Grab a Seat! Nudging Providers to Sit Improves the Patient Experience in the Emergency Department

Orloski, Clinton J; Tabakin, Erica R.; Shofer, Frances S.; Myers, Jennifer S.; Mills, Angela M.

doi:10.1177/2374373518778862

Cited by 12 publications

(20 citation statements)

References 17 publications

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“…6,7 The physician-patient relationship, built upon verbal and non-verbal communication, is particularly important in EDs. 7,8,9 However, it is not clear whether the same predictors of patient satisfaction could contribute to a better-perceived quality of healthcare or whether patient perceptions could form a different attitude toward satisfaction and the perceived quality of healthcare.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

“…Patient satisfaction with the ED may be influenced by numerous factors, including experience with nursing care, communication, infrastructure, and environment in which the healthcare professional practices. 9,15 Patient factors that may influence satisfaction include age, gender, income, education level, expectations, marital status, and where they live. 13 Hospital-related factors such as staff, waiting times, facilities, and processes may also influence patient satisfaction.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

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Predictors of Patient Satisfaction and the Perceived Quality of Healthcare in an Emergency Department in Portugal

Abidova

Silva

Moreira

2020

WestJEM

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Introduction: The predictors of patient satisfaction in emergency medicine (EM) have been widely studied and discussed in the scientific literature; the results vary depending on the specific EM attributes, cultural aspects, researchers’ preferences, and approaches. However, it is not clear whether the same predictors of patient satisfaction can contribute to a better-perceived quality of healthcare or whether patients’ perceptions form a different attitude toward satisfaction and perceived quality of healthcare. The goal of this study was to identify the key predictors of patient satisfaction and perceived quality of healthcare in the framework of an emergency department (ED). Methods: We conducted a retrospective study of patients seen at an ED between January -December 2016. Data collection took place in the public hospital in Lisbon, Portugal, between May - November 2017. The total sample size included 382 patients. The sample distribution had a 5% margin of error and a 95% confidence interval. Data for this research, using a questionnaire, was collected by mail or e-mail according to the respondent’s preference. Results: A detailed analysis showed that three out of the 18 predictors had a statistically significant relationship with satisfaction: overall satisfaction with doctors, with a positive correlation (r = 0.14, p ≤ 0.01); qualitative perceived waiting time for triage, with a positive correlation (r = 0.08, p ≤ 0.05); and meeting expectations, with a positive correlation (r = 0.53, p ≤ 0.01). Furthermore, a detailed analysis showed that only two out of the 18 predictors had a statistically significant relationship with the perceived quality of healthcare (PQHC): overall satisfaction with doctors, with a positive correlation (r = 0.43, p ≤ 0.01) and meeting expectations, with a positive correlation (r = 0.26, p ≤ 0.01). Conclusion: The main predictors of satisfaction and perceived quality of healthcare were overall satisfaction with doctors and meeting expectations. We should note that “meeting expectations” plays the most important role in terms of satisfaction; however, in terms of PQHC the predictor “overall satisfaction with doctors” plays the most important role due to its stronger correlation. In addition, the qualitative perceived waiting time for triage could be considered as another predictor, influencing satisfaction only, thus emphasizing similarities and differences between satisfaction and the PQHC in an ED context.

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Section: How Does This Improve Population Health?mentioning

confidence: 99%

Section: How Does This Improve Population Health?mentioning

confidence: 99%

Predictors of Patient Satisfaction and the Perceived Quality of Healthcare in an Emergency Department in Portugal

Abidova

Silva

Moreira

2020

WestJEM

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“…Sixteen of the studies delivered their intervention via Electronic Health Record (EHR) systems, either through the prescription and ordering interface or through patient records. Six studies delivered the intervention mainly through modifications in the physical environment such as posters [ 36 , 37 ], aromatization [ 29 , 38 , 39 ], or props [ 40 ]. Four studies combined other strategies with email communication in order to provide feedback and statistics on the performance of the target behaviour [ 37 , 41 – 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…The second largest target was the modification of behaviours with respect to certain care procedures ( n = 7) such as ventilation settings for intubated patients [ 30 , 42 ], improving inpatient sleep [ 49 ], sedation during endoscopy [ 47 ], screening for risk of cardio-vascular disease in primary care [ 58 ], sitting down during examinations [ 40 ], and pain management after Caesarean Section surgery [ 48 ]. Four studies targeted hand hygiene [ 29 , 38 , 39 , 43 ], and two studies focused on vaccination of healthcare providers [ 45 , 46 ].…”

