Research Forum Abstracts
221 Patients’ Perceptions of Waiting Times and the Effect
on Patient Satisfaction in the Emergency Department
Saxon K, London K, Bacharouch A, Smith K, Santen S, Perry M/University of Michigan,
Ann Arbor, MI
Study Objectives: Emergency department (ED) wait times are considered an
important facet of patient satisfaction. They can be a trigger for patient complaints and
are now being advertised on billboards to attract patients. Prior studies have indicated
that when asked what feature of the ED visit was most important, patients consistently
rated wait time (Holden 1999), and that if the waiting time was less than expected,
patients had increased satisfaction with their overall visit (Thompson 1996). The
objective of this study was to determine if the patients’ perception of their wait time in
the ED correlated with their actual length of stay (LOS), and if the LOS would affect
patients’ ratings of overall satisfaction of the visit.
Methods: This is a cross-sectional survey study in an academic ED with volume of
80,000 per year and was exempt by the IRB. Patients nearing the end of their stay
completed an anonymous survey regarding their experience. Using a Likert scale, the
survey asked them to rate the amount of time they waited to see a provider and how
satisfied they were with the ED visit. When starting the survey, the patient’s total LOS
in the ED was recorded from electronic trackboard, which included time in the waiting
room as well as the treatment room. The patients’ LOS was compared to their
satisfaction score, and the actual LOS and perception of wait times were evaluated
using t-tests and chi-square analysis.
Results: 613 surveys were completed. The average LOS was 6 hours and 22
minutes (SD 4h56min). Of the patients surveyed, 19.5% rated the time they waited
for a provider as “too much”; their mean LOS was 6h51min (SD 5h07min). The
remaining 80.5% of patients who felt the wait time was “about right” had a mean LOS
of 6h14min (SD 4h54min). There is no statistically significant difference between
these two groups’ LOS (p¼0.2).
The majority of patients (92%) rated their overall visit highly. There was no
difference in LOS for those patients who were not satisfied (mean LOS of 6h43min SD
5h29min) and those who were satisfied (mean LOS of 5h56min SD 4h54min, p¼0.3).
Although the overall rating of the visit was not affected by the LOS, perceptions of the
LOS did affect the rating. The patients who rated their LOS as “about right” gave
higher satisfaction ratings, while those who rated the LOS as “too much” gave a lower
satisfaction score (p<0.005).
Conclusions: The patients’ actual LOS in the ED did not affect whether they rated
their visit favorably, but those who perceived their LOS was “about right” gave better
ratings of their visit. Although wait times increase when the resource capacity of
providers and services is exceeded, longer wait times may not affect satisfaction scores
because sicker patients usually require more time for evaluation. The initial time to
seeing a provider is considered to have the strongest effect on patients’ perception of
wait time and satisfaction. A more meaningful metric for quality may be evaluating
time to admission or discharge (Weiner 2013) as a patient’s actual LOS does not
correlate with their satisfaction.
222 Initial Patient Evaluation of Physicians, Based on Attire
Burgess A, Lee DH, Totten V/University Hopsitals Case Medical
Center, Cleveland, OH; Case Western Reserve University, Cleveland, OH; University
Hospitals Case Medical Center, Cleveland, OH
Study Objectives: The goal was to learn if patient’s initial assessment of physician’s
attire is different now compared to the past, since the advent of TV shows which depict
physicians wearing scrubs and other less formal attire.
Methods: This was a convenience sample of persons in a large urban Midwestern
teaching hospital. Respondents looked at 6 photos: one male and one female physician
of similar age, both white, dressed in 3 levels of formality with a white coat: business
casual, scrubs, and jeans. Faces were blurred. Patients were asked to assume
characteristics of the physicians based solely on their attire.
Results: Two hundred ninety-four respondents; 71.67%, female, 73.04% African
American, and 44.03% with a high school diploma. The majority (55.63%) preferred
the physician in scrubs, while only 8.2% preferred that the physicians wear jeans. No
significant correlations were found by sex, race, education, or respondent age or
number of hours of medical TV shows watched per week.
Conclusions: There has been a change in preferred physician attire since the 1980s.
Scrubs are more acceptable to patients. Jeans remain unacceptable to our Midwest
population. There was no correlation with number of hours per week watching medical
TV shows and patients’ attituted toward emergency physician attire.
