Improving Patient Experience and Perception of Emergency Department Wait Times

Objective: : Multiple initiatives have been developed to improve throughput and patient flow within the Emergency Department, however patients are often unaware of ED constraints and efforts to provide quality care for them. Without effective communication between ED staff and patients, patient satisfaction and staff frustration will remain at sub-optimal levels. Patient perception and satisfaction have been shown to correlate with patient outcomes, however communication between ED staff and patients has been shown to be ineffective at our institution based on Press Ganey scores. The objective of this project was to increase patient satisfaction through improved communication with patients by triage clinical staff.

EBP Model:: Our institution uses the Iowa Model Revised as an Evidence Based Practice Model.

Setting:: This project took place in a teaching, urban level I trauma center in the Western United States.

Participants:: Our department’s Unit Practice Council (UPC) conceived and implemented this project. Based on a review of the available evidence, education was provided by UPC members to front-end nursing staff.

Methods: : A review of the literature revealed that one of the most common factors affecting ED patient satisfaction is communication with providers and that patient satisfaction has been positively linked to patient outcomes, making this an important project to pursue for improving both the perception of our institution’s service quality and actual patient outcomes. Furthermore, literature also suggested that it is both the actual wait times experienced and the perception of those wait times that are important factors in patient satisfaction.
To improve the perception of wait times in the ED triage environment, the UPC group sought to standardize communication provided by clinical staff. Communication coaching was provided to triage staff and the use of key phrases “The emergency department is unpredictable” and “I want to keep you informed” were encouraged. To prompt triage staff, these key phrases were posted near computers in the clinical triage space. A brochure was created to explain ED flow for patients and front end triage staff were encouraged to provide it to arriving patients.

Outcomes:: In the first quarter post-implementation, non-significant improvements were seen in the Press Ganey scores for the three questions "Nurse Kept You Informed", "Courtesy of Nurses" and "Nurses' Attention to your Needs". In the second quarter post-implementation scores on all three questions had dropped to just below pre-implementation levels. This represents preliminary data as educational efforts are ongoing and survey data to determine usage of the key phrasing has not yet been collected.

Implications:: Effective communication between ED triage clinicians and patients represents a best practice to improve patient safety in the ED environment. Ongoing data collection will help determine if standardized communication, including key phrasing in the ED triage environment serves to provide effective communication for patients in the waiting room as reported on Press Ganey surveys. Final data analysis will also include rates of patients that left without being seen or eloped and the number of security activations for aggressive patients as secondary outcomes reflecting a culture of safety at our institution.