UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST Accident and Emergency Department Survey Management Report

UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST 2014 Accident and Emergency Department Survey Management Report

Contents Introduction 3 National Trends 4 Executive Summary 8 Respondents' Characteristics 11 Survey Results 13 Arrival at the A&E Department 14 Doctors and Nurses 23 Your Care and Treatment 33 Hospital Environment and Facilities 49 Leaving A&E 54 Overall 64 Results 68 Survey Results Manual 69 2

Introduction The National Emergency Department Survey was undertaken for UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST between May and July 2014. Some changes to the content of the questionnaire were made since the survey was last undertaken in 2012. The survey required a random sample of 850 patients seen during January, February or March 2014. There were a number of categories of patients excluded from the survey e.g. current inpatients and minor injury unit patients. Response Rate The target response rate for the survey set nationally was to achieve at least from the usable sample, and the number of usable responses being at least 425. 282 completed surveys were returned from the 's sample of 850. 47 patients were excluded for the following reasons: Moved/not known at this address 30 Ineligible 2 Deceased 13 The overall response rate for was 35% (282 usable responses from a sample of 805). 3

National Trends The National Accident and Emergency Department Survey has now been run on four separate occasions, and there are some interesting and encouraging trends The national A&E survey has been run four times: in 2004, 2008, 2012 and 2014. The methodology on each occasion has been very similar, with a postal survey being sent to 850 patients who had attended the relevant A&E department. Patients attending a Minor Injuries Unit have been excluded each time. Quality Health has undertaken a detailed analysis of the data sets from each year, in order to understand and describe the trends in the scores. The four data sets are not identical. The 2004, 2008 and 2012 datasets represent all acute s with A&E departments that conducted the survey; however, the 2014 dataset contains only those s that used Quality Health for the A&E survey (40). It is not possible to access the full national data set for 2014 as yet, as this is not yet in the public domain. However, it should be noted that the Quality Health national dataset is always very close in terms of scores to the full dataset published by the Care Quality Commission, and therefore it is extremely unlikely that there will be any significant differences in these overall trends. There have been some changes to question content in the survey over the years. The comparison below is made only where questions were identical or substantially similar and are therefore comparable. Our overall conclusions from this analysis are as follows: Scores improved on a large number of questions between 2012 and 2014. Of 37 comparable questions, 30 questions scored higher this year than last, with 17 questions improved by at least 3% Scores declined on only 1 question; Q35 [Before you left the A&E Department, were any new medications prescribed for you?] between 2012 and 2014, and this by only 1% Q35 has declined from 37% in 2004 to 33% this year Before you left the A&E Department, were any new medications prescribed for you? 2004 2008 2012 2014 4

The questions with the biggest improvement between 2012 and 2014 were Q31 [In your opinion how clean was the A&E Department?] and Q5 [Were you given enough privacy when discussing your condition with the receptionist?] (both up 7%), Q30 [Do you think the hospital staff did everything they could to help control your pain?] (up 8%), and Q33 [Were you able to get suitable food or drinks when you were in the A&E Department?] (up 11%) The questions with the biggest improvements over time are Q23 [Did you have any tests (such as x-rays, scans or blood tests) when you visited the A&E Department?] (up 11% since 2004), Q5 [Were you given enough privacy when discussing your condition with the receptionist?] (up 14% since it was first introduced in 2008), and Q31 [In your opinion how clean was the A&E Department?] (up 17% since 2004). There are some small improvements in scores on giving information on medication side effects, giving information on discharge in respect of danger signals to be watched for by the patient, and on the cleanliness of the A&E department. Did you have any tests (such as x-rays, scans or blood tests) when you visited the A&E Department? 2004 2008 2012 2014 Were you given enough privacy when discussing your condition with the receptionist? 2004 2008 2012 2014 5

In your opinion, how clean was the A&E Department? 2004 2008 2012 2014 Other notable trends on individual questions are as follows: Q21 [Were you involved as much as you wanted to be in decisions about your care and treatment?] declined between 2004 and 2008 from 64% to 62%, remained the same in 2012, but has now improved back to its 2004 level Were you involved as much as you wanted to be in decisions about your care and treatment? 2004 2008 2012 2014 6

Q27 [Were you in any pain while you were in the A&E Department?] has fallen in every year of the survey. Overall since 2004 it has decreased by 8% to Were you in any pain while you were in the A&E Department? 2004 2008 2012 2014 The significant improvement in Q30 this year reverses a decline that had been seen between 2008 and 2012. Do you think the hospital staff did everything they could to help control your pain? 2004 2008 2012 2014 7

