The Effect of Emergency Department Crowding on Patient Satisfaction for Admitted Patients

Abstract

Objectives: The objective was to study the association between factors related to emergency department (ED) crowding and patient satisfaction. Methods:The authors performed a retrospective cohort study of all patients admitted through the ED who completed Press-Ganey patient satisfaction surveys over a 2-year period at a single academic center. Ordinal and binary logistic regression was used to study the association between validated ED crowding factors (such as hallway placement, waiting times, and boarding times) and patient satisfaction with both ED care and assessment of satisfaction with the overall hospitalization.Results: A total of 1,501 hospitalizations for 1,469 patients were studied. ED hallway use was broadly predictive of a lower likelihood of recommending the ED to others, lower overall ED satisfaction, and lower overall satisfaction with the hospitalization (p < 0.05). Prolonged ED boarding times and prolonged treatment times were also predictive of lower ED satisfaction and lower satisfaction with the overall hospitalization (p < 0.05). Measures of ED crowding and ED waiting times predicted ED satisfaction (p < 0.05), but were not predictive of satisfaction with the overall hospitalization.Conclusions: A poor ED service experience as measured by ED hallway use and prolonged boarding time after admission are adversely associated with ED satisfaction and predict lower satisfaction with the entire hospitalization. Efforts to decrease ED boarding and crowding might improve patient satisfaction. ACADEMIC EMERGENCY MEDICINE 2008; 15:825-831 ª 2008 by the Society for Academic Emergency MedicineKeywords: emergency department crowding, overcrowding, patient satisfaction, hallway, boarding, crowding P atient satisfaction data are used by emergency department (ED) administrators to track aggregate data over time, study interventions, assess individual physician performance, and construct financial incentive plans.1,2 A recent study identified six elements of emergency care associated with poor satisfaction: 1) not receiving help when needed, 2) a poorly explained problem, 3) not being told about waiting times, 4) not being told when to resume normal activities, 5) not having test results explained, and 6) not understanding when to return to the ED.3,4 While many elements of satisfaction are under provider control, many elements of ED care are difficult for an individual provider to improve, such as waiting time, boarding time, use of hallway treatment space, and overall levels of ED crowding that might reduce staff availability and impede ancillary services such as radiology and laboratory results. 5-11Despite the challenges of obtaining reliable and valid data, measurement of patient satisfaction is recognized by providers and regulators as vital to quality assurance and improvement.12,13 Satisfied patients are more likely to be compliant with their medications, return for continuing medical care, and communicate more effectively with their physicians.14-16 Patient satisfaction itself has been prop...

Overcrowding in emergency department: an international issue

“…Boarding in the ED results in decreased patient satisfaction, financial loss from walk-outs, decreased patient safety, and decreased staff morale. Pines et al [5] demonstrate that ED boarding decreases patient satisfaction with the entire hospitalization, not just the ED portion. In fact, patient's satisfaction is correlated with the amount of time spent in the ED.…”

“…The potential utility of clinical indicators Long waits in the ED not only contribute to the problem of overcrowding, but also are associated with increased patient morbidity and mortality [5,9,[12][13][14]. The long delays experienced by patients attempting to access emergency care in the United Kingdom gained a high profile in the 1990s, and led to the United Kingdom being the first country to introduce mandatory, nationwide clinical indicators [15].…”

Educational Excellence in a Crowded Emergency Department: Consensus Recommendations From the Council of Emergency Medicine Residency Directors 2010

“…2 Crowding has been shown to result in slower processes of care and lower satisfaction scores by patients. [3][4][5][6][7][8][9][10][11] Very few studies, however, have assessed the impact of crowding on education in the ED. [12][13][14] Crowding may both harm and benefit the education of medical students and residents in academic EDs.…”

A Real-Time Autonomous Dashboard for the Emergency Department: 5-Year Case Study (Preprint)

“…Influenced are such major quality factors as timeliness, effectiveness, efficiency, safety, and patient-centeredness, resulting in increased mortality and morbidity. [5,[8][9][10] Multiple studies have suggested using system engineering and science to improve ED performance, streamlining process and improving throughput. [11][12][13] However, a strategic approach to finding process delays and supply-demand mismatch by traditional hospital information systems (HISs) is not feasible.…”

“…[3,4] Moreover, a many EDs are already overcrowded, causing more complexity. [5][6][7] While ED overcrowding remains a major healthcare issue, it significantly and adversely affects quality of care. Influenced are such major quality factors as timeliness, effectiveness, efficiency, safety, and patient-centeredness, resulting in increased mortality and morbidity.…”