Section: Resultsmentioning

confidence: 99%

Nudging healthcare professionals in clinical settings: a scoping review of the literature

Sant'Anna¹,

Vilhelmsson

Wolf

2021

BMC Health Serv Res

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Background Healthcare organisations are in constant need of improvement and change. Nudging has been proposed as a strategy to affect people’s choices and has been used to affect patients’ behaviour in healthcare settings. However, little is known about how nudging is being interpreted and applied to change the behaviour of healthcare professionals (HCPs). The objective of this review is to identify interventions using nudge theory to affect the behaviour of HCPs in clinical settings. Methods A scoping review. We searched PubMed and PsycINFO for articles published from 2010 to September 2019, including terms related to “nudging” in the title or abstract. Two reviewers screened articles for inclusion based on whether the articles described an intervention to change the behaviour of HCPs. Two reviewers extracted key information and categorized included articles. Descriptive analyses were performed on the data. Results Search results yielded 997 unique articles, of which 25 articles satisfied the inclusion criteria. Five additional articles were selected from the reference lists of the included articles. We identified 11 nudging strategies: accountable justification, goal setting, suggested alternatives, feedback, information transparency, peer comparison, active choice, alerts and reminders, environmental cueing/priming, defaults/pre-orders, and education. These strategies were employed to affect the following 4 target behaviours: vaccination of staff, hand hygiene, clinical procedures, prescriptions and orders. To compare approaches across so many areas, we introduced two independent dimensions to describe nudging strategies: synchronous/asynchronous, and active/passive. Conclusion There are relatively few studies published referring to nudge theory aimed at changing HCP behaviour in clinical settings. These studies reflect a diverse set of objectives and implement nudging strategies in a variety of ways. We suggest distinguishing active from passive nudging strategies. Passive nudging strategies may achieve the desired outcome but go unnoticed by the clinician thereby not really changing a behaviour and raising ethical concerns. Our review indicates that there are successful active strategies that engage with clinicians in a more deliberate way. However, more research is needed on how different nudging strategies impact HCP behaviour in the short and long term to improve clinical decision making.

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“…The pamphlet was distributed at the time of ED registration on alternating 2-week blocks with usual care on opposite weeks. The intervention processes and outcomes were studied by administering an 8-question, previously used survey at ED discharge by trained research assistants between the hours of 7 am and midnight ( 13 ). The survey utilized a 4-point Likert scale (strongly disagree, disagree, agree, and strongly agree) on questions about patient understanding different components of the pamphlet and is available in Appendix A .…”

Section: Methodsmentioning

confidence: 99%

Improving Emergency Department Patient Experience Through Implementation of an Informational Pamphlet

Sangal

Orloski

Shofer

et al. 2019

Journal of Patient Experience

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Objective: Patient satisfaction is emerging as a new health-care metric. We hypothesized that an emergency department (ED) informational pamphlet would significantly improve patient understanding of ED operations and ultimately improve patient satisfaction. Methods: We performed a prospective study of patients presenting to a single tertiary care center ED from April to July 2017. All patients were given a pamphlet on alternating weeks with regular care on opposite weeks and were surveyed upon ED discharge. The primary outcome was patient satisfaction with ED care. Secondary outcomes included patient understanding of various wait times (test results, consultants), discharge process, who was on the care team and what to expect during the ED visit. Results: Four hundred ninety-four patients were included in this study and 266 (54%) were in the control group. Of 228 (46%) patients who were given the pamphlet, 116 (51%) were unaware they received it. Of the remaining 112 (49%) patients who remembered receiving the pamphlet, 43 (38%) stated they read it. Among those reading the pamphlet, only two statements were significant: knowing what to expect during the ED visit (88% vs 71%; P = 0.012) and waiting time for test results (95% vs 75%; P = 0.003) when compared to those who did not receive or read the pamphlet. Conclusion: An ED informational pamphlet, when utilized by patients, does improve patient understanding of some aspects of the ED visit but does not appear to be the best tool to convey all information. Ultimately, sustained improvement in patient satisfaction is a complex and dynamic issue necessitating a multifactorial approach and other methods should be explored.

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Grab a Seat! Nudging Providers to Sit Improves the Patient Experience in the Emergency Department

Cited by 12 publications

References 17 publications

Predictors of Patient Satisfaction and the Perceived Quality of Healthcare in an Emergency Department in Portugal

Predictors of Patient Satisfaction and the Perceived Quality of Healthcare in an Emergency Department in Portugal

Nudging healthcare professionals in clinical settings: a scoping review of the literature

Improving Emergency Department Patient Experience Through Implementation of an Informational Pamphlet

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