Patient satisfaction with chest pain unit care: findings from the Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions (ESCAPE) cluster randomised trial

Abstract

Background: Chest pain attendances at the emergency department (ED) in the UK are continuing to rise. Chest pain units (CPU) provide nurse-led, protocol-driven care for patients attending the ED with acute chest pain. The ESCAPE trial evaluated the effectiveness, cost-effectiveness and acceptability of CPU care in the NHS. This paper reports the quantitative evaluation of acceptability: patient satisfaction with CPU and routine care.

Methods: The ESCAPE study was a cluster-randomised controlled trial of 14 hospitals in which seven hospitals were allocated to establish CPU care and seven to continue providing routine care. As part of the study, postal questionnaires were sent to a subgroup of patients attending the ED with chest pain before and after intervention at all 14 hospitals.

Results: There was a 42.8% response rate (2389/5584) for unsolicited self-administered questionnaires. There was no significant change in any dimension of patient satisfaction, although there was some weak evidence that the introduction of CPU care was associated with reduced satisfaction with explanations about medical procedures and treatments (effect of CPU -0.16 points on a 5-point Likert scale, 95% CI -0.35 to 0.02; p=0.089) and attention given to what the patient had to say (-0.17 points, 95% CI -0.35 to 0.02; p=0.077). CPU care had no effect on overall satisfaction with care (-0.08 points, 95% CI -0.26 to 0.10; p=0.393).

Conclusions: No evidence was found that improvements in patient satisfaction associated with CPU care in previous single-centre trials were reproduced in this multicentre study.

Trial registration number: ISRCTN55318418 International Standard Randomised Controlled Trial Number Register.