Executive Summary This section pulls together the conclusions and action points from each section of the Report to give an overview of the s results and areas for consideration for action planning. Arrival at the A&E Department Actions: Ensure that patients are able to speak to a doctor or nurse as soon as possible after their arrival in A&E Ensure that patients are examined by a doctor or nurse as soon as possible after their arrival in A&E Ensure that patients are given a clear and realistic indication of how long they will have to wait to see a doctor or nurse Doctors and Nurses Actions: Ensure that patients are given enough time to discuss their condition and that they feel listened to Make sure that patients have been spoken to in a way that they are able to understand - check with them that this is the case Some patients say that they did not have trust and confidence in the doctors and nurses who examined them - look at how this can be addressed as a priority Some patients say that doctors and nurses sometimes talked in front of them as if they weren't there - take action to ensure that this doesn't happen Ensure that family members or those accompanying the patient are given enough time to talk to doctors and nurses Your Care and Treatment Actions: Some patients say that they are not given enough information about their care and treatment whilst in A&E; look at how this can be improved, considering different methods of giving information to suit the patient's needs Ensure that patients have enough privacy while they are being examined Ensure that patients can get help when needed - tell them how they do this and ensure that response is forthcoming Many patients feel that they are not involved in decisions about their care and treatment as much as they want to be - look at how this can be addressed Ensure that patients are given clear information about why they need the tests that they need 8

If patients are not able to receive their test results before leaving A&E, make sure that they are told when they will receive them Ensure that patients are given adequate pain relief when they need it or if they request it Hospital Environment and Facilities Actions: Monitor infection control systems including cleanliness of the department given the poor scores and perception of patients Some patients report that they feel threatened by other patients or visitors - look at how security measures can be taken to ensure that this is not the case Ensure that adequate provision is made for patients to get something to eat and drink while they are in A&E Leaving A&E Actions: Ensure that all patients have the purpose of medications and any possible side effects explained in a clear way - this is one of the most important issues from a patient's perspective Ensure that patients are signposted to help them choose the right service in future to access e.g. GP, NHS Direct or NHS111, out of hours service, walk in service, minor injuries or emergency care centres Overall Actions: Some patients feel that they are not treated with respect and dignity during their time in A&E - urgently look at how this can be addressed Look at ways to make the urgent care system easier to navigate as this would improve patient experience Ensure that information about how to comment or complain (such as leaflets and posters) are visible and available for patients in hospital; staff are up to date on comments and complaints procedures and able to explain and easily communicate this to patients Triangulate and link patient experience data, FFT and patient outcomes (PROMS) and use in the organisation to identify specific actions that can be put in place. Such actions will, on the basis of analysis of very large NHS datasets, have the potential to improve patients perceived outcomes of care 9

Ensure that the links between patient experience data and patient outcomes data is used in the organisation to identify specific actions that can be put in place. Look at your SRM (data at end of management report) looking for trends year on year where possible, and take appropriate action Use SOLAR to interrogate your results and identify specific areas where issues may be prevalent Undertake clinical audit on patients records in A+E With Commissioners map and analyse patient flows around the system to identify bottlenecks and the scope for changing pathways to reduce the use of hospitals and to ensure that there is sufficient capacity across the health and social care system. 10

Respondents' Characteristics Details of the characteristics of the patients who responded to the survey are set out below. Gender, age, and ethnic background is crucial, as it is clear from Quality Health's research into patient attitudes over many years that there are significant variations in the views of patients because of demographic differences. There are also differences between patients depending on their route of entry to hospital and the specialty of treatment because of the nature of the patient's medical problems. The can analyse the survey data by these variables using Quality Health's SOLAR online reporting facility. 1. GENDER AND AGE PROFILE 57% of patients responding were women; 43% were men. The gender of 5 patients is not identifiable from patient responses; however, gender can be established from the patient's identification data supplied by the. The chart below shows the percentage of respondents in each age group. Unlike the profile of inpatients in any hospital, the age profile of A&E attendees is more evenly spread with the peak being in the middle years of life, as a consequence in part of the higher rate of accidents amongst younger people. Age Range of Patients 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Level 11

2. RELIGION AND BELIEF The chart below shows the religion of respondents. 4 of the respondents preferred not to say what religion they were. Religion and Belief No religion Buddhist Christian Hindu Jewish Muslim Sikh Other I would prefer not to say Level 3. SEXUAL ORIENTATION 94% of respondents identifed themselves as heterosexual. 3 of the respondents identifed themselves as gay or lesbian. No-one identifed themselves as bisexual. 2 of the respondents described their sexuality as 'other'. 11 of the respondents preferred not to say. 4. Disability 46% of respondents said they had a long standing condition of either a physical or mental nature. Of this group, 34% of respondents said their disability did not cause any difficulty with their day-to-day activities. 5. Ethnic Background of respondents were White British, 5% of respondents were White Irish, Gypsy or Irish Traveller or from another White background, 4 of the respondents were from a mixed or mulitple ethnic background, 9% of respondents were Asian or Asian British (including Chinese), 10 of the respondents were Black or Black British, no-one identified their ethnic group as 'Arab', no-one identified their ethnic group as 'Other'. 12

