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Anxiety of patients in the waiting room of the emergency department
Abstract and Figures
This study aims at understanding the patient's experience in the waiting room of the emergency department. The research explores and unveils the context and interactions in the waiting room and the factors that cause anxiety. As a result, a service that helps patients moderate anxiety has been developed. For the research, 12 patients and their family members were observed, and an interview with the head of the department was conducted. These methods were used to answer the following research questions: How do people experience the waiting room in the emergency department? How can the negative aspects be relieved? The main findings of this study reveal distrust between the patients and staff of the hospital, the patients' consistent focus on their status, and an uncertainty about the waiting time. The focus of this study is on alleviating these negative aspects by enabling patients to acquire sufficient information about the procedure and the waiting time.
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... Given the major role of emotions in alleviating (or hindering) health issues, research that explores the possibilities to design to influence emotions continues to emerge in the domain of healthcare and HCI. For example, researchers have investigated the effects of various interior settings on patients' and caregivers' emotions in home and hospitals [e.g., 22]. Various interactive artifacts were developed and tested concerning their contribution to facilitating certain emotional states and improving users' health [e.g., 13,19]. ...
... As one of the strategies for down-regulating negative emotions, problem-focused coping can be used in the stage of situation modification (see Figure 1). A design example of problem-focused coping is the information service for patients waiting in the emergency department [22]. The service intends to create an informative environment through the visualization of silhouettes of animated characters that correspond to each of the patient profiles and the order of waiting list in realtime on the basis of the result of patients' triage tests. ...
... Patients' uncertainty and confusion about the treatment process and wait times in the ED waiting area have been identified to be related to patient anxiety (Yoon & Sonneveld, 2010). Wait times have been the most significant patient concern in ED visits (Dansky & Miles, 1997;Gordon et al., 2010;Holden & Smart, 1999;Nairn et al., 2004), with substantial studies addressing a negative association between increased wait times and patient satisfaction in their hospital visits (Anderson et al., 2007;Derlet & Richards, 2000;Huang, 1994). ...
Visitors to emergency department waiting areas often experience high anxiety, which results in discomfort during their waits. Our findings offer empirical evidence for the positive impact of including natural elements in these waiting areas. We created four high-fidelity virtual environments that incorporated natural elements in three ways, i.e., the presence of plants, the use of nature images and natural materials, and a combination of those two, in addition to a controlled environment without natural elements. We tested how subjects responded to each environmental setting. Our findings demonstrated that the inclusion of natural elements significantly lowered patients' anxiety in hospital environments, confirming previous research, and the presence of natural elements improved perceived wait time, as well as service quality through anxiety and perceived wait time. The combination yielded higher scores in anxiety, perceived wait time, and service quality than the other conditions. Serial mediation analysis results revealed that underlying anxiety and patients' perceived wait time mediated the effect of natural elements on perceived service quality. Among the five dimensions of service quality, the mediating effects of anxiety and perceived wait time appeared stronger in reliability and responsiveness.
... Therefore, the level of patient satisfaction is correlated with the duration of time spent waiting [43]. Furthermore, the literature shows that waiting time at emergency departments (ED) increases anxiety in patients since they tend to think about negative scenarios while waiting [44]. It should be noted that patients admitted to the ED are likely to feel unwell and fatigued, due to the long time spent waiting to be seen, and they leave the ED, which adds to the stress and anxiety of the patient. ...
Patient experience is a widely used indicator for assessing the quality-of-care process during a patient’s journey in hospital. However, the literature rarely discusses three components: patient stress, anxiety, and frustration. Furthermore, little is known about what drives each component during hospital visits. In order to explore this, we utilized data from a patient experience survey, including patient- and provider-related determinants, that was administered at a local hospital in Abu Dhabi, UAE. A machine-learning-based random forest (RF) algorithm, along with its embedded importance analysis function feature, was used to explore and rank the drivers of patient stress, anxiety, and frustration throughout two stages of the patient journey: registration and consultation. The attribute ‘age’ was identified as the primary patient-related determinant driving patient stress, anxiety, and frustration throughout the registration and consultation stages. In the registration stage, ‘total time taken for registration’ was the key driver of patient stress, whereas ‘courtesy demonstrated by the registration staff in meeting your needs’ was the key driver of anxiety and frustration. In the consultation step, ‘waiting time to see the doctor/physician’ was the key driver of both patient stress and frustration, whereas ‘the doctor/physician was able to explain your symptoms using language that was easy to understand’ was the main driver of anxiety. The RF algorithm provided valuable insights, showing the relative importance of factors affecting patient stress, anxiety, and frustration throughout the registration and consultation stages. Healthcare managers can utilize and allocate resources to improve the overall patient experience during hospital visits based on the importance of patient- and provider-related determinants.
