Improving patient care experience in the pediatric emergency department: a systematic review

The primary objective of the project was to summarize existing evidence on patient experiences in pediatric emergency departments (EDs). The secondary objectives were to characterize patient care experience in pediatric EDs, identify barriers to optimal patient care in pediatric EDs, and identify equity, diversity, and inclusion (EDI) principles influencing pediatric emergency care.

We performed a systematic review of cohort, cross-sectional, and controlled clinical studies on children's (≤ 21 years) experience in the pediatric ED. We searched MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), Cochrane Database of Systematic Reviews (Ovid), CENTRAL (Ovid), and CINAHL (EBSCO) from inception until September 7, 2023. Two reviewers independently screened articles for primary outcomes involving any health care outcome or health care utilization, along with secondary outcomes of EDI factors influencing patient care. Data were obtained from included studies using narrative and descriptive analysis. The process was strengthened by input from patients, families, and providers on the Manitoba Emergency Advisory Committee, who proposed additional areas for consideration.

Six articles were included, assessing 12 experiences. All studies were from high-volume centers. The primary outcome data indicated an overall satisfaction being rated positively, with satisfaction levels exceeding 70% despite lower ratings in privacy, communication, and waiting areas. Wait times and speed of care were significantly correlated with satisfaction (r = -0.48, P < 0.01 and r = 0.38, P < 0.01, respectively), noting wait times and privacy as barriers to care. The EDI factor impacting patient experience was race, showing decreased scores for privacy and patient voice for those identifying as non-white.

Even with a high overall satisfaction in the pediatric EDs, aspects influencing the experience can be improved. Wait times, waiting areas, privacy and EDI factor such as race should be addressed to help overcome barriers and improve the care patients receive.