Survey Results This section of the report describes the results for each part of the questionnaire in the order in which it was read by service users. The results from each question in the survey are described in the following sections. A vertical bar chart shows the as well as the National score for the current survey, for the purpose of comparison; a line chart shows the as well as the National score over the life of the survey. At the end of most sections, a scored and standardised dataset has been used to produce benchmark Red Amber Green (RAG) bar charts for key questions within that section. The scoring applied uses the CQC methodology, which scores responses based on how positive they are. To produce a "score" the CQC takes the most positive answer line and combines it in most cases with of the next most positive answer line. When this process has been undertaken, and the data has been standardised by age and gender, it means that the CQC scores in this section will usually be different from the results set out in the Survey Results Manual (frequency tables) at the end of this report. The purpose of displaying the CQC scored data, and giving the its real unscored data, is to enable the to understand how their results are changed by the scoring system, and to build Quality Improvement Plans based on accurate data. Each bar represents the range of results across all s that took part in the survey with Quality Health for one question. The bar is divided into: a red section: scores for the lowest-scoring of s; an amber section: scores for the intermediate of s; a green section: scores for the highest-scoring of s. The black circle represents the score for this. For example, if the circle is in the green section of the bar, it means that the is among the top of s surveyed by Quality Health for that question. The line on either side of the circle shows the 95% confidence interval (the degree of uncertainty surrounding the s score). Under each RAG chart is a data table. The first column of the table shows the 's score for this year (represented by the black circle on the chart). The fourth column represents the highest value in the lowest scoring of s (i.e. the threshold or end of the red section on the chart); the fifth column represents the lowest value in the highest scoring of s (i.e. the threshold or start of the green section on the chart). The final column is filled in red for any question where the s score falls within the lowest of scores for that question, and green where the 's score falls within the highest of scores for that question. Finally, there are a number of management recommendations at the end of each section for consideration when action planning. 13

Arrival at the A&E Department PREVIOUS ATTENDANCE AT A&E ABOUT SAME CONDITION Before your most recent visit to A&E, had you previously been to A&E about the same condition or something related to it? 29% of those attending A&E had attended previously for the same or related condition. Of these people, 3% said they had attended within the previous week. 71% said that they had not previously attended A&E for this condition or something related to it. Previous Attendance at A&E for Same or Related Condition In previous week 1 week to 1 month ago Over 1 month ago Hasn't attended Don't know REASON FOR ATTENDING A&E Who advised you to go to the A&E Department? of patients said that they were advised to attend A&E by a health professional, 18% decided on their own that they need to go to A&E, and 13% were advised to attend by "somebody else". The chart below shows the full range of people advising respondents to attend A&E. Person Advising Patient to got to A&E Ambulance service WIC or MIU doctor/nurse Out of hours GP Local surgery GP NHS 111 or NHS Direct Other health professional Somebody else No-one Don't know 14

TRAVEL TO HOSPITAL Were you taken to the hospital in an ambulance? 36% of patients arrived by ambulance. This compares to 42% of patients nationally, as the chart below shows. Patients Taken to A&E in Ambulance Yes No WAIT WITH AMBULANCE CREW AT HOSPITAL Once you arrived at hospital, how long did you wait with the ambulance crew before your care was handed over to the A&E staff? Of those travelling to A&E in an ambulance, 49% did not have to wait until their care was handed over to A&E staff. 46% had to wait for up to an hour, compared to 47% nationally. 4% had to wait for over 2 hours. Length of Wait with Ambulance Crew Before Care Handed to A&E Staff Didn't wait Up to 15 minutes 16-30 minutes 31-60 minutes 1-2 hours 2hrs + Don't know 15

RECEPTION Were you given enough privacy when discussing your condition with the receptionist? 59% of patients discussing their condition with a receptionist said they were definitely given enough privacy; 9% were not given enough privacy. Given Enough Privacy Discussing Condition with Receptionist Definitely To some extent No Did not discuss with receptionist Comparison over time for this question: Definitely Given Enough Privacy Discussing Condition with Receptionist 2004 2008 2012 2014 16

WAIT TO SPEAK TO NURSE OR DOCTOR How long did you wait before you first spoke to a nurse or doctor? The chart demonstrates the range of waiting times reported by patients before they first spoke to a nurse or a doctor. waited up to 15 minutes, and a further 31% waited between 16 and 30 minutes. 15% reported that they waited over an hour. Length of Wait Before First Speaking to Nurse or Doctor 0-15 minutes 16-30 minutes 31-60 minutes 60 minutes + Comparison over time for this question: Length of Wait Before First Speaking to Nurse or Doctor Less than 1 Hour 2004 2008 2012 2014 17

WAITING TIME FOR EXAMINATION From the time you first arrived at the A&E Department, how long did you wait before being examined by a doctor or nurse? 69% of patients were seen by a doctor or nurse within an hour of arrival in A&E. 16% of those seeing a doctor or nurse reported that they did not have to wait at all; 37% waited less than half an hour; and a further 17% waited between half an hour and an hour. 11% of patients waited over 2 hours to see one of these professionals. Length of Wait Before Being Examined by Doctor or Nurse No wait 1-30 minutes 31-60 minutes 1-2 hours 2-4 hours 4 hours + Can't remember Didn't see doctor/nurse Comparison over time for this question: Length of Wait Before Being Examined by Doctor or Nurse up to 1 Hour 2004 2008 2012 2014 18

