Schull, M. J., Kiss, A.Szalai, J. P.
 The effect of low-complexity patients on emergency department waiting times.
Ann Emerg Med. 2007 Mar;49:257-264.
It is well known that patients frequently present to the ED with minor illnesses and injuries. As managers work to reduce throughput times, the impact of this population has come under scrutiny. This study looked at the impact of low acuity patients on waiting times at Ontario hospitals during a one year period. There were 4.1 million patient visits at 110 EDs during the study period. Low, medium and high complexity patients represented 50.9%, 37.1% and 12% of all patients, respectively. In adjusted analyses, every 10 low complexity patients arriving per 8 hours was associated with a 5.4 minute increase in mean length of stay and a 2.1 minute increase in mean time to physician contact for medium and high complexity patients. The authors conclude that low complexity patients are associated with a negligible increase in ED length of stay and time to first physician contact. Diverting this population of patients away from the ED are unlikely to improve these parameters.
Spahr CD, Flugstad NA, Brousseau DC.
The impact of a brief expectation survey on parental satisfaction in the pediatric emergency department.
Acad Emerg Med. 2006 Dec;13:1280-1287
It is widely known that unmet expectations are associated with lower satisfaction in the emergency department. These authors asked parents to complete an "expectation survey," on arrival, which was then either placed back in the enrollment envelope (control), or given to the physician who would be caring for the child (intervention). 614 of the 930 enrolled parents completed the survey. Only 42% of the intervention group surveys had documented physician review. In their analysis, there was a significant improvement in parental satisfaction for the physicians who had reviewed the surveys. This was a difficult study to carry out, but the results suggest that physician knowledge of specific parental expectations may enhance satisfaction.
Chan TC, Killeen JP, Kelly D et al.
Impact of rapid entry and accelerated care at triage on reducing emergency
department patient wait times, lengths of stay, and rate of left without being seen.
Ann Emerg Med. 2005 Dec;46:491-497.
This study examines the impact of interventions to expedite ED care on length of stay and waiting times. Changes in
operation in this ED with 37,000 annual visits included informatics revisions, bringing patients into the ED immediately
if beds were available and physician-directed ancillary testing and care at triage when no beds were available. The
result was a 42% decrease in the frequency of left before being seen patients, an 83% increase in the proportion of
patients with wait times of 5 minutes or less, and a 35% decline in total wait times. This is yet another study which
demonstrates the benefits of establishing rapid ED entry processes to improve parameters which are specifically linked
to patient satisfaction.
Brown AD, Sandoval GA, Levinton C et al.
Developing an efficient model to select emergency department patient
satisfaction improvement strategies.
Ann Emerg Med. 2005 Jul;46:3-10.
While patient satisfaction is widely recognized as an important goal in emergency departments, the specific tactics to
achieve improved satisfaction can be difficult to delineate. This study of 20,500 patients from 123 emergency departments
used logistic regression models to explore satisfaction attributes. In developing an optimization model to select the most
efficient combination of measures, 4 predictors stood out: 1) perceived waiting time to receive treatment, 2) courtesy of
the nursing staff, 3) courtesy of the physicians, and 4) thoroughness of the physicians. It is suggested that these predictors
must be improved by 15% to increase overall satisfaction measures by 5%.
Gorelick MH, Yen K, Yun HJ.
The effect of in-room registration on emergency department length of stay.
Ann Emerg Med. 2005 Feb;45(2):128-33.
Discusses the positive impact of establishing in-room registration in a 45,000 visit pediatric emergency department. While many factors clearly influence throughput times, this study suggests that getting patients into rooms immediately following triage significantly decreases total ED time and increases patient satisfaction.
Boudreaux ED, Friedman J, Chansky ME, Baumann BM.
Emergency department patient satisfaction: examining the role of acuity.
Acad Emerg Med 2004;11:162-168.
Suggests that perceived throughput times are more important than actual times in improving patient satisfaction. Approximately 1/3 of the 1,865 patients in this prospective study were less than 18 years old.
Magaret ND, Clark TA, Warden CR, Magnusson AR, Hedges JR.
Patient satisfaction in the emergency department--a survey of pediatric patients and their parents.
Acad Emerg Med. 2002 Dec;9(12):1379-88.
Shows that both parental and child satisfaction with emergency department visits are associated with the quality of the provider-patient interaction and the adequacy of information provided
Mayer TA, Cates RJ, Mastorovich MJ, Royalty DL.
Emergency department patient satisfaction: customer service training improves patient satisfaction and ratings of physician and nurse skill.
J Healthc Manag. 1998 Sep-Oct;43(5):427-40; discussion 441-2.
Suggests that a focused customer improvement initiative results in improved perceived care, reduced complaints, and increased compliments.
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