Managing patient expectations at emergency department triage

Emergency departments (ED) overcrowding, long wait, and uncomfortable waiting room conditions may lower perceived quality of the patient experience and satisfaction. This study investigates the relationship between patient satisfaction and communication of expected wait times, at the point of triage. A pre-post (11/4/ 2008 – 2/5/2009) group design with convenience sample (n=1,209) of all discharge adult ED patients was utilized for this study. A static expected wait time model (i.e., average wait time + one standard deviation) based on time of the day, day of the week and triage levels was employed to communicating expected wait time at triage while an in-house survey with five-point Likert-scale patient satisfaction questions (satisfied with wait time in triage, informed about delays, and overall rating of ED visit) was administrated at the discharge desk. The communication of delays intervention was significant for only overall rating of ED, while binary communication status was significantly associated with all three patient satisfaction questions. The patients who didn’t receive any communication about delays, were between 1.42 to 5.48 times more likely to rate the three satisfaction questions lower than very good. With communication about delays, the percentage of patients responding very good and very poor/poor were 14.6% higher and 5.9% lower, respectively, for the satisfied with wait time in triage question. Although communication of delays intervention was not significant, the patients who received wait times information were significantly more satisfied. This indicates that patients are more likely to accept longer wait times provided their expectations are managed via communication. Future studies should explore technological solutions for communication of delays and operational improvement initiatives along with alignment of incentives for ED staff to further improve the patient experience.