... Most importantly, the patient-app based history taking reduced the patient waiting time for the triage nurse from 34.06 minutes to 15.54 minutes i.e. a reduction in waiting time for triage of 54%. Reduced waiting time is not only inconvenient for patients, but particularly in an urgent care setting it also results in patients anxiety and this is more pronounced for older patients [28,29]. Unacceptable waiting times, also cause staff stress, and this is particularly the case in waiting for the triage nurse [29]. ...
Objectives: This study explores the effect of patient clinical history taking, using a digital symptom assessment app, on patient flow.
Design, methods and participants: We used a discrete event approach to simulate patient flow in an urgent care center.
Setting: The base case: a small center with 2 triage nurses, 2 doctors, 1 treatment/examination nurse and 1 discharge administrator in service.
Intervention/comparator: Four scenarios with different numbers of staff and with or without digital symptom assessment.
Outcome: Average overall patient waiting time and average queue length is measured to explore the optimality of patient flow.
Results: Compared to the base case, a decrease of 4.63 patients in the triage nurse queue length was observed when using a symptom assessment app. This was accompanied with increasing the doctors queue of 1.85 patients. Average overall patient waiting time was 6.61 minutes less than in the base case and the patients waiting time for triage was reduced from 34.06 to 15.54 minutes, a reduction of 54%.
Conclusions: Compared to the base case of the UCC, the use of app based intelligent digital symptom taking has the potential to decrease the average patient waiting to a similar degree to the addition of a triage nurse, and also, fewer people wait for examination by the doctors and the patient average overall patient waiting time is reduced. Most importantly, there is the potential to have a 54% reduction in waiting time to see the triage nurse and reducing this time is known to reduce patient anxiety, staff anxiety and to improve patient care. These simulation results have been used for clinical trial hypotheses forming and have the potential, through this, to impact service provision and approaches to digitalisation.
... Drajat Prawiranegara menggambarkan sebanyak 42,6% anggota keluarga mengalami kecemasan sedang. Keluarga pasien yang sedang menunggu di IGD merasa cemas, berharap ada perubahan terhadap keluarga yang sakit, dan merasa tidak berdaya (Yoon & Sonneveld, 2010) Penyebab stress dan kecemasan keluarga adalah adanya beberapa kebutuhan keluarga yang belum maksimal terpenuhi (Dicle & Firat, 2016) Menurut Redley, tahun 2003 kebutuhan keluarga tersebut adalah kebutuhan kedekatan dengan pasien, komunikasi, dukungan, kenyamanan dan dimengerti. ...
The patient's condition and the environment of the Emergency Installation (ER) that are unique can affect the psychological condition of the patient's family. This causes the emergence of psychological problems in the patient's family, such as anxiety, stress, and depression, these problems can affect the role of the family as a supporting system of patients in the process of handling actions while in the ER. These problems can be minimized by fulfilling family needs while in the ER to accompany the patient. The purpose of this study is to find out the description of the patient's family needs in the emergency room. This research is a descriptive quantitative study with a survey approach, with the research instrument in the form of a CCFNI-ED questionnaire. Respondents numbered 96 patient families obtained through convenience sampling techniques. The results of this study indicate that family needs which according to the family are important to fulfill are communication needs followed by understandable needs, support needs, comfort needs and needs close to the patient. Communication needs are considered the most important needs needed by the patient's family while in the emergency room. This research is expected to be a source of reference for the nursing profession in meeting family needs while in the emergency room, so it is expected to increase the family's role in healing patients.
