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The accident and emergency department questionnaire: a measure for patients’ experiences in the accident and emergency department
  1. Nanne Bos1,
  2. Steve Sizmur2,
  3. Chris Graham2,
  4. Henk F van Stel1
  1. 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Picker Institute Europe, Oxford, UK
  1. Correspondence to Nanne Bos, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands; n.bos-2{at}


Background The National Health Service National Patient Survey Programme systematically gathers patients’ experiences about the care they have recently received. Prioritising quality improvement activities in the accident and emergency (A&E) department requires that survey outcomes are meaningful and reliable. We aimed to determine which method of obtaining summary scores for the A&E department questionnaire optimally combined good interpretability with robust psychometric characteristics.

Methods A&E department questionnaire data from 151 hospital trusts were analysed, covering 49 646 patients. Three methods of grouping and summarising items of the questionnaire were compared: principal components analysis (PCA); Department of Health dimensions; sections according to the patient's journey through the A&E department. The patient-level reliability of summary scores was determined by Cronbach's α coefficients (threshold: α>0.70), construct validity by Pearson's correlation coefficients, and the discriminative capacity by intra-class correlation coefficients (ICCs) and reliability of A&E-level mean scores.

Results The PCA provided the best score reliability on six clear and interpretable composites: waiting time; doctors and nurses; your care and treatment; hygiene; information before discharge; overall. The discriminative power of the concepts was comparable for the three methods, with ICCs between 0.010 and 0.061. A&E sample sizes were adequate to obtain good to excellent reliability of A&E-level mean scores.

Conclusions The A&E department questionnaire is a valid and reliable questionnaire to assess patients’ experiences with the A&E. The discriminative power of six summary scores offers a reliable comparison of healthcare performance between A&Es to increase patient centredness and quality of care.

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