INFORMATION ON WAITING Were you told how long you would have to wait to be examined? of patients said that they were not told how long it would be before they saw a professional for an examination. 14% of all patients said that they were told, but that the wait was longer than they had been told it would be. Told Expected Length of Wait to be Examined Yes, wait was shorter Yes, wait was expected length Yes, wait was longer No, not told Don't know Comparison over time for this question: Told Expected Length of Wait to be Examined 2004 2008 2012 2014 19

OVERALL TIME IN A&E Overall, how long did your visit to the A&E Department last? Patients were asked how long they spent overall in the department. 36% spent over 4 hours in the department; 15% had an overall visit of up to one hour. Total Length of A&E Visit Up to 1 hour 1-2 hours 2-4 hours 4-6 hours 6-8 hours 8-12 hours 12-24 hours 24 hours + Can't remember Comparison over time for this question: Total Length of A&E Visit up to 4 Hours 2004 2008 2012 2014 20

Scored % in highest/lowest of s 2014 Number of responders for this Highest 's percentage score Threshold for highest scoring of all s Threshold for lowest scoring of all s Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Arrival at the Emergency Department Q5: Given enough privacy when discussing condition with the receptionist Q6: Length of wait to first speak to nurse or doctor (less time scores higher) Q7: Length of wait to be first examined by a doctor or nurse (less times scores higher) Q8: Told how long the wait to be examined would be (waited longer scores lower) Q9: Length of visit to A&E (less time scores higher) < worse Percentage score better > RKB Question Given enough privacy when discussing Q5 75% 76% 79% 219 condition with the receptionist Q6 Length of wait to first speak to nurse or doctor (less time scores higher) 66% 71% 62% 72% 79% 265 Length of wait to be first examined by a Q7 doctor or nurse (less times scores 64% 58% 62% 69% 74% 260 higher) Q8 Told how long the wait to be examined would be (waited longer scores lower) 86% 82% 89% 86% 92% 94% 107 Length of visit to A&E (less time scores Q9 65% 59% 71% 63% 68% 75% 254 higher) 21

Actions: Ensure that patients are able to speak to a doctor or nurse as soon as possible after their arrival in A&E Ensure that patients are examined by a doctor or nurse as soon as possible after their arrival in A&E Ensure that patients are given a clear and realistic indication of how long they will have to wait to see a doctor or nurse 22

Doctors and Nurses TIME TO DISCUSS HEALTH WITH PROFESSIONALS Did you have enough time to discuss your health or medical problem with the doctor or nurse? Patients were asked whether they had enough time to discuss their health or medical problems with the doctor or nurse seeing them. 72% of patients who saw a doctor or nurse said that they definitely did; 24% said that they had time only "to some extent". 5% said that they did not have enough time with the doctor or nurse. Had Enough Time to Discuss Health or Medical Problem with Doctor or Nurse Yes definitely Yes to some extent No Didn't see doctor or nurse Comparison over time for this question: Definitely Had Enough Time to Discuss Health or Medical Problem with Doctor or Nurse 2004 2008 2012 2014 23

EXPLANATION OF CONDITION AND TREATMENT While you were in the A&E Department, did a doctor or nurse explain your condition and treatment in a way you could understand? 68% of patients who wanted one said they were given an explanation about their condition and treatment that they could understand completely; 25% said they only received an explanation that they could understand to some extent. 7% said they did not receive an explanation that they could understand at all. Condition and Treatment Explained in Understandable Way in A&E Completely To some extent No Didn't need an explanation Comparison over time for this question: Condition and Treatment Explained in Completely Understandable Way in A&E 2004 2008 2012 2014 24

PROFESSIONALS LISTENING Did the doctors and nurses listen to what you had to say? 77% of patients said doctors and nurses definitely listed to what they had to say. 14 patients ( 5% ) said that professionals did not listen to them at all; 18% said that they were listened to only to some extent. Doctors and Nurses Listened to Patient Yes definitely Yes to some extent No Comparison over time for this question: Doctors and Nurses Definitely Listened to Patient 2004 2008 2012 2014 25

PATIENTS' ANXIETIES AND FEARS If you had any anxieties or fears about your condition or treatment, did a doctor or nurse discuss them with you? of patients said their anxieties and fears were discussed completely, 31% said these were discussed, but only to some extent, 19% said their anxieties or fears were not discussed at all. Anxieties or Fears Discussed with Patient Yes completely Yes to some extent No I did not have anxieties or fears Comparison over time for this question: Anxieties or Fears Completely Discussed with Patient 2004 2008 2012 2014 26

CONFIDENCE AND TRUST Did you have confidence and trust in the doctors and nurses examining and treating you? 73% of patients said they had confidence and trust in the doctors and nurses examining and treating them; 7% said they did not. Confidence and in Doctors and Nurses Yes definitely Yes to some extent No Comparison over time for this question: Definitely Had Confidence and in Doctors and Nurses 2004 2008 2012 2014 27

