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Examining Patient Desires for ED Function

Examining Patient Desires for ED Function
Author Information (click to view)

Jeffrey Druck, MD, and Paul Leccese

Druck,-Jeffrey
Jeffrey Druck, MD
Associate Professor of Emergency Medicine
Director, Integrated Clinician’s Course
University of Colorado School of Medicine
Associate Residency Director, Residency Program in Emergency Medicine
Denver Health Medical Center

Jeffrey Druck, MD, has indicated to Physician’s Weekly that he has or has had no financial interests to report. Paul Leccese has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Leccese,-Paul
Paul Leccese
MD Candidate, Class of 2016
University of Colorado School of Medicine

Paul Leccese has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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Jeffrey Druck, MD, and Paul Leccese (click to view)

Jeffrey Druck, MD, and Paul Leccese

Druck,-Jeffrey
Jeffrey Druck, MD
Associate Professor of Emergency Medicine
Director, Integrated Clinician’s Course
University of Colorado School of Medicine
Associate Residency Director, Residency Program in Emergency Medicine
Denver Health Medical Center

Jeffrey Druck, MD, has indicated to Physician’s Weekly that he has or has had no financial interests to report. Paul Leccese has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Leccese,-Paul
Paul Leccese
MD Candidate, Class of 2016
University of Colorado School of Medicine

Paul Leccese has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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A survey has found that many ED visitors would like handouts about how the emergency room functions. Increasing updates and educational materials in the waiting room could impact patient experiences in the waiting room and in the hospital overall.
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Average ED wait times in the United States vary considerably, but some locations have particularly long wait times. This time spent in the waiting room often frustrates patients and their families as other ED visitors receive care while those who are waiting are given few, if any, updates. Some research has explored educating patients while they wait to be seen by ED personnel, and this appears to be a potentially valuable tool. “Some studies suggest that providing education in the ED waiting room is of interest to patients,” says Jeffrey Druck, MD.

In a study published in the Western Journal of Emergency Medicine, Dr. Druck, Paul Leccese, and colleagues aimed to determine baseline knowledge of ED and hospital processes among ED patients. “One of our goals was to establish types of information that waiting room patients wanted, including expected wait times, causes of delays, and the triage process,” explains Leccese. “We also wanted to see how they would like this information to be delivered.” In addition, the study asked participants what they expected regarding wait times for labs, imaging studies, and admission. The authors also assessed links between racial groups and their desire for information as well as whether or not patients wanted educational health materials.

New Data

For the study, a 32-question survey was administered to patients and showed that 55% of the 544 respondents indicated that they had a primary care physician (PCP). Of these patients, about 53% reported calling a PCP before they came to the ED. About 72% of participants wanted to know about delays, but just 25% wanted to know others’ wait times. “While patients wanted regular updates,” Dr. Druck says, “it didn’t matter if they received these updates from physicians or other ED personnel.”

Nearly 69% of patients reported knowing why some patients were seen sooner than others despite arriving later. “We observed a significant difference in the percentage of respondents saying it was fair to see some patients before others between the group that did not claim to know why this happens and groups that claimed to know why this happens and provided a valid explanation as to why,” says Leccese (Table).

Results also showed that 41% of respondents wanted information on how the ED functions, 60% of whom wanted handouts and 43% wanted a video. Information on updates and common medical emergencies was significantly more important to respondents than materials on common illnesses, finding a PCP, or ED function. The median estimated time for medical workups ranged from 35 minutes for radiographs, to 60 minutes for lab results, CTs, specialist consults, and admissions.

Only about 69% of respondents claimed to know the definition of what constituted a teaching hospital, and approximately 87% of this group knew they were currently in a teaching hospital. “When asked to identify aspects that differentiate teaching hospitals from other hospitals, the responses varied considerably,” Dr. Druck says (Figure). In a subgroup analysis between racial groups, minority groups had significantly less knowledge of the definitions of triage and teaching hospitals, but wanted significantly more information on ED function. These differences did not appear to be related to language barriers and could represent variations in cultural beliefs regarding the value of ED visits or disparities in healthcare literacy.

Important Implications

“To reduce barriers between waiting room patients and ED providers, it’s important to understand what patients wish to know as they wait and how to best describe ED workflow to patients,” Leccese says. Many strategies have been used to reduce the time and improve the experience of waiting room patients, but the problem is multifactorial. Many patients leave the ED without being seen because their wait times are too long. “Our study provides a better understanding of factors that need to be addressed to improve experiences in the waiting room and ensure that patients don’t leave because of long wait times,” adds Dr. Druck.

The study suggests that there are possible high-impact targets for interventions in patient education and ED throughput that may improve patient satisfaction, according to Dr. Druck. “These interventions could include providing educational materials about hospital and ED function and severe health conditions,” he says. “We should also strive to provide regular updates when there are foreseeable delays.” This can increase transparency as patients gain an understanding of what is happening during their visit and how much time they can reasonably expect it to take. This may also have the potential to reduce the stress and frustration of waiting.

Readings & Resources (click to view)

Seibert T, Veazey K, Leccese P, Druck J. What do patients want? Survey of patient desires for education in an urban university hospital. West J Emerg Med. 2014;15:764-769. Available at: http://westjem.com/original-research/patients-want-survey-patient-desires-education-urban-university-hospital.html.

Horwitz LI, Green J, Bradley EH. US emergency department performance on wait time and length of visit. Ann Emerg Med. 2010;55:133-141.

Delgado MK, Ginde AA, Pallin DJ, et al. Multicenter study of preferences for health education in the emergency department population. Acad Emerg Med. 2010;6:652-658.

Ibanez G, Guerin L, Simon N. Which improvements could prevent the departure of the left-without-being-seen patients? Emerg Med J. 2011;28:945-947.

McCarthy ML, Zeger SL, Ding R, et al. Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Ann Emerg Med. 2009;54:492-503.

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