Administration of Emergency Medicine
Support for a Waiting Room Time Tracker: A Survey of Patients Waiting in an Urban ED

Presented at the Annual Meeting of the Society for Academic Emergency Medicine, Boston, MA, June 2011.
https://doi.org/10.1016/j.jemermed.2012.02.053Get rights and content

Abstract

Background

Emergency Department (ED) crowding and inpatient boarding lead to lengthy wait times for patients, which may cause them to choose to leave without being seen. A new initiative to improve communication with patients is to provide an estimated wait time with a “time tracker” display, but it is unclear whether ED patients would welcome this.

Objective

To estimate the proportion of ED patients who would favor a time tracker display.

Methods

This survey-based study was conducted from March to July 2010 at an urban academic center. After being triaged, patients were asked to answer a multiple-choice questionnaire, asking their preference toward a time tracker display.

Results

Of the 375 patients who were approached, 340 (91%) participated. Two hundred fourteen of them (63%) preferred an ED with a time tracker, 53 (16%) were unsure, and 73 (21%) did not prefer an ED with a time tracker. Patients with low-acuity conditions (Emergency Severity Index [ESI] 4 or 5) were 1.2 times more likely (95% confidence interval 1.0–1.4) to favor a time tracker than those with higher acuity (ESI 3). Preference was not related to race, age, insurance status, or employment.

Conclusions

The majority of patients in our study preferred an ED with a time tracker display (63% for vs. 21% against). Support for a time tracker was higher among patients triaged with lower ESI levels (4 or 5). A time tracker is viewed positively by many patients and may be a beneficial addition in the ED waiting room.

Introduction

With the challenges of Emergency Department (ED) crowding, EDs across the country struggle to keep patients from leaving the waiting room without being seen by a health care provider. Patients might leave without being seen (LWBS) if they feel they have not been seen in a timely manner. Strategies to decrease door-to-provider time, such as physician triage, are now emerging. A new approach is to provide an estimated wait time with a “time tracker.” Time trackers range from a wait-time display in the waiting room (usually digital) to a banner on the hospital website.

Businesses often post wait times for clients waiting in line for service. Banks, hotels, government agencies, and theme parks employ this method so that customers are aware of the time they can expect to spend in line. Experts in business suggest that customers are more anxious when they are unaware of the wait time (1). The anxiety can come from many sources, but many customers become concerned that they have been forgotten and experience nervous anticipation (1). The more anxiety that develops, the more the wait can become intolerable. Being told the estimated wait time helps the customer relax and accept the delay in service (1).

It is not clear whether this strategy would be viewed positively among patients waiting for emergency care. Some may welcome knowledge of their expected wait time, whereas others may view a time tracker negatively and as suggestive that the hospital views his/her medical problem as minor. Patients' preferences regarding time trackers in the emergency care setting is an important consideration for hospitals considering posting estimated wait times for patients presenting to the ED.

The goal of our study was to estimate the proportion of patients waiting for emergency care who support having a time tracker in the waiting room. We also analyzed whether support for a time tracker is affected by factors such as illness acuity, age, or insurance status.

Section snippets

Settings and Participants

Between March and July 2010, in an urban, academic center that sees 46,000 patients annually, we approached adult patients registered for emergency medical care between 8:00 a.m. and 10:00 p.m. To minimize convenience sampling, we approached every other patient who registered for care during these shifts. We approached these patients after triage but before they were seen by a physician. We included patients between 18 and 89 years of age who had been triaged with an Emergency Severity Index

Results

Of the 375 patients who were eligible for participation, 340 (91%) consented to complete the questionnaire. Those who refused were similar to participants in age, gender, race, insurance status, phone status, acuity level, and time waiting before contact with the research team.

Characteristics of our study population are shown in Table 1. For 173 (51%) patients, this was their first visit to this ED, whereas 34 (10%) reported four or more previous visits.

Two hundred fourteen patients (63%; 95%

Discussion

Managing patient wait times in the ED is challenging. Although patients may wait at various intervals along the spectrum from ED arrival to discharge (or admission), wait time in the ED waiting room is an area of intense focus. In recent years, numerous operational improvement strategies, such as physician triage, have been implemented to minimize wait times. Despite these improvements, many EDs continue to have lengthy waiting room times. As a result of the uncertainty, some patients choose to

Conclusion

The results of this study demonstrate that patients prefer an ED with a time tracker display. To our knowledge, this is the first study to assess ED patient attitudes toward a display of estimated wait times. These findings support current literature that indicates that those waiting in line favor more information (improved communication) about wait times. The results seemingly refute the opinion that a time tracker display is viewed negatively by patients and may dissuade them from waiting,

Acknowledgments

The authors would like to acknowledge the work of Heather Riggle, Allison Lindell, Ian Rossfrye, Krystle Shafer, Karan Chopra, Howard Fishbein, Fraser Mackay, Erin Knepp, and Gelane Gemechisa in collecting data for this study. The manuscript was copyedited by Linda J. Kesselring, ms, els, the technical editor/writer in the Department of Emergency Medicine at the University of Maryland School of Medicine.

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This work was done at the University of Maryland School of Medicine, Baltimore, Maryland.

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