STAFF TALKING IN FRONT OF PATIENTS Did doctors or nurses talk in front of you as if you weren't there? Patients were asked if doctors or nurses talked in front of them as if they were not there. 81% said that they did not; 5% said that they definitely did, and a further 14% said they did to some extent. Doctors / Nurses Talked as if Patient Wasn't There Yes definitely Yes to some extent No Comparison over time for this question: Doctors / Nurses Definitely Didn't Talk as if Patient Wasn't There 2004 2008 2012 2014 28

OPPORTUNITY FOR FAMILY OR FRIENDS TO TALK TO DOCTOR If your family or someone else close to you wanted to talk to a doctor, did they have enough opportunity to do so? 62% of patients who wanted their family or friends to have the opportunity to speak to a doctor thought that they definitely did get that opportunity. 28% thought that they did only to some extent and a further 11% thought that they did not. Family / Friends Had Opportunity to Talk to Doctor if Necessary Yes definitely Yes to some extent No Comparison over time for this question: Family / Friends Definitely Had Opportunity to Talk to Doctor if Necessary 2004 2008 2012 2014 29

Scored % in highest/lowest of s 2014 Number of responders for this Highest 's percentage score Threshold for highest scoring of all s Threshold for lowest scoring of all s Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Doctors and Nurses (Part 1 of 2) Q10: Had enough time to discuss health or medical problem with the doctor or nurse Q11: Doctor or nurse explained condition and treatment Q12: Doctors and nurses listened to what patient had to say Q13: Doctor or nurse discussed patient's anxieties and fears < worse Percentage score better > RKB Question Had enough time to discuss health or Q10 83% 79% 88% 82% 86% 89% 274 medical problem with the doctor or nurse Doctor or nurse explained condition and Q11 81% 76% 85% 78% 83% 86% 262 treatment Doctors and nurses listened to what Q12 86% 82% 85% 91% 276 patient had to say Doctor or nurse discussed patient's Q13 65% 67% 73% 77% 210 anxieties and fears 30

Actions: Ensure that patients are given enough time to discuss their condition and that they feel listened to Make sure that patients have been spoken to in a way that they are able to understand - check with them that this is the case Some patients say that they did not have trust and confidence in the doctors and nurses who examined them - look at how this can be addressed as a priority Some patients say that doctors and nurses sometimes talked in front of them as if they weren't there - take action to ensure that this doesn't happen Ensure that family members or those accompanying the patient are given enough time to talk to doctors and nurses 32

Your Care and Treatment ENOUGH INFORMATION While you were in the A&E Department, how much information about your condition or treatment was given to you? Patients were asked how much information was given to them about their condition and treatment whilst in A&E. 76% said they were given the right amount as the chart shows. Amount of Information About Condition / Treatment Given in A&E Not enough Right amount Too much No information Comparison over time for this question: Right Amount of Information About Condition / Treatment Given in A&E 2004 2008 2012 2014 33

PRIVACY Were you given enough privacy when being examined or treated? 82% of patients said that they were definitely given enough privacy when being examined or treated. Given Enough Privacy When Being Examined or Treated Yes definitely Yes to some extent No Comparison over time for this question: Definitely Given Enough Privacy When Being Examined or Treated 2004 2008 2012 2014 34

HELP FROM STAFF WHEN REQUIRED If you needed attention, were you able to get a member of medical or nursing staff to help you? A key issue for patients in A&E is whether they can obtain assistance from a member of staff when they feel they need it. Of those patients who said they needed attention at some point, 58% said that they could always obtain assistance when they needed it; 18 patients (9%) said they could not find anyone to help them. 3% said that they had a staff member with them all the time. Able to Get Help if Needed Attention Yes always Yes sometimes No With staff all the time Comparison over time for this question: Always Able to Get Help if Needed / Always with Member of Staff 2004 2008 2012 2014 35

CONFLICTING INFORMATION Sometimes in a hospital, a member of staff will say one thing and another will say something quite different. Did this happen to you in the A&E Department? 81% of patients said that they did not receive conflicting information from different members of staff; 7% said they definitely did. Given Conflicting Information Yes definitely Yes to some extent No Comparison over time for this question: Not Given Conflicting Information 2004 2008 2012 2014 36

INVOLVEMENT IN CARE AND TREATMENT Were you involved as much as you wanted to be in decisions about your care and treatment? There was some concern about lack of involvement in decisions about their care and treatment from patients well enough to be involved. 23% of patients said they were involved to some extent only; a further 13% were not involved at all. 63% said they were definitely as involved as they wanted to be. Involved in Decisions About Care Yes definitely Yes to some extent No Not well enough to be involved Comparison over time for this question: Definitely Involved in Decisions About Care 2004 2008 2012 2014 37

STAFF REASSURED PATIENTS If you were feeling distressed while you were in the A&E Department, did a member of staff help to reassure you? 52% of patients said that a member of staff helped to reassure them if they were feeling distressed. 24% of patients said that they were not reassured by a member of staff. Reassured by staff Yes definitely Yes to some extent No Not distressed 38

