Application of four-dimension criteria to assess rigour of qualitative research in emergency medicine

Roberto Forero,Gerry Fitzgerald,Mohammed Mohsin,Josephine De Costa,Nick Gibson,Shizar Nahidi,Patrick Aboagye-Sarfo,Sally Mccarthy

doi:10.1186/s12913-018-2915-2

Abstract

BackgroundThe main objective of this methodological manuscript was to illustrate the role of using qualitative research in emergency settings. We outline rigorous criteria applied to a qualitative study assessing perceptions and experiences of staff working in Australian emergency departments.MethodsWe used an integrated mixed-methodology framework to identify different perspectives and experiences of emergency department staff during the implementation of a time target government policy. The qualitative study comprised interviews from 119 participants across 16 hospitals. The interviews were conducted in 2015–2016 and the data were managed using NVivo version 11. We conducted the analysis in three stages, namely: conceptual framework, comparison and contrast and hypothesis development. We concluded with the implementation of the four-dimension criteria (credibility, dependability, confirmability and transferability) to assess the robustness of the study,ResultsWe adapted four-dimension criteria to assess the rigour of a large-scale qualitative research in the emergency department context. The criteria comprised strategies such as building the research team; preparing data collection guidelines; defining and obtaining adequate participation; reaching data saturation and ensuring high levels of consistency and inter-coder agreement.ConclusionBased on the findings, the proposed framework satisfied the four-dimension criteria and generated potential qualitative research applications to emergency medicine research. We have added a methodological contribution to the ongoing debate about rigour in qualitative research which we hope will guide future studies in this topic in emergency care research. It also provided recommendations for conducting future mixed-methods studies. Future papers on this series will use the results from qualitative data and the empirical findings from longitudinal data linkage to further identify factors associated with ED performance; they will be reported separately.

Highlights

The main objective of this methodological manuscript was to illustrate the role of using qualitative research in emergency settings
Qualitative research methods have been used in emergency settings in a variety of ways to address important problems that cannot be explored in another way, such as attitudes, preferences and reasons for presenting to the emergency department (ED) versus other type of clinical services [1,2,3,4]
The rationale of our study was to address the perennial question of how to assess and establish methodological robustness in these types of studies. We conducted this mixed method study to explore the impact of the 4HR/NEAT in 16 metropolitan hospitals in four Australian states and territories, namely: Western Australia (WA), Queensland (QLD), New South Wales (NSW), and the Australian Capital Territory (ACT) [18, 19]

Summary

Introduction

The main objective of this methodological manuscript was to illustrate the role of using qualitative research in emergency settings. The Four-Hour Rule and the National Emergency Access Target (4HR/NEAT) was an important policy implemented in Australia to reduce EDs crowding and boarding (access block) [8,9,10,11,12,13]. This policy generated the right conditions for using mixed methods to investigate the impact of 4HR/NEAT policy implementation on people attending, working or managing this type of problems in emergency departments [2, 3, 5,6,7, 14,15,16,17]. We conducted this mixed method study to explore the impact of the 4HR/NEAT in 16 metropolitan hospitals in four Australian states and territories, namely: Western Australia (WA), Queensland (QLD), New South Wales (NSW), and the Australian Capital Territory (ACT) [18, 19]

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Discussion

Conclusion