Emergency departments (ED) overcrowding, long wait, and uncomfortable waiting room conditions may lower perceived quality of the patient experience and satisfaction. This study investigates the relationship between patient satisfaction and communication of expected wait times, at the point of triage. A pre-post (11/4/ 2008 -2/5/2009) group design with convenience sample (n=1,209) of all discharge adult ED patients was utilized for this study. A static expected wait time model (i.e., average wait time + one standard deviation) based on time of the day, day of the week and triage levels was employed to communicating expected wait time at triage while an in-house survey with five-point Likert-scale patient satisfaction questions (satisfied with wait time in triage, informed about delays, and overall rating of ED visit) was administrated at the discharge desk. The communication of delays intervention was significant for only overall rating of ED, while binary communication status was significantly associated with all three patient satisfaction questions. The patients who didn't receive any communication about delays, were between 1.42 to 5.48 times more likely to rate the three satisfaction questions lower than very good. With communication about delays, the percentage of patients responding very good and very poor/poor were 14.6% higher and 5.9% lower, respectively, for the satisfied with wait time in triage question. Although communication of delays intervention was not significant, the patients who received wait times information were significantly more satisfied. This indicates that patients are more likely to accept longer wait times provided their expectations are managed via communication. Future studies should explore technological solutions for communication of delays and operational improvement initiatives along with alignment of incentives for ED staff to further improve the patient experience.
Objectives and BackgroundA Department of Health study has shown parents of children presenting with fever who did not receive safety net advice were more likely to unnecessarily re-attend. This work aimed to improve the proportion of safety net advice given by junior doctors at the outset of their attachment. In 2009, an audit of feverish children who presented to our Emergency Department found the number of junior doctors providing safety net advice to parents fell from 70.9% in July to 55.9% when a new cohort commenced in August.MethodsA key slide set was introduced into the paediatric induction lecture (given during the Emergency Department's internal programme) regarding safety net advice in August 2010.ResultsFollowing this awareness campaign, an audit involving 457 case notes revealed safety net advice increased significantly from 76.0% in July 2010 to 89.5% in the August cohort. In 2009 there were 41 medically related re-attendances in July (39.0% subsequently admitted) and 48 in August (41.7% admitted). These “return to be admitted” rates were not significantly different (Z value 0.037, p>0.05). In 2010 there were 50 medically related representations in July (40.0% admitted) and 54 in August (27.8% admitted). These “return to be admitted” rates were not significantly different (Z value 1.11, p>0.05). In children aged 16 and over the total number of re-attendees increased from 6.5% to 7.2% between July and August 2010 with the August result significantly higher than the year total (Z value 2.655, p<0.01) although August had the highest re-attendance amount of the year. In children under 16 re-attendees fell from 3.9% to 3.6% between July and August with the August result not being significantly different from the year total (Z value 1.502, p>0.05).ConclusionThe provision of improved safety net advice did not increase the Clinical Quality Indicator of unplanned re-attendance. Induction programmes have an important role to play in promoting evidence-based practice and improving quality.
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