- Email: [email protected]
Patients’ Perceptions of Waiting Times and the Effect on Patient Satisfaction in the Emergency Department
Research Forum Abstracts
221
Patients’ Perceptions of Waiting Times and the Effect on Patient Satisfaction in the Emergency Department
Saxon K, London K, Bacharouch A, Smith K, Santen S, Perry M/University of Michigan, Ann Arbor, MI
Study Objectives: Emergency department (ED) wait times are considered an important facet of patient satisfaction. They can be a trigger for patient complaints and are now being advertised on billboards to attract patients. Prior studies have indicated that when asked what feature of the ED visit was most important, patients consistently rated wait time (Holden 1999), and that if the waiting time was less than expected, patients had increased satisfaction with their overall visit (Thompson 1996). The objective of this study was to determine if the patients’ perception of their wait time in the ED correlated with their actual length of stay (LOS), and if the LOS would affect patients’ ratings of overall satisfaction of the visit. Methods: This is a cross-sectional survey study in an academic ED with volume of 80,000 per year and was exempt by the IRB. Patients nearing the end of their stay completed an anonymous survey regarding their experience. Using a Likert scale, the survey asked them to rate the amount of time they waited to see a provider and how satisfied they were with the ED visit. When starting the survey, the patient’s total LOS in the ED was recorded from electronic trackboard, which included time in the waiting room as well as the treatment room. The patients’ LOS was compared to their satisfaction score, and the actual LOS and perception of wait times were evaluated using t-tests and chi-square analysis. Results: 613 surveys were completed. The average LOS was 6 hours and 22 minutes (SD 4h56min). Of the patients surveyed, 19.5% rated the time they waited for a provider as “too much”; their mean LOS was 6h51min (SD 5h07min). The remaining 80.5% of patients who felt the wait time was “about right” had a mean LOS of 6h14min (SD 4h54min). There is no statistically significant difference between these two groups’ LOS (p¼0.2). The majority of patients (92%) rated their overall visit highly. There was no difference in LOS for those patients who were not satisfied (mean LOS of 6h43min SD 5h29min) and those who were satisfied (mean LOS of 5h56min SD 4h54min, p¼0.3). Although the overall rating of the visit was not affected by the LOS, perceptions of the LOS did affect the rating. The patients who rated their LOS as “about right” gave higher satisfaction ratings, while those who rated the LOS as “too much” gave a lower satisfaction score (p<0.005). Conclusions: The patients’ actual LOS in the ED did not affect whether they rated their visit favorably, but those who perceived their LOS was “about right” gave better ratings of their visit. Although wait times increase when the resource capacity of providers and services is exceeded, longer wait times may not affect satisfaction scores because sicker patients usually require more time for evaluation. The initial time to seeing a provider is considered to have the strongest effect on patients’ perception of wait time and satisfaction. A more meaningful metric for quality may be evaluating time to admission or discharge (Weiner 2013) as a patient’s actual LOS does not correlate with their satisfaction.
222
Initial Patient Evaluation of Physicians, Based on Attire
Burgess A, Lee DH, Totten V/University Hopsitals Case Medical Center, Cleveland, OH; Case Western Reserve University, Cleveland, OH; University Hospitals Case Medical Center, Cleveland, OH
Study Objectives: The goal was to learn if patient’s initial assessment of physician’s attire is different now compared to the past, since the advent of TV shows which depict physicians wearing scrubs and other less formal attire. Methods: This was a convenience sample of persons in a large urban Midwestern teaching hospital. Respondents looked at 6 photos: one male and one female physician of similar age, both white, dressed in 3 levels of formality with a white coat: business casual, scrubs, and jeans. Faces were blurred. Patients were asked to assume characteristics of the physicians based solely on their attire. Results: Two hundred ninety-four respondents; 71.67%, female, 73.04% African American, and 44.03% with a high school diploma. The majority (55.63%) preferred the physician in scrubs, while only 8.2% preferred that the physicians wear jeans. No significant correlations were found by sex, race, education, or respondent age or number of hours of medical TV shows watched per week. Conclusions: There has been a change in preferred physician attire since the 1980s. Scrubs are more acceptable to patients. Jeans remain unacceptable to our Midwest population. There was no correlation with number of hours per week watching medical TV shows and patients’ attituted toward emergency physician attire.
