What shapes patient experience of diagnosis in the emergency department? Findings from a mixed-methods study.

OBJECTIVES: Patient experience is a key indicator of quality in emergency department (ED) care. Prior research has shown that patients report more positive experiences when diagnostic imaging is performed, yet the mechanisms underlying this association remain unclear. The Patient-Reported Measure of Diagnostic Excellence in the Emergency Department (PRIME-ED) was developed to better characterize patients' perceptions of diagnostic processes, accuracy, and communication. The objective of this work was to implement PRIME-ED in a Midwestern academic ED and evaluate patient-reported ratings and free-text comments regarding diagnosis and diagnostic experience. METHODS: Adult patients (18 and older) visiting a single academic ED between October 2024 and July 2025 were surveyed using PRIME-ED. Responses were measured on a 5-point Likert scale across three domains (process, accuracy, and communication) and combined into a composite score. Qualitative comments were analyzed using an iterative, inductive coding approach and categorized by topic and overall sentiment. RESULTS: A total of 205 patients completed the survey. Mean scores were similar across domains (process 4.1, accuracy 3.9, communication 4.0), with a composite score of 4.0. Of respondents, 143 (69.8 %) provided free-text comments. Six thematic categories emerged, most commonly communication and diagnosis. Overall sentiment was predominantly positive (42.7 %), followed by neutral (29.4 %) and negative (28.0 %). Negative comments frequently reflected frustration when diagnostic testing did not yield a clear explanation for symptoms or when patients desired additional testing. Positive comments often emphasized thorough diagnostic evaluations. CONCLUSIONS: Findings from this study suggest that diagnostic testing may serve as a proxy for thoroughness and attentiveness from the patient perspective.