Issue 1 : Patient Expectation and Wait Time

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Patient Expectation and Wait Time


Problem Definition

Lack of Communication

1)Expectation of visit

2)Knowledge of the process

3)Satisfaction with visit


Research

  • Need to do research on literacy and development of educational/informational materials


Metrics

  • Patient Satisfaction
  • Family Satisfaction
  • LWBS/AMA
  • Need something objective (vs. subjective), since different people have different patience levels


Resources

http://www.familycenteredcare.org/

Cooke T, Watt D, Wertzler W, Quan H.Patient expectations of emergency department care: phase II--a cross-sectional survey. CJEM. 2006 May;8(3):148-57.

Just tell us how long we'll wait, ED patients urge hospitals. Hospitals & Health Networks. Chicago: Jul 2008. Vol. 82, Iss. 7; pg. 127, 2 pgs

Eamonn O'Neill, Dawn Woodgate, Vassilis Kostakos: Easing the wait in the emergency room: building a theory of public information systems;Symposium on Designing Interactive Systems; 2004 http://doi.acm.org.www.library.gatech.edu:2048/10.1145/1013115.1013120

COMMENTS: Ackerman Wait time is one of a large number of patient expectation issues that we don't address well. LWOBS and AMA are pooled which is a problem - AMA means I could apprise you of the risks and you left after understanding those risks whereas LWOBS means I never saw you. Both are bad but for different reasons and often occur for differing reasons. I believe a useful metric is actual clinician time at bedside. I believe that as I have incorperated including expectation setting in my evaluation it has reduced how much time I and the nurses actually spend with the patients. On the front end it costs 60 seconds per patient with is made up for by 90 seconds on the back end for me and 4-5 minutes per nurse. Might be interesting to actually measure this. Other measures - call bell use, compliance with treatment plan/testing plan in the ED. Patient satisfaction is lovely but is too easily colored by other things. Perhaps asking the patient "what are you waiting for now?" "what wile happen next" percieved wait versus actual time. One of the wrinkles in this to be aware of - there had been some discussion that alerting patients to expected wait time could be construed as advising the patient to seek care elsewhere which is a violation of federal law (EMTALA) and could constitute an "illegal transfer"

Comments: Williams There are many ED's that provide educational materials in the lobby about the ED visit. If the patient actually reads the information, this may help them in their visit. Another area, you may want to look at is the ED patient representative or ED patient liaison programs and how they are impacting expectations, and communication. Patient expectation, patient wait time, and lack of communication could also be looked at in regards to cultural diversity. This is definitely a different twist.


Patient satisfaction planner. Communication is critical for patients to be happy. Despite longer wait times, satisfaction still improves. Hospital Peer Review [Hosp Peer Rev] 2007 Dec; Vol. 32 (12), pp. 169-70. http://www.library.gatech.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=18232293&site=ehost-live

Edwin D. Boudreaux PhD, Determinants of patient satisfaction in a large, municipal ED: The role of demographic variables, visit characteristics, and patient perceptions File:Determinants.pdf