TESTS Did you have any tests (such as x-rays, scans or blood tests) when you visited the A&E Department? of patients stated that they had some kind of test or investigation whilst they were attending A&E. Had Tests in A&E Yes No Comparison over time for this question: Had Tests in A&E 2004 2008 2012 2014 39

EXPLANATION OF TESTS Did a member of staff explain why you needed these test(s) in a way you could understand? As the chart shows, of those who had tests in A&E, 71% had a completely understandable explanation of why they needed those tests. 11% did not get an understandable explanation. Reasons for Tests Explained Understandably Yes completely Yes to some extent No Comparison over time for this question: Reasons for Tests Explained Completely Understandably 2004 2008 2012 2014 40

GETTING THE RESULTS OF TESTS Before you left the A&E Department, did you get the results of your tests? 7% of those who had tests were told that they would get the results at a later date. Of those who were not told this, 75% got the results before they left A&E; 25% did not. Given Test Results Before Leaving A&E Yes No Don't know Told would be given results later Comparison over time for this question: Given Test Results Before Leaving A&E 2004 2008 2012 2014 41

Did a member of staff explain the results of the tests in a way you could understand? 77% definitely understood the explanation they were given, understood it to some extent, 2% did not understand it at all. Results of Tests Explained Understandably Yes definitely Yes to some extent No Not sure / can't remember 42

PAIN Were you in any pain while you were in the A&E Department? 56% of patients said they were in pain whilst they were in A&E. In Pain Whilst in A&E Yes No Comparison over time for this question: In Pain Whilst in A&E 2004 2008 2012 2014 43

PAIN RELIEF REQUESTED Did you request pain relief medication? 27% of patients requested pain relief whilst in the A&E. 25% of patients were given pain relief without asking. Requested Pain Relief Yes No Given pain relief without asking LENGTH OF TIME TAKEN FOR PAIN RELIEF TO BE GIVEN How many minutes after you requested pain relief medication did it take before you got it? 59% of patients who requested pain relief medication received it in under 15 minutes. Requested Pain Relief 0 minutes / right away 1-5 minutes 6-10 minutes 11-15 minutes 16-30 minutes More than 30 minutes Pain relief medication wasn't given 44

CONTROL OF PAIN Do you think the hospital staff did everything they could to help control your pain? It is clear that there is a large group of patients who believe the hospital staff could have acted more efficiently to control the pain they were experiencing. As the chart shows, 19% stated that the staff did not do everything possible to help; a further said that they helped to some extent only. Staff Did Everything They Could to Control Pain Yes definitely Yes to some extent No Can't say / Don't know Comparison over time for this question: Staff Definitely Did Everything They Could to Control Pain 2004 2008 2012 2014 45

Scored % in highest/lowest of s 2014 Number of responders for this Highest 's percentage score Threshold for highest scoring of all s Threshold for lowest scoring of all s Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Your Care & Treatment (Part 1 of 2) Q17: Rating of the amount of information about condition or treatment given to patient in A+E Q18: Given enough privacy when being examined or treated Q19: Patient was able to get staff to help if needed Q20: Not given conflicting information by staff in A+E Q21: Involved as much as wanted to be in decisions about care and treatment Q22: Reassured by Staff When Distressed < worse Percentage score better > RKB Question Rating of the amount of information Q17 about condition or treatment given to 85% 81% 89% 84% 87% 278 patient in A+E Q18 Given enough privacy when being examined or treated 87% 94% 89% 93% 96% 279 Q19 Patient was able to get staff to help if needed 76% 71% 81% 75% 82% 83% 195 Q20 Not given conflicting information by staff in A+E 87% 83% 91% 86% 93% 281 Q21 Involved as much as wanted to be in decisions about care and treatment 75% 75% 85% 263 Q22 Reassured by Staff When Distressed 64% 59% 61% 67% 72% 123 46

Actions: Some patients say that they are not given enough information about their care and treatment whilst in A&E; look at how this can be improved, considering different methods of giving information to suit the patient's needs Ensure that patients have enough privacy while they are being examined Ensure that patients can get help when needed - tell them how they do this and ensure that response is forthcoming Many patients feel that they are not involved in decisions about their care and treatment as much as they want to be - look at how this can be addressed Ensure that patients are given clear information about why they need the tests that they need If patients are not able to receive their test results before leaving A&E, make sure that they are told when they will receive them Ensure that patients are given adequate pain relief when they need it or if they request it 48

Hospital Environment and Facilities CLEANING In your opinion, how clean was the A&E Department? 62% of patients said that the department was very clean, and a further 35% said that it was fairly clean. 3% said it was not very clean and none said said it was not at all clean. Cleanliness of A&E Department Very clean Fairly clean Not very clean Not at all clean Can't say Comparison over time for this question: A&E Department "Very Clean" 2004 2008 2012 2014 49

