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Aims and ObjectivesCrowding is the most pressing issue currently faced by UK emergency departments (ED). When departments are crowded then hospital admissions are delayed, and the risk of mortality is increased. Professionals working in crowded departments feel unable to provide high quality care and are predisposed to burnout. Awareness of the impact on patients, however, is limited to analyses of service outcomes rather than more detailed understanding of perspectives. This project aimed to develop a rich understanding of patients’ experiences receiving emergency healthcare in a crowded department.Method and DesignA qualitative service evaluation was undertaken in a single UK ED. Adults were recruited using convenience sampling during periods of crowding, defined by ED space occupancy exceeding 75% and by ambulance handover times exceeding 30 minutes. Semi-structured interviews explored factors contributing to experience. Participants shared potential mitigating interventions. Verbatim transcripts were read, checked for accuracy, re-read, and reflected upon and discussed among the project group. Researcher bias was identified through reflexivity and peer debriefing was used to improve validity. Analysis for themes contributing to experience was based on the interpretative phenomenological approach.Results and ConclusionSeven patients and three accompanying partners participated in interviews lasting 10-44 minutes. They were aged 24-87 and had ethnicity representing the city’s diverse population. Participants were recruited during crowding in the waiting room (2), ambulatory area (3), and ambulance assessment area (2). Crowding negatively impacted upon healthcare experience, characterised by themes of ‘loss of autonomy’, ‘unmet expectations’, and ‘vulnerability’. Potential mitigating interventions included realistic communication and provision for basic care needs.In this focussed evaluation, participants’ healthcare experiences were impaired by crowding. They suggested simple person-centred interventions to help cope with their situation. Other EDs may wish to adapt these methods and findings to identify further possible ways of improving patient experience in their own crowded environments.

BackgroundEmergency department (ED) crowding causes increased mortality. Professionals working in crowded departments feel unable to provide high-quality care and are predisposed to burnout. Awareness of the impact on patients, however, is limited to metrics and surveys rather than understanding perspectives. This project investigated patients’ experiences and identified mitigating interventions.MethodsA qualitative service evaluation was undertaken in a large UK ED. Adults were recruited during periods of high occupancy or delayed transfers. Semi-structured interviews explored experience during these attendances. Participants shared potential mitigating interventions. Analysis was based on the interpretative phenomenological approach. Verbatim transcripts were read, checked for accuracy, re-read and discussed during interviewer debriefing. Reflections about positionality informed the interpretative process.ResultsSeven patients and three accompanying partners participated. They were aged 24–87 with characteristics representing the catchment population. Participants’ experiences were characterised by ‘loss of autonomy’, ‘unmet expectations’ and ‘vulnerability’. Potential mitigating interventions centred around information provision and better identification of existing ED facilities for personal needs.ConclusionParticipants attending a crowded ED experienced uncertainty, helplessness and discomfort. Recommendations included process and environmental orientation.