S82 Annals of Emergency Medicine
223
Differences Between Actual Arrival Time and Triage Time in an Urban, Academic Emergency Department
Houston C, Fischer C, Volz K, Sanchez L, Wolfe R/Beth Israel Deaconess Medical Center, Boston, MA
Background: The Centers for Medicare and Medicaid Services requires reporting of metrics based on time of arrival to the emergency department (ED), including time to evaluation, discharge or admission, and therapeutic interventions. Most facilities use the time of initial triage as the time of arrival. Little is known about how long patients wait prior to triage. As reimbursement to the hospital may be tied to these metrics, it is essential to accurately record the time of arrival. Study Objectives: To quantify the time spent waiting to be triaged for patients arriving to the ED. Methods: Pilot study conducted in an urban academic ED with 57,000+ annual visits. A convenience sample was taken from 10/10/12 to 11/4/12, between 10:00AM11:00PM. An observer greeted patients as they entered the ED and recorded the time of arrival. The triage time was recorded as normal. The difference between the arrival time and triage time was calculated. Results: There were 2967 visits that occurred when an observer was present. Arrival times were recorded for 903 (30%) patients. If the patient went directly from door to triage or was missed by the observer, a separate arrival time was not recorded, thus not able to be included in the analysis. For greeted patients, median time from arrival to triage was 7 minutes (IQR 4-13, range 0-55). 299 (33%) of patients who were greeted waited more than 10 minutes before triage. When stratified by the number of new patients who arrived in the ED in the previous hour, the percentage of greeted patients who waited more than 10 minutes before triage was: 0-5 new patients 4.0%; 5-10 new patients 24.8%; 10-15 new patients - 36.6%; 15þ new patients 48.5%. Conclusions: From this sampling of ED visits, patients often waited more than 10 minutes from the time of arrival to the ED until they were triaged. As the number of patients registered in the previous hour increased, the percentage of patients who waited more than 10 minutes before triage increased significantly as expected based on queuing theory. During times of peak volume, nearly half of all patients arriving waited more than 10 minutes before triage. This wait is not accounted for in the normal reporting of ED throughput times and metrics, and may have an effect on quality of care and throughput metrics. We suspect that this phenomenon is not limited to our ED. Further investigation into the effects of these waiting times is warranted.
224
Utility of Blood Cultures for Discharged Patients in the Emergency Department
Roque PJ, Khor K-N, Kassel D, Stapczynski JS, LoVecchio F/Maricopa Medical Center, Phoenix, AZ; University of Arizona, Phoenix, AZ
Study Objective: This retrospective study assessed the follow-up for discharged emergency department (ED) patients for whom blood cultures were ordered while seen in the ED. Since blood cultures are often not resulted until several days after the patient is already discharged, the study examined the utility of blood cultures in discharged ED patients. Methods: This was a retrospective study conducted from October 2009 to July 2012 at Maricopa Medical Center in Phoenix, AZ. Only patients 17 years and older that were seen, had blood cultures drawn and were subsequently discharged from the emergency department were included in the study. Any patients admitted to the hospital from the emergency department were excluded from the study. A chart review of all patients discharged from the emergency department with a subsequent positive blood cultures was conducted. Information extracted from the chart included age, sex, race, discharge diagnosis, follow-up visits, antibiotics started (if any) and mortality. Results: From October 2009 to July 2012, 984 blood cultures were ordered on patients aged 17 years and older who were discharged from the emergency department. Of these cultures results, 173 were excluded because they were canceled, did not result, met exclusion criteria, or were duplicate results. A total of 811 blood cultures were included in the final analysis. The true positive blood culture rate was 1% (10/811). The false positive blood culture rate was 6% (49/811). The true negative blood culture rate was 92.7% (752/811). The false negative blood culture rate was 0% (0/811). Seven of the 10 true positive blood culture results were called after receipt of laboratory results and were recommended to return to the emergency department for further treatment. All 7 patients called back were prescribed antibiotics with only one of these patients requiring antibiotics while in the emergency department. The remaining three subjects with positive blood cultures were not contacted because one was treated while in the ED and further follow-up was unnecessary, one died, and the third one was transferred to another
