Person-centred emergency care: translation and cross-cultural validation of the Australian Emergency Department Patient-Reported Experience Measure (ED PREM) in the Netherlands

BACKGROUND: Measuring and evaluating patient experience in the emergency department (ED) is essential for improving the quality of emergency care. However, specific and validated tools to measure patient experience in the ED are lacking in many countries. The aim of this study was therefore to translate and cross-culturally validate the Australian ED Patient-Reported Experience Measure (ED PREM) for the Dutch setting. METHODS: A single-centre validation study was conducted in a Dutch academic hospital. Step 1 involved forward and backward translation to produce a Dutch translation of the ED PREM (prototype). Step 2 involved establishing face and content validity of the Dutch prototype through cognitive patient interviews and researcher team consensus meetings. Step 3 involved administering the resultant Dutch pilot ED PREM to an ED population (n=527), to be able to perform psychometric analyses on this sample. Descriptive statistics and item reduction analyses were conducted prior to confirmatory factor analysis (CFA). CFA was used to confirm the structural validity of the Dutch ED PREM, and internal consistency was assessed. RESULTS: The face and content validity of the prototype Dutch ED PREM was 'good' after 15 cognitive interviews and expert consultation. Over two-thirds of participants (357/527) completed the Dutch pilot ED PREM. Scores were high across all four domains. Several items were removed due to high ceiling effects and a large number of 'not applicable' responses. The final 18-item Dutch ED PREM showed acceptable model fit with CFA (χ2(df) 7519.55 (153), p<0.001, Root Mean Square Error of Approximation=0.090, Tucker-Lewis Index=0.942, Comparative Fit Index=0.951, Standardised Root Mean Square Residual=0.035). Internal consistency was high (Cronbach's alpha ranged 0.85-0.97 per domain). CONCLUSIONS: The final 18-item Dutch ED PREM showed good validity and reliability for measuring ED patient experience. It is suitable and feasible for use in clinical practice to assess and improve the person-centredness of emergency care.

• ✓The final 18-item Dutch ED PREM showed acceptable model fit with CFA (χ2(df) 7519.55 (153), p<0.001, Root Mean Square Error of Approximation=0.090, Tucker-Lewis Index=0.942, Comparative Fit Index=0.951, Standardised Root Mean Square Residual=0.035).
• ✓Internal consistency was high (Cronbach's alpha ranged 0.85-0.97 per domain).
• ✓CONCLUSIONS: The final 18-item Dutch ED PREM showed good validity and reliability for measuring ED patient experience.
• ✓It is suitable and feasible for use in clinical practice to assess and improve the person-centredness of emergency care.