Improving the wait room experience of emergency room

Anki
Ankita Gupta Projects
5 min readFeb 11, 2018

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How might we make patients more aware of ED process and improve communication channel with hospital staff.

Description:

The hospital is one of the leading medical care facility in Michigan, however the surveys conducted by Press Ganey reflected that patients were not satisfied with the amount of wait and the experience associated with it. As a part of coursework project, our team of 4 had to come up with recommendations to communicate the wait and improve the patient experience in the Adult emergency department (ED).

Role: User Researcher

Duration: 10 weeks

Team: Gaurang Alat, Kelsey McCormick, Andrew Miller

Questions to understand the problem space?

  • Is it wait time time or waste time?
  • What are patient’s perceptions of their own wait time?
  • How is this perception affected, both in good and bad ways?
  • What is the expectation of care team on wait times?
  • How do other domains innovate(or rather avoid) wait times?

The following methods were used to answer our questions

Literature review

Why? I am not a healthcare expert and I wanted to understand this sector plus all the research that has already been done. Another aspect of this review was to check how airports and restaurants keep their customers happy during wait times.

Interviews

Why? To identify experiences patients and care team associate to wait rooms.

We conducted interviews with patients, emergency department staff and patient advisors. These interviews were helpful to understand patient’s experiences while also unbiasing ourselves by bringing hospital’s take on wait times.

Observations

Why? To understand the ED space and also use it as an empathy tool for ourselves

Affinity mapping

  • Current ED infrastructure negatively impacts waiting experience
  • ED inspires negative experience
  • Communication can be improved
  • Wait time is unpredictable
  • Patients don’t know what is happening in the ED

The following methods were used to validate these findings:

<discussion with coordinator and the care team>

We identified that patient education and communication amongst staff and patients affects all the other factors associated with wait time experience.

The following methods were used to strategize the ideal solution:

How might we….to achieve….

As a researcher we often ask questions to get some answers, and we used this approach to guide ourselves in framing our “how might we”s with a goal.

How might we make patients more aware of ED process to educate them about what to expect when in an ED?

  • Informational pamphlet/brochure
  • TV with informational slides
  • Informative design of wait time system
  • Trackboard displaying triage levels and their respective wait times

How might we improve the communication channel between care providers and patients/caregivers to build a trustful understanding

  • Regular updates from staff
  • SMS for regular personal update
  • Better hospitality to keep patient’s mind away from the wait time

Brainstorming

Limitations affecting the kind of solution:

  • Lack of beds
  • Small waiting area
  • Unpredictable nature of wait time
  • Scope limited to waiting room area

Final solution

  • Stage in visit (helps them understand right away what is happening and gives them an idea for what’s ahead)
  • Time stamps (gives them a realistic understanding of how long they’ve been waiting)
  • Triage level (provides information about their ailments)
  • Test results (lets them know they are being treated even while waiting)
  • Symptoms (allows patients to be aware of their own feelings and can provide detailed information eventually to physicians)
  • Educational information
  • The uncertain time predictor makes it clear to the patients that this is just a guess and not a certainty. It is better to provide a higher limit guess rather than an inaccurate shorter wait time.
  • Showed intermittently with ED process, triage information
  • The key to resolving the miscommunication, Jung determines, is not to provide a more accurate prediction, but to make it clear that the visualization is just a guess, not a certainty. “Makes the nature of the estimate more salient” and “imprecision in visualization can emphasize the uncertainty of information”

The following methods helped us turn our ideas into reality:

Domain analysis

How will it help:

Our main recommendations focus on patient education and patient communication. Patients value their satisfaction based on treatment as a person by the hospital staff. They consider their treatment as positive if they are treated with respect and dignity and have all their expectations met. Hence by setting the right expectations in the beginning, and achieving them will boost the patient satisfaction.

“Stage in visit” Form:

  • Educates patients about ED process hence reducing their anxiety
  • Regular update about their condition
  • Assurance to patients that care has already started in the back end
  • Don’t have to repeat the symptoms again to the physician

Wait time predictor:

  • Freedom to choose another medical option
  • Patient education that ED is dependent on triage level
  • Regular update on wait time
  • Visual medium better than verbal information for anxious patients

Research on ED info-brochures about wait times and ED processes have noted a positive impact on patient satisfaction (Ekwall et. al, 800–809)(Nelson et al., 39–41)(Meek et al., 212–217). For example Hong Kong, patients are usually told their allocated triage category, and there are notices in the waiting room explaining what these categories mean (Slade, 147–154). Patients prefer to be notified of delays and the reason than kept in the dark (Slade, 147–154).

Ekwall A, Gerdtz M, Manias E. The influence of patient acuity on satisfaction with emergency care: Perspectives of family, friends and carers. Journal of Clinical Nursing 2008; 17​: 800–809.

Meek R, Phiri W. Australasian Triage Scale: Consumer perspective. Emergency Medicine Australasia 2005; 17​: 212–217.

Slade, Diana, et al. Communicating in hospital emergency departments. Springer, 2015. Pp 1–154

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