Volume 62, no. 4s : October 2013
221
Patients’ Perceptions of Waiting Times and the Effect on Patient Satisfaction in the Emergency Department
Saxon K, London K, Bacharouch A, Smith K, Santen S, Perry M/University of Michigan, Ann Arbor, MI
Study Objectives: Emergency department (ED) wait times are considered an important facet of patient satisfaction. They can be a trigger for patient complaints and are now being advertised on billboards to attract patients. Prior studies have indicated that when asked what feature of the ED visit was most important, patients consistently rated wait time (Holden 1999), and that if the waiting time was less than expected, patients had increased satisfaction with their overall visit (Thompson 1996). The objective of this study was to determine if the patients’ perception of their wait time in the ED correlated with their actual length of stay (LOS), and if the LOS would affect patients’ ratings of overall satisfaction of the visit. Methods: This is a cross-sectional survey study in an academic ED with volume of 80,000 per year and was exempt by the IRB. Patients nearing the end of their stay completed an anonymous survey regarding their experience. Using a Likert scale, the survey asked them to rate the amount of time they waited to see a provider and how satisfied they were with the ED visit. When starting the survey, the patient’s total LOS in the ED was recorded from electronic trackboard, which included time in the waiting room as well as the treatment room. The patients’ LOS was compared to their satisfaction score, and the actual LOS and perception of wait times were evaluated using t-tests and chi-square analysis. Results: 613 surveys were completed. The average LOS was 6 hours and 22 minutes (SD 4h56min). Of the patients surveyed, 19.5% rated the time they waited for a provider as “too much”; their mean LOS was 6h51min (SD 5h07min). The remaining 80.5% of patients who felt the wait time was “about right” had a mean LOS of 6h14min (SD 4h54min). There is no statistically significant difference between these two groups’ LOS (p¼0.2). The majority of patients (92%) rated their overall visit highly. There was no difference in LOS for those patients who were not satisfied (mean LOS of 6h43min SD 5h29min) and those who were satisfied (mean LOS of 5h56min SD 4h54min, p¼0.3). Although the overall rating of the visit was not affected by the LOS, perceptions of the LOS did affect the rating. The patients who rated their LOS as “about right” gave higher satisfaction ratings, while those who rated the LOS as “too much” gave a lower satisfaction score (p<0.005). Conclusions: The patients’ actual LOS in the ED did not affect whether they rated their visit favorably, but those who perceived their LOS was “about right” gave better ratings of their visit. Although wait times increase when the resource capacity of providers and services is exceeded, longer wait times may not affect satisfaction scores because sicker patients usually require more time for evaluation. The initial time to seeing a provider is considered to have the strongest effect on patients’ perception of wait time and satisfaction. A more meaningful metric for quality may be evaluating time to admission or discharge (Weiner 2013) as a patient’s actual LOS does not correlate with their satisfaction.
222
Initial Patient Evaluation of Physicians, Based on Attire
Burgess A, Lee DH, Totten V/University Hopsitals Case Medical Center, Cleveland, OH; Case Western Reserve University, Cleveland, OH; University Hospitals Case Medical Center, Cleveland, OH
Study Objectives: The goal was to learn if patient’s initial assessment of physician’s attire is different now compared to the past, since the advent of TV shows which depict physicians wearing scrubs and other less formal attire. Methods: This was a convenience sample of persons in a large urban Midwestern teaching hospital. Respondents looked at 6 photos: one male and one female physician of similar age, both white, dressed in 3 levels of formality with a white coat: business casual, scrubs, and jeans. Faces were blurred. Patients were asked to assume characteristics of the physicians based solely on their attire. Results: Two hundred ninety-four respondents; 71.67%, female, 73.04% African American, and 44.03% with a high school diploma. The majority (55.63%) preferred the physician in scrubs, while only 8.2% preferred that the physicians wear jeans. No significant correlations were found by sex, race, education, or respondent age or number of hours of medical TV shows watched per week. Conclusions: There has been a change in preferred physician attire since the 1980s. Scrubs are more acceptable to patients. Jeans remain unacceptable to our Midwest population. There was no correlation with number of hours per week watching medical TV shows and patients’ attituted toward emergency physician attire.