BEHAVIOUR OF OTHER PATIENTS While you were in the A&E Department, did you feel threatened by other patients or visitors? 6% of patients said they felt threatened or bothered by some other patients' behaviour whilst they were in the department either definitely or to some extent. 94% said they were not bothered or threatened. Felt Threatened by Other Patients or Visitors Yes definitely Yes to some extent No Comparison over time for this question: Did Not Feel Threatened by Other Patients or Visitors 2004 2008 2012 2014 50

FOOD AND DRINK Were you able to get suitable food or drinks when you were in the A&E Department? 4% were told not to eat or drink during their visit. 37% did not want anything to eat or drink. of patients who wanted and were allowed were able to get suitable food or drinks in A&E, but 26% were not, and a further 5% of patients were not aware if they could eat or drink in A&E and Able to Get Food or Drink Yes No Told not to Didn't know if allowed Didn't want anything Comparison over time for this question: Able to Get Food or Drink 2004 2008 2012 2014 51

Actions: Monitor infection control systems including cleanliness of the department given the poor scores and perception of patients Some patients report that they feel threatened by other patients or visitors - look at how security measures can be taken to ensure that this is not the case Ensure that adequate provision is made for patients to get something to eat and drink while they are in A&E 53

Leaving A&E WHAT HAPPENED What happened at the end of your visit to the A&E Department? 34% of patients said that they were admitted to the same hospital as an inpatient at the end of their stay in A&E; 62% of the patients went home. The chart below shows the full range of responses to this question. Destination on Leaving A&E Admitted to same hospital Transferred to different hospital/nursing home Went home Went to stay with a friend/relative Went to stay somewhere else 54

MEDICATIONS Before you left the A&E Department, were any new medications prescribed for you? Patients were asked if they had been prescribed any new medications before they left A&E. 45% of patients said they were. Prescribed New Medications in A&E Yes No Comparison over time for this question: Prescribed New Medications in A&E 2004 2008 2012 2014 55

PURPOSE OF MEDICATION Did a member of staff explain the purpose of the medications you were to take at home in a way you could understand? 6% of those patients having new medication said they received no explanation of the purpose of the medication; a further 12% stated that they only received some information. Purpose of New Medication Explained Understandably Yes completely Yes to some extent No I did not need an explanation Comparison over time for this question: Purpose of New Medication Definitely Explained Understandably 2004 2008 2012 2014 56

MEDICATION SIDE EFFECTS Did a member of staff tell you about medication side effects to watch for? There were differing views as to whether patients had been told about the potential side effects of medication. 48% of those patients who felt they needed it said they received no information on side effects. Told About Medication Side Effects Yes completely Yes to some extent No I did not need this type of information Comparison over time for this question: Told Completely About Medication Side Effects 2004 2008 2012 2014 57

INFORMATION Did a member of staff tell you when you could resume your usual activities, such as when to go back to work or drive a car? There were differing experiences in terms of whether patients were told about any post-attendance lifestyle restrictions that might apply to them, such as driving a car or going back to work. 27% of patients said they were given no information at all on these issues, whereas 48% were definitely told about them as the chart shows. Told When Usual Activities Could be Resumed Yes definitely Yes to some extent No I did not need this type of information Comparison over time for this question: Definitely Told When Usual Activities Could be Resumed 2004 2008 2012 2014 58

HOME SITUATION AT DISCHARGE Did hospital staff take your family or home situation into account when you were leaving the A&E Department? Of those patients who thought it was necessary, 26% said that staff completely took their family or home situation into account when they were due to leave A&E. 53% thought that staff did not do this. Family or Home Situation Taken into Account When Planning Discharge from A&E Yes completely Yes to some extent No Don't know Comparison over time for this question: Family or Home Situation Taken into Account Completely When Planning Discharge from A&E 2004 2008 2012 2014 59

DANGER SIGNALS Did a member of staff tell you about what danger signals regarding your illness or treatment to watch for after you went home? 48% of patients who thought they needed it were told completely what danger signals to look for regarding their illness of treatment; said they were not told, as the chart shows. Told About Danger Signals to Watch for After Leaving A&E Yes completely Yes to some extent No Didn't need this information Comparison over time for this question: Completely Told About Danger Signals to Watch for After Leaving A&E 2004 2008 2012 2014 60

WHO TO CONTACT POST-DISCHARGE Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left the A&E Department? 81% of patients said they were told by hospital staff who to contact if they were worried about their condition or treatment after they left the department. 19% said they were not told who to contact. Told Who to Contact if Worried About Condition / Treatment After Leaving A&E Yes No Don't know / Can't remember Comparison over time for this question: Told Who to Contact if Worried About Condition / Treatment After Leaving A&E 2004 2008 2012 2014 61