S82 Annals of Emergency Medicine
223 Differences Between Actual Arrival Time and Triage
Time in an Urban, Academic Emergency Department
Houston C, Fischer C, Volz K, Sanchez L, Wolfe R/Beth Israel Deaconess Medical
Center, Boston, MA
Background: The Centers for Medicare and Medicaid Services requires reporting
of metrics based on time of arrival to the emergency department (ED), including time
to evaluation, discharge or admission, and therapeutic interventions. Most facilities use
the time of initial triage as the time of arrival. Little is known about how long patients
wait prior to triage. As reimbursement to the hospital may be tied to these metrics, it is
essential to accurately record the time of arrival.
Study Objectives: To quantify the time spent waiting to be triaged for patients
arriving to the ED.
Methods: Pilot study conducted in an urban academic ED with 57,000+ annual
visits. A convenience sample was taken from 10/10/12 to 11/4/12, between 10:00AM-
11:00PM. An observer greeted patients as they entered the ED and recorded the time
of arrival. The triage time was recorded as normal. The difference between the arrival
time and triage time was calculated.
Results: There were 2967 visits that occurred when an observer was present. Arrival
times were recorded for 903 (30%) patients. If the patient went directly from door to
triage or was missed by the observer, a separate arrival time was not recorded, thus not
able to be included in the analysis. For greeted patients, median time from arrival to
triage was 7 minutes (IQR 4-13, range 0-55). 299 (33%) of patients who were greeted
waited more than 10 minutes before triage. When stratified by the number of new
patients who arrived in the ED in the previous hour, the percentage of greeted patients
who waited more than 10 minutes before triage was: 0-5 new patients  4.0%; 5-10
new patients  24.8%; 10-15 new patients - 36.6%; 15þ new patients  48.5%.
Conclusions: From this sampling of ED visits, patients often waited more than 10
minutes from the time of arrival to the ED until they were triaged. As the number of
patients registered in the previous hour increased, the percentage of patients who
waited more than 10 minutes before triage increased significantly as expected based on
queuing theory. During times of peak volume, nearly half of all patients arriving waited
more than 10 minutes before triage. This wait is not accounted for in the normal
reporting of ED throughput times and metrics, and may have an effect on quality of
care and throughput metrics. We suspect that this phenomenon is not limited to our
ED. Further investigation into the effects of these waiting times is warranted.
224 Utility of Blood Cultures for Discharged Patients in the
Emergency Department
Roque PJ, Khor K-N, Kassel D, Stapczynski JS, LoVecchio F/Maricopa Medical Center,
Phoenix, AZ; University of Arizona, Phoenix, AZ
Study Objective: This retrospective study assessed the follow-up for discharged
emergency department (ED) patients for whom blood cultures were ordered while seen
in the ED. Since blood cultures are often not resulted until several days after the patient
is already discharged, the study examined the utility of blood cultures in discharged ED
patients.
Methods: This was a retrospective study conducted from October 2009 to July
2012 at Maricopa Medical Center in Phoenix, AZ. Only patients 17 years and older
that were seen, had blood cultures drawn and were subsequently discharged from the
emergency department were included in the study. Any patients admitted to the
hospital from the emergency department were excluded from the study. A chart review
of all patients discharged from the emergency department with a subsequent positive
blood cultures was conducted. Information extracted from the chart included age, sex,
race, discharge diagnosis, follow-up visits, antibiotics started (if any) and mortality.
Results: From October 2009 to July 2012, 984 blood cultures were ordered on
patients aged 17 years and older who were discharged from the emergency department.
Of these cultures results, 173 were excluded because they were canceled, did not result,
met exclusion criteria, or were duplicate results. A total of 811 blood cultures were
included in the final analysis. The true positive blood culture rate was 1% (10/811). The
false positive blood culture rate was 6% (49/811). The true negative blood culture rate
was 92.7% (752/811). The false negative blood culture rate was 0% (0/811). Seven of the
10 true positive blood culture results were called after receipt of laboratory results and
were recommended to return to the emergency department for further treatment. All 7
patients called back were prescribed antibiotics with only one of these patients requiring
antibiotics while in the emergency department. The remaining three subjects with
positive blood cultures were not contacted because one was treated while in the ED and
further follow-up was unnecessary, one died, and the third one was transferred to another
Volume 62, no. 4s : October 2013