Perspectives of patients with acute abdominal pain in an emergency department observation unit and a surgical assessment unit: a prospective comparative study.

Abstract

To investigate the patient perspective when admitted with acute abdominal pain to an emergency department observation unit compared with the perspective when admitted to a surgical assessment unit. An increase in emergency department observation units has led to more short-term admissions and has changed the patient journey from admission to specialised wards staffed by specialist nurses to stays in units staffed by emergency nurses. A comparative field study. The study included 21 patients. Participant observation and qualitative interviews were performed, and the analyses were phenomenological-hermeneutic. Emergency department observation unit patients had extensive interaction with health professionals, which could create distrust. Surgical assessment unit patients experienced lack of interaction with nurses, also creating distrust. Emergency department observation unit patients had more encounters with fellow patients than the surgical assessment unit patients did, which was beneficial when needing assistance, but disturbing when needing rest. The limited contact with other patients in the surgical assessment unit revealed the opposite effect. In both units, there was nonpersonalised care, making it difficult for patients to make informed decisions. The multibedded rooms in the emergency department observation unit had a positive influence on patient–nurse interaction, but a negative influence on privacy; the opposite was found in the surgical assessment unit with its rooms with fewer beds. The extensive professional–patient interactions in the emergency department observation unit created distrust. The limited professional–patient interaction in the surgical assessment unit did the same. That the emergency department observation unit was staffed by emergency nurses seemed to have a positive influence on the length of patient–nurse interactions, while the surgical assessment unit staffed by specialist nurses seemed to have the opposite effect. There was lack of information and personalised care in both units. Units receiving acute patients need to provide personalised care and information about how the unit functions and about care and treatment to improve the patients' ability to make decisions during admission.