one service could increase their subsequent use of other services in the system. Proactive behaviour from health professionals was an important system characteristic because it could allay patient anxiety by making patients feel that their concerns were being taken seriously and that staff could sort out problems such as feeling 'stuck in' or 'bounced around' the system. 'Candidacy', whereby eligibility for health care is jointly negotiated between the user and the service provider, was evident as an issue for patients across the social spectrum when seeking help urgently. Conclusions: Questionnaires designed to assess patients' views and experiences of emergency and urgent care should address system-level as well as service-specific issues in order to address the full range of patient concerns.