By Manas Mishra

(Reuters Health) – A pilot study aimed at gauging the real-time mood in busy emergency rooms suggests doctors and nurses often feel strained as the number of waiting patients rises.

The study’s aim was to test the feasibility of using terminals with touch-button emoji faces as a quick way of measuring sentiments of patients and staff – in contrast to standard surveys sent after a visit that typically garner few responses.

During five-months in an urban emergency department, 9,472 responses were recorded from two counters facing workstations of nurses and doctors, and 4,377 responses from a terminal placed at the patient exit. The results show such a method could be effective in measuring “on-shift” sentiment in real time, the research team writes in Annals of Emergency Medicine.

But the data also showed that a majority, 59%, of responses registered at terminals near nurses’ and doctors’ workstations were negative, and correlated with times when a large number of patients were waiting to see a doctor or were “boarding” in the emergency department.

“The negative reactions associated with waiting patients really reflects the reality of pressure that clinicians feel every day, especially in the emergency room,” said Cynda Rushton at the Johns Hopkins School of Nursing’s Berman Institute of Bioethics and the School of Nursing in Baltimore, who was not involved in the study.

“Most people go into healthcare, irrespective of the discipline, because they want to help people. When they feel like they are not able to do that, and you’re not able to meet patient needs, that creates a lot of stress,” Rushton, whose current research focuses on moral distress in clinicians, told Reuters Health by phone.

The staff was made aware of the feedback counters by email, and subsequently terminals with four emoji faces – green and light green to convey positive emotions, and pink and red to convey negative ones, were placed in the department.

The researchers, led by Anish Agarwal at the University of Pennsylvania Department of Emergency Medicine in Philadelphia, found that 52.6% of the responses came from the nurses’ bay, which also averaged the most negative responses per day.

The patients’ terminal had more positive than negative feedback overall, recording an average of 23.6 positive responses per day versus 17.7 negative ones. Longer wait times, more patients waiting to be seen and more leaving without being seen were associated with higher negative feedback.

The study has several limitations, the researchers noted. The terminals may not have been used by their intended audience, and it is possible only a small number of users may have been using the terminals repeatedly, but the machines had a fail-safe to prevent multiple responses within 5 seconds.

“This first study was all about feasibility. Would people use the terminals or not, when would they use them, and what would we start to see,” Agarwal said by email.

“I think now the hard work begins in diving deeper into moments of struggle (and happiness) to understand why sentiment shifts,” he added. “Having a way to capture the data is incredibly important, because we did not have it before. Now with the data we can pilot-test different tactics of addressing what it is that is making people happy or what is not.”

Past research has shown stress among healthcare professionals is higher than in the general population. Work-related burnout has also been associated with self-injury, stress on relationships and wellbeing, the study team writes.

“I think our healthcare system is fundamentally broken. The way that we have been practicing isn’t working – it’s not working for patients and it’s not working for clinicians,” Rushton said.

The surveys underline that “system pressures that the clinicians are being expected to manage on a day to day, moment-to-moment basis, are exceeding their ability to provide good care,” she added.

“It’s really an important conversation.”

SOURCE: Annals of Emergency Medicine, online September 4, 2019.