Differences in Clinicians’ and patients’ perception on the quality of emergency department (ED) care in a hospital in Bangladesh: a pre-and-post intervention situational analysis
1
Department of Emergency and Rescue Medicine (UNZ), University of Freiburg, Freiburg, Germany
2
Centre for Medicine & Society (Global Health), University of Freiburg, Freiburg, Germany
3
MVZ Klinik Dr. Hancken, Stade, Germany
4
Gonoshasthaya Kendra (GK) and Gonoshasthaya Samaj Vittik Medical College (GSVMC) & Hospital, Dhaka, Bangladesh
5
Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Hospital-based ED should have six-steps (screening-and-registration, initial-assessments, diagnostic-assessments, planning, medication, disposition) of high-quality clinical care [1]. Most EDs in under-resourced settings, Bangladesh, often fail to offer quality care, causing high mortality. Following an ED-based intervention-study [1], we evaluated its impact on care quality by analysing clinicians' and patients' perspectives.
METHODS:
During 2021-24, we conducted a pre–post intervention-study in a Bangladeshi ED. The intervention comprised training clinicians in structured-clinical-approaches, triage, and point-of-care-ultrasound/POCUS. Applying a 0-4 scale (very-good – very-bad), we measured N=382(before-intervention) and N=396(after-intervention) emergency-patients experiences concerning received care. We assessed N=24 clinicians’ perspectives in both phases. To compare improvements, we conducted Student’s t-tests at 5% significance level.
RESULTS:
Following the intervention, both patients and clinicians reported significant improvements in multiple domains of ED care quality. There was a significant improvement in the overall quality of ED care (arrival – disposition; patients: from Mean-M=1.90 at baseline to 2.13 at follow-up; clinicians: from M=2.04 to 2.67; p=0.00). Notable gains were observed in the screening-and-registration (patients: Mean-M=1.74 versus 3.03; clinicians: M=2.04 versus 2.96; p=0.00), initial-assessments (patient: from M=1.82 to 2.55; clinicians: from M=2.00 to 3.38; p=0.00), decision-making (patient: from M=1.94 to 2.18; clinicians: from M=1.96 to 2.71; p=0.00), medication/interventions (patient: from M=1.94 to 2.18; clinicians: from M=1.83 to 2.58; p=0.00), and disposition (patient: from M=2.00 to 2.12; clinicians: from M=2.33 to M=3.00; p=0.00). Improvements in diagnostic-assessment were reported by clinicians (from M=1.83 to 2.50; p=0.00), while patients’ ratings in this domain showed no significant change (from M=2.50 to 3.03; p=0.78).
CONCLUSIONS:
The implementation of relatively simple and context-appropriate interventions substantially improved the perceived quality of ED care in a resource-constrained hospital setting. Incorporating both patient and clinician perspectives provides a more comprehensive assessment of care quality and should be taken into account when designing and scaling-up ED care improvements in low-and-middle-income countries.
Hospital-based ED should have six-steps (screening-and-registration, initial-assessments, diagnostic-assessments, planning, medication, disposition) of high-quality clinical care [1]. Most EDs in under-resourced settings, Bangladesh, often fail to offer quality care, causing high mortality. Following an ED-based intervention-study [1], we evaluated its impact on care quality by analysing clinicians' and patients' perspectives.
METHODS:
During 2021-24, we conducted a pre–post intervention-study in a Bangladeshi ED. The intervention comprised training clinicians in structured-clinical-approaches, triage, and point-of-care-ultrasound/POCUS. Applying a 0-4 scale (very-good – very-bad), we measured N=382(before-intervention) and N=396(after-intervention) emergency-patients experiences concerning received care. We assessed N=24 clinicians’ perspectives in both phases. To compare improvements, we conducted Student’s t-tests at 5% significance level.
RESULTS:
Following the intervention, both patients and clinicians reported significant improvements in multiple domains of ED care quality. There was a significant improvement in the overall quality of ED care (arrival – disposition; patients: from Mean-M=1.90 at baseline to 2.13 at follow-up; clinicians: from M=2.04 to 2.67; p=0.00). Notable gains were observed in the screening-and-registration (patients: Mean-M=1.74 versus 3.03; clinicians: M=2.04 versus 2.96; p=0.00), initial-assessments (patient: from M=1.82 to 2.55; clinicians: from M=2.00 to 3.38; p=0.00), decision-making (patient: from M=1.94 to 2.18; clinicians: from M=1.96 to 2.71; p=0.00), medication/interventions (patient: from M=1.94 to 2.18; clinicians: from M=1.83 to 2.58; p=0.00), and disposition (patient: from M=2.00 to 2.12; clinicians: from M=2.33 to M=3.00; p=0.00). Improvements in diagnostic-assessment were reported by clinicians (from M=1.83 to 2.50; p=0.00), while patients’ ratings in this domain showed no significant change (from M=2.50 to 3.03; p=0.78).
CONCLUSIONS:
The implementation of relatively simple and context-appropriate interventions substantially improved the perceived quality of ED care in a resource-constrained hospital setting. Incorporating both patient and clinician perspectives provides a more comprehensive assessment of care quality and should be taken into account when designing and scaling-up ED care improvements in low-and-middle-income countries.
| eISSN: | 2654-1459 |
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