S82 Annals of Emergency Medicine
223
Differences Between Actual Arrival Time and Triage Time in an Urban, Academic Emergency Department
Houston C, Fischer C, Volz K, Sanchez L, Wolfe R/Beth Israel Deaconess Medical Center, Boston, MA
Background: The Centers for Medicare and Medicaid Services requires reporting of metrics based on time of arrival to the emergency department (ED), including time to evaluation, discharge or admission, and therapeutic interventions. Most facilities use the time of initial triage as the time of arrival. Little is known about how long patients wait prior to triage. As reimbursement to the hospital may be tied to these metrics, it is essential to accurately record the time of arrival. Study Objectives: To quantify the time spent waiting to be triaged for patients arriving to the ED. Methods: Pilot study conducted in an urban academic ED with 57,000+ annual visits. A convenience sample was taken from 10/10/12 to 11/4/12, between 10:00AM11:00PM. An observer greeted patients as they entered the ED and recorded the time of arrival. The triage time was recorded as normal. The difference between the arrival time and triage time was calculated. Results: There were 2967 visits that occurred when an observer was present. Arrival times were recorded for 903 (30%) patients. If the patient went directly from door to triage or was missed by the observer, a separate arrival time was not recorded, thus not able to be included in the analysis. For greeted patients, median time from arrival to triage was 7 minutes (IQR 4-13, range 0-55). 299 (33%) of patients who were greeted waited more than 10 minutes before triage. When stratified by the number of new patients who arrived in the ED in the previous hour, the percentage of greeted patients who waited more than 10 minutes before triage was: 0-5 new patients 4.0%; 5-10 new patients 24.8%; 10-15 new patients - 36.6%; 15þ new patients 48.5%. Conclusions: From this sampling of ED visits, patients often waited more than 10 minutes from the time of arrival to the ED until they were triaged. As the number of patients registered in the previous hour increased, the percentage of patients who waited more than 10 minutes before triage increased significantly as expected based on queuing theory. During times of peak volume, nearly half of all patients arriving waited more than 10 minutes before triage. This wait is not accounted for in the normal reporting of ED throughput times and metrics, and may have an effect on quality of care and throughput metrics. We suspect that this phenomenon is not limited to our ED. Further investigation into the effects of these waiting times is warranted.
224
Utility of Blood Cultures for Discharged Patients in the Emergency Department
Roque PJ, Khor K-N, Kassel D, Stapczynski JS, LoVecchio F/Maricopa Medical Center, Phoenix, AZ; University of Arizona, Phoenix, AZ
Study Objective: This retrospective study assessed the follow-up for discharged emergency department (ED) patients for whom blood cultures were ordered while seen in the ED. Since blood cultures are often not resulted until several days after the patient is already discharged, the study examined the utility of blood cultures in discharged ED patients. Methods: This was a retrospective study conducted from October 2009 to July 2012 at Maricopa Medical Center in Phoenix, AZ. Only patients 17 years and older that were seen, had blood cultures drawn and were subsequently discharged from the emergency department were included in the study. Any patients admitted to the hospital from the emergency department were excluded from the study. A chart review of all patients discharged from the emergency department with a subsequent positive blood cultures was conducted. Information extracted from the chart included age, sex, race, discharge diagnosis, follow-up visits, antibiotics started (if any) and mortality. Results: From October 2009 to July 2012, 984 blood cultures were ordered on patients aged 17 years and older who were discharged from the emergency department. Of these cultures results, 173 were excluded because they were canceled, did not result, met exclusion criteria, or were duplicate results. A total of 811 blood cultures were included in the final analysis. The true positive blood culture rate was 1% (10/811). The false positive blood culture rate was 6% (49/811). The true negative blood culture rate was 92.7% (752/811). The false negative blood culture rate was 0% (0/811). Seven of the 10 true positive blood culture results were called after receipt of laboratory results and were recommended to return to the emergency department for further treatment. All 7 patients called back were prescribed antibiotics with only one of these patients requiring antibiotics while in the emergency department. The remaining three subjects with positive blood cultures were not contacted because one was treated while in the ED and further follow-up was unnecessary, one died, and the third one was transferred to another
Volume 62, no. 4s : October 2013