Introduction

Patient-centered care (PCC) is an approach to patient-provider interactions that promotes a collaborative partnership among health care providers, patients, and their families. In clinical practice, emphasis is placed on understanding patients and their clinical presentation within the larger context that includes their family, personal views, preferences, values, past experiences, and cultural factors. By embracing each patient as an individual, a patient-centered approach seeks to ensure high-quality care that consistently meets the needs and preferences of patients and their families.

Goals

The goals of this chapter are as follows:

Background

The concept of PCC gained attention with the influential Institute of Medicine reports in 1999 (“To Err Is Human”) and 2001 (“Crossing the Quality Chasm”). The first report outlined mechanisms to improve patient safety, including efforts to engage patients in their care and enhance their understanding of their treatment.¹ Two years later, “Crossing the Quality Chasm” identified PCC as one of the six aims intended to improve the quality of health care in our country.²

In 2006, the American College of Emergency Physicians (ACEP) and the American Academy of Pediatrics issued a joint policy statement supporting patient and family-centered care as an important means of improving satisfaction, safety, and quality of care for patients and their families.³

The emergency department (ED) environment is inherently challenging to the communication process between patients and providers, and a patient-centered approach to care can be particularly valuable in this setting. ED providers routinely confront significant time constraints, unpredicted interruptions, and overcrowding while caring for patients with life-threatening illness and injury.^4–7 Given these circumstances, it is essential that ED providers possess skill in rapidly establishing rapport and engaging patients in critical decision making. A patient-centered approach to care is vital in overcoming barriers to the communication process through an understanding of the many situational and personal factors that characterize a patient’s visit to the ED. In many cases, fear, anxiety, and uncertainty, as well as preconceived and often unrealistic expectations, play an important role, and these factors must be recognized and appropriately managed to effectively communicate with patients.³

A patient-centered approach to care provides clear benefits to the immediate patient-provider interaction, but it also appears to have a positive impact on important outcomes for the patient and provider. Although research in this area is challenging, early work indicates that PCC improves patient satisfaction and may also enhance adherence and health outcomes.^8–12

Personal Issues

As individual providers, there are many simple things that we can do every day in the ED during our patient interactions that facilitate the provision of PCC. The following sections highlight practical approaches and strategies that can be realistically incorporated into clinical practice on a daily basis. Our discussion will consider three areas: communication, operational considerations, and humanistic considerations.