Patient perceptions of caring and association with emergency department activity and access block


  • Sarah Limbourn, BSc, MBBS (Hons), Senior Registrar in Emergency Medicine; Antonio Celenza, MBBS, MClinEd, FACEM, FCEM, Winthrop Professor of Emergency Medicine and Medical Education.

Dr Sarah Limbourn, Emergency Department, G Block, QE II Medical Centre, Nedlands, WA 6009, Australia. Email:


Objective:  To develop and validate a questionnaire isolating patients' perceptions of caring as individuals provided by ED doctors. This tool was then applied to explore the relationship between ED activity and patient perceptions of caring.

Methods:  Following questionnaire development and reliability analysis, a prospective, cross-sectional study was performed of ED patients who completed the written questionnaire regarding perceptions of caring. The ED tracking database obtained demographic data, patient visit characteristics and markers of departmental activity. Spearman's rho evaluated associations between perceptions of caring and activity. Free text responses were analysed thematically.

Results:  In reliability testing the questionnaire demonstrated Kappa 0.679, Cronbach's alpha 0.891. The survey was completed by 467 patients. Over 95% of patients agreed that ED doctors: identified themselves; took the problem seriously; treated patients with respect; were courteous and considerate; and demonstrated an overall caring attitude towards patients. Lower agreement occurred with doctors: not distracted by other issues; patient involvement in decisions about care; respect for cultural or religious needs; and doctors going out of their way to help. There were no significant differences in the proportion of patients recruited from different days of the week, shifts or sex. No clinically important associations were demonstrated between perceptions of caring and departmental activity. Least liked aspects of ED care related to system issues rather than the interpersonal relationship with the ED doctors.

Conclusions:  This study has validated a questionnaire isolating caring attributes. ED activity was not associated with patients' perceptions of being cared for by ED doctors.