Empathy at the core: a qualitative study of patient experience in an urban and rural emergency department setting

Positive patient experiences in the Emergency Department (ED) are associated with improved clinical outcomes, greater trust in the healthcare system, and higher levels of patient satisfaction. Understanding comprehensive accounts of ED patient experience and how these accounts differ between ED settings can offer a deeper understanding of patient perspectives, allowing for the identification of areas for improvement. The purpose of our study is to utilize qualitative methods to gain a comprehensive, in-depth understanding of the key factors influencing patient experience in the EDs of an urban academic center and a rural community hospital. Qualitative, semi-structured individual interviews with ED patients, using a constructivism approach, were conducted across two EDs, an urban academic center (UAC) and a rural community hospital (RCH). An inductive thematic analysis approach was used for data analysis. Fifty-six participants were interviewed. We identified one unifying theme of empathy which encompasses five major themes: attitudes of staff, showing concern, patient-centered communication, frequent updates and discrimination. Overall, positive experiences were associated with empathetic attitudes of staff, frequent updates throughout their ED visit, patient-centered communication particularly during the discharge process, and having the ability to ask questions without feeling rushed. Two distinguishing features between the UAC vs. the RCH included confidence in care received and differences in the ED environment, such as crowdedness and the use of hallway beds. Regardless of the patient’s experience, showing empathy, even in unfavorable situations, was identified as the most impactful part of their visit. Patients’ perceptions of healthcare staff empathy is a critical driver in influencing overall ED patient experience. Future studies should further explore patients’ perceptions of empathy, including cultural differences, and interpersonal and systemic interventions to improve perceived empathy.