Scored % in highest/lowest of s 2014 Number of responders for this Highest 's percentage score Threshold for highest scoring of all s Threshold for lowest scoring of all s Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Leaving the A&E Department Q36: Staff explained purpose of new medications Q37: Told about medication side effects to watch out for Q38: Told when they could resume their usual activities Q39: Staff took home or family situation into account when leaving A&E if necessary Q40: Told about danger signals to watch out when they got home Q41: Told who to contact if worried about condition or treatment after leaving A+E < worse Percentage score better > RKB Question Q36 Staff explained purpose of new medications 88% 85% 94% 99% 77 Q37 Told about medication side effects to watch out for 44% 39% 49% 45% 73% 64 Q38 Told when they could resume their usual activities 61% 55% 66% 48% 59% 63% 99 Q39 Staff took home or family situation into account when leaving A&E if necessary 36% 43% 42% 54% 62% 66 Q40 Told about danger signals to watch out when they got home 59% 53% 65% 52% 68% 105 Q41 Told who to contact if worried about condition or treatment after leaving A+E 81% 75% 87% 68% 76% 82% 165 62

Actions: Ensure that all patients have the purpose of medications and any possible side effects explained in a clear way - this is one of the most important issues from a patient's perspective Ensure that patients are signposted to help them choose the right service in future to access e.g. GP, NHS Direct or NHS111, out of hours service, walk in service, minor injuries or emergency care centres 63

Overall TREATED WITH RESPECT AND DIGNITY Overall, did you feel you were treated with respect and dignity while you were in the A&E Department? of patients felt that they had been dealt with in a dignified and respectful way all of the time. Treated With Respect and Dignity in A&E of the time Some of the time No Comparison over time for this question: Treated With Respect and Dignity of the Time in A&E 2004 2008 2012 2014 64

OVERALL RATING OF EXPERIENCE Overall Rating of Experience: (0=Very Poor; 10=Very Good) Patients were asked to rate their overall experience on a scale of 0-10, with 10 being "very good". The ratings patients gave to their overall experience are shown in the chart, below. Overall Rating of Experience in A&E 1 2 3 4 5 6 7 8 9 10 65

Scored % in highest/lowest of s 2014 Number of responders for this Highest 's percentage score Threshold for highest scoring of all s Threshold for lowest scoring of all s Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Overall Q42: Treated with respect and dignity in A+E Q43: Rating of overall experience < worse Percentage score better > RKB Question Q42 Treated with respect and dignity in A+E 88% 84% 91% 86% 93% 276 Q43 Rating of overall experience 79% 74% 84% 77% 81% 83% 262 66

Actions: Some patients feel that they are not treated with respect and dignity during their time in A&E - urgently look at how this can be addressed Look at ways to make the urgent care system easier to navigate as this would improve patient experience Ensure that information about how to comment or complain (such as leaflets and posters) are visible and available for patients in hospital; staff are up to date on comments and complaints procedures and able to explain and easily communicate this to patients Triangulate and link patient experience data, FFT and patient outcomes (PROMS) and use in the organisation to identify specific actions that can be put in place. Such actions will, on the basis of analysis of very large NHS datasets, have the potential to improve patients perceived outcomes of care Ensure that the links between patient experience data and patient outcomes data is used in the organisation to identify specific actions that can be put in place. Look at your SRM (data at end of management report) looking for trends year on year where possible, and take appropriate action Use SOLAR to interrogate your results and identify specific areas where issues may be prevalent Undertake clinical audit on patients records in A+E With Commissioners map and analyse patient flows around the system to identify bottlenecks and the scope for changing pathways to reduce the use of hospitals and to ensure that there is sufficient capacity across the health and social care system. 67

Survey results This report sets out the results from the 2014 National Accident and Emergency Department Survey, ordered in exactly the same way as in the questionnaire sent to patients. Reading the columns of figures The results are shown firstly in absolute numbers then as percentages. The first two columns show the results for the in 2012 (2012); the second two columns show the results for the in 2014 (2014); and the final two columns show the results for all the s with Accident and Emergency Departments surveyed by Quality Health in 2014 (). These columns are shaded to distinguish one from another. The purpose of presenting the figures in this way is to give direct, at-a-glance, comparisons between the 's performance in 2012 and 2014; and between the A&E Department and other A&E Departments in the Quality Health database in 2014. Conventions The percentages are calculated after excluding those patients who did not answer that particular question. percentages are rounded to the nearest whole number. When added together, the percentages for all answers to a particular question may total more or less than because of this rounding. The 'Missing' figures show the number of patients who did not reply to that particular question. In some cases, the Missing figure is quite high because it includes patients who did not answer that question or group of questions because it was not applicable to their circumstances (e.g. question 4). On some questions there are also some figures which are italicised, and the relevant reponse shaded in light green. The percentages on these questions have been recalculated to exclude responses where the question was not applicable to the patient s circumstances. For example, questions such as Q7 about length of time waiting to be examined by a doctor or nurse, where those answering (Missing) and those saying they Can't remember/i did not see a doctor or nurse are excluded from the percentage calculations. Changes made to the data There are a number of questions which are routed (i.e. where patients are directed to a subsequent question depending on their answer to the lead question). Sometimes there are conflicts in the answers that patients give to these questions and the data is corrected to account for this. For example, if option 2 in question 3 is ticked and the patient goes on to answer question 4 etc., then any data between question 3 and question 5 (where the patient was directed) will be deleted as the patient should not have answered these questions. 68