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Perceptions of emergency care using a seizure care pathway for patients presenting to emergency departments in the North West of England following a seizure: a qualitative study
  1. Leanne Rachel Male1,
  2. Adam Noble1,
  3. Darlene Ann Snape1,
  4. Peter Dixon1,
  5. Tony Marson1,2
  1. 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  2. 2 The Walton Centre NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Leanne Rachel Male; hllmale{at}student.liv.ac.uk

Abstract

Objectives To establish the appropriateness of a previously developed seizure care pathway by exploring to what extent patients valued the intervention and perceived it as being helpful or not.

Design Qualitative descriptive study, using semistructured, in-depth interviews and thematic template analysis, theoretically informed by critical realism.

Setting In North West England, a seizure care pathway has been developed in collaboration with a specialist neurology hospital to support clinical management of seizure patients on initial presentation to the emergency department (ED), as well as access to follow-up services on discharge, with the aim of improving patient experience. Three National Health Service (NHS) EDs and a specialist neurology hospital provided the setting for participant recruitment to this study.

Participants 181 patients fulfilled the inclusion criterion with 27 participants taking part following their experience of an ED attendance and outpatient follow-up appointment after a seizure.

Results Five main themes emerged from the data: decision to seek care, responsiveness of services, waiting and efficiency, information and support, and care continuity. Two integrative themes spanned the whole study: lived experience and communication. This paper reports on two of the main themes: care continuity, and waiting and efficiency. The average time between ED presentation and interview completion was 100 days.

Conclusions Implementation of a care pathway is a complex intervention, requiring long-term follow-up to assess its integration into practice and effectiveness in service improvement. The seizure care pathway has the potential to enhance the care of seizure patients in the ED and at follow-up by improving continuity and management of care. The study demonstrates good aspects of the seizure care pathway as observed by patients and also recognises shortcomings within current service provision and questions what the NHS should and should not be delivering. Our study suggests various ways to enhance the pathway at service level to potentially drive improved patient experience.

  • organisation of health services
  • quality in health care
  • epilepsy
  • qualitative research

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Contributors TM, PD and AN conceived the initial idea of the study, designed the trial and obtained research funding. LRM recruited, carried out and analysed the interviews, with input from DAS. LRM drafted the manuscript and PD, AN, DAS and TM made contributions to its development. All authors reviewed and approved the final manuscript.

  • Funding This work was supported by the National Institute of Health Research (CLAHRC NWC).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approvals were obtained from the research sponsor (University of Liverpool – protocol number: UoL001140) and from Wales Research Ethics Committee 7 (reference number: 15/WA/0207). Approval from HRA and the Research and Development department of each of the participating NHS hospital trusts (IRAS ID 173222) was also sought prior to commencing the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No unpublished data are currently available outside of the research study team.

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