Impact of waiting room times on patient satisfaction in an era of emergency department (ED) overcrowding

Background: In 2006, the Institute of Medicine reported the prominence of ED overcrowding in the United States. This may have an effect on patient satisfaction with ED services.

Objective: To assess the effect of ED waiting room delays on patient satisfaction and in comparison to the prior literature.

Methods: Slightly modified H-CAHPS and PSQ-18 patient satisfaction surveys were obtained from a random sample of ED patients who spoke English and were not too ill during a systematic sample of ED shifts over a five-month interval in an urban public hospital ED.

Results: Of the 436 eligible patients, 370 answered survey questions (85% response rate). The average total length of stay (LOS) for the sample prior to the patient satisfaction survey was 8 hours and 43 minutes (8:43) with a range of 0:36-36:57. The average duration of time spent in the waiting room was 4:00 and the average time perceived spent in the waiting room was similar at 3:56 (r = 0.80). On a 0-10 scale, 64% of respondents rated their overall satisfaction highly at 8-10, and 32% gave a 10 on H-CAHPS. Sixty-seven percent would “definitely recommend” this ED to family and friends. On the PSQ-18, 62% rated care above average on the general satisfaction subscale. There was no correlation between LOS or waiting room times and general measures of satisfaction (r < 0.3).

Conclusions: Although several previous studies discuss service delivery times in the ED as they correlate to patient satisfaction, most utilized non-validated questionnaires and evaluated results at academic or community hospitals. They report diminished satisfaction associated with perception of increased waiting room time. We sought to look at patient satisfaction in a public hospital setting, where crowding and waiting might be highest, and found that patients were fairly satisfied, in spite of the delays. Their satisfaction did not correlate to LOS, actual, or perceived waiting room times. Reasons for this might include varying expectations for care compared to those found in the private sector, a prioritization for receiving care at all over the timing of that care, cross-cultural considerations, or availability of ancillary or specialty services.