Introduction:
Staff in emergency departments work in an environment where they are continuously exposed to situations with aggressive patients and their caretakers. With increasing incidents of reported violence, the present study was conducted to identify factors associated with stress levels among patients' attendants.
Methods:
A prospective, cross-sectional, observational study was conducted among 256 attendants of patients presenting to Emergency Department (ED). Signs of stress and imminent violence were recorded using STAMP method at initial encounter. Stress levels were assessed using Perceived Stress Scale 10 and Visual Analog Scale at the end of 2 h during patient's stay in emergency department. Factors associated with stress were studied using linear regression analysis. There was a follow-up to estimate the level of stress, to identify risk factors and types of violence in the sample population.
Results:
98.9% of attendants exhibited some form of stress. Age of <40 years, female gender, single marital status, lower educational background, lack of previous experience with ED, perceived long waiting time, and first-degree relatives were the significant risk factors associated with high stress. Verbal aggression was the most common and frequent form of aggression. Noncritically ill patient attendants, no previous experience with EDs, graduates, middle age group, perceived long waiting time, and poor patient response to treatment were found to be risk factors for impending violence.
Conclusion:
Stress was exhibited in majority of caregivers. Further programs are needed to strengthen training for ED staff to identify early and impending violence and to develop coping mechanisms for well-being of both attendants and health-care professionals.
Background:
Many factors influence patient satisfaction during an emergency department (ED) visit, but the perception of wait time plays a central role. A long wait time in the waiting room increases the risk of hospital-acquired infection, as well as the risk of a patient leaving before being seen by a physician, particularly those with a lower level of urgency who may have to wait for a longer time.
Objective:
We aimed to improve the perception of wait time through the implementation of a semiautomatic SMS text message system that allows patients to wait outside the hospital and facilitates the recall of patients closer to the scheduled time of meeting with the physician.
Methods:
We performed a cross-sectional survey to evaluate the system using a tailored questionnaire to assess the patient perspective and the Unified Theory of Acceptance and Use of Technology questionnaire for the caregiver perspective. We also monitored the frequency of system use with logs.
Results:
A total of 110 usable responses were collected (100 patients and 10 caregivers). Findings revealed that 97 of 100 (97%) patients were satisfied, with most patients waiting outside the ED but inside the hospital. The caregiver evaluation showed that it was very easy to use, but the adoption of the system was more problematic because of the perceived additional workload associated with its use.
Conclusions:
Although not suitable for all patients, our system allows those who have a low-severity condition to wait outside the waiting room and to be recalled according to the dedicated time defined in the Swiss Emergency Triage Scale. It not only has the potential to reduce the risk of hospital-acquired infection but also can enhance the patient experience; additionally, it was perceived as a real improvement. Further automation of the system needs to be explored to reduce caregiver workload and increase its use.
Background
Crowding can negatively affect patient and staff experience, and consequently the performance of health care facilities. Crowding can potentially be eased through streamlining and the reduction of duplication in patient history-taking through the use of a digital symptom-taking app.
Objective
We simulated the introduction of a digital symptom-taking app on patient flow. We hypothesized that waiting times and crowding in an urgent care center (UCC) could be reduced, and that this would be more efficient than simply adding more staff.
Methods
A discrete-event approach was used to simulate patient flow in a UCC during a 4-hour time frame. The baseline scenario was a small UCC with 2 triage nurses, 2 doctors, 1 treatment/examination nurse, and 1 discharge administrator in service. We simulated 33 scenarios with different staff numbers or different potential time savings through the app. We explored average queue length, waiting time, idle time, and staff utilization for each scenario.
Results
Discrete-event simulation showed that even a few minutes saved through patient app-based self-history recording during triage could result in significantly increased efficiency. A modest estimated time saving per patient of 2.5 minutes decreased the average patient wait time for triage by 26.17%, whereas a time saving of 5 minutes led to a 54.88% reduction in patient wait times. Alternatively, adding an additional triage nurse was less efficient, as the additional staff were only required at the busiest times.
Conclusions
Small time savings in the history-taking process have potential to result in substantial reductions in total patient waiting time for triage nurses, with likely effects of reduced patient anxiