Displaying emergency patient estimated wait times: a multi-centre, qualitative study of patient, community, paramedic and health administrator perspectives

Abstract

Background Emergency Departments have the potential ability to predict patient wait times and to display this to patients and other stakeholders. Little is known about whether consumers and stakeholders would want this information and how wait time predictions might be used. The aim of this study was to gain perspectives from consumer, referrer and health services personnel regarding the concept of emergency wait time visibility. Methods In 2019, 103 semi-structured interviews and one focus group were conducted with emergency medicine patients/families, paramedics, well community members and hospital/paramedic administrators. Nine emergency departments and multiple organisations in Victoria, Australia, contributed data. Transcripts were coded and themes are presented. Results Consumers and paramedics face physical and psychological difficulties when wait times are not visible. Consumers believe about a 2-hour wait is tolerable, beyond this most begin to consider alternative strategies for seeking care. Consumers want to see triage to doctor times; paramedics want door to off-stretcher times (for all possible transport destinations); with 47/50 consumers and 30/31 paramedics potentially using this information. Twenty-eight of 50 consumers would use times to inform facility or provider choice, 19/50 want information once in the waiting room. During prolonged waits, 1/52 consumers would consider not seeking care. Visibility of approximate waits would better inform decision-making, improve load-spreading, allow planning and access to basic needs and might reduce anxiety. Conclusions Consumers and paramedics want wait time information visibility. They would use the information in a variety of ways, both pre-hospital and whilst waiting for care.

Visualising Emergency Department Wait Times; Rapid Iterative Testing to Determine Patient Preferences for Displays

“…Patients arrive hoping to see a clinician immediately, but usually have to wait for care. Approximate wait times are important to patients and families [41]. Before attending, online wait time displays can be used to inform a decision about which facility to attend [36].…”

“…Despite the high volume of patients exposed to ED waits, when displays are designed there is little to no input from patients and families who are the end users of the displays. Displayed information about wait times is important as high stakes decisions may be made by patients in response, such as leaving before being attended by a physician or rearranging multiple external commitments [41]. Additionally, patients are having to make these decisions in what is an emotionally and physically stressful environment.…”

“…Before attending, online wait time displays can be used to inform a decision about which facility to attend [36]. Once in an ED, wait estimates are used to meet patient emotional, logistic and physical needs and also assist paramedics whilst patients wait on stretchers [41]. Wait times can be estimated using prediction models, with varied accuracy [2, 37, 40, 42].…”

An operations research approach to automated patient scheduling for eye care using a multi-criteria decision support tool

“…As a result of the COVID-19 pandemic, there have been increased breaches in waiting time targets for ophthalmology outpatient clinics 6 . Prior to the pandemic, such waiting times were already undesirably high due to the backlog resulting from the vast number of patients requiring treatment, compounded by existing inefficient scheduling practices 7,8 . This is further complicated by the ever-present budgetary restrictions on health services.…”