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Testing of the ‘Always Events’ approach to improve the patient experience in the emergency department
  1. David John Lowe1,2,
  2. Cameron Kay2,3,
  3. Dagshagini Taylor2,
  4. Nicola Littlewood1,
  5. Scott Hepburn1,
  6. Paul Bowie4
  1. 1Emergency Department, NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, UK
  2. 2Wolfson Medical School, University of Glasgow, Glasgow, UK
  3. 3School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
  4. 4Medical Directorate, NHS Education for Scotland, Glasgow, UK
  1. Correspondence to Dr David John Lowe; davidlowe{at}


Maintaining quality of care and meeting patient expectations in the face of rising demand within emergency departments (ED) is a significant challenge for clinicians. This study tested the Always Events (AE) approach as a means to identify AE’s relevance to patient care in the ED and act on this to address patient concerns. The project team looked to identify aspects of care patients would like to see improved within the minor injuries stream (MIS). Following triage, patients typically have presentations that do not require admission and require a single interaction with a clinician. Interventions seeking to improve patient experience were created and impact was monitored using patient feedback using a quality improvement (QI) framework.

AEs were identified via convenience sampling using a short semistructured survey questionnaire. Patients were asked ‘What should always happen in the Emergency Department?’ Communication and information provision regarding how the department worked were identified as key themes. Two interventions, an educational poster and a video campaign, were designed and implemented. Improvement was assessed via convenience sampling of patient questionnaires using a 5-point Likert scale and free-text responses.

Initial patient satisfaction levels regarding information provision stood at 80%, rising to 88% after our poster intervention and 92% by the end of the video intervention. Understanding of how the ED functions was initially 83% in the baseline sample before rising to 86% following poster and video interventions. Patient questionnaires indicated that information provision directly from staff was variable throughout the study period.

Implementing the AE approach in the MIS has improved patient experience. Our poster intervention had the greatest benefit regarding patient understanding of the ED and information provision. This project has also indicated that the AE method can be successfully combined with a QI tool and applied in the ED to address patient needs.

  • emergency department
  • patient-centred care
  • patient satisfaction
  • quality improvement
  • quality improvement methodologies

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors DJL contributed to the conception, design and drafting of the manuscript. CK contributed to the recruitment, data analysis and drafting of the manuscript. DT contributed to the recruitment and initial thematic review. SH and NL contributed to the conception and design of the study and critical review of the manuscript. PB contributed to the design, critical review and drafting of the manuscript.

  • Funding This project was partially funded by The Health Foundation.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at This manuscript was presented at the RCEM scientific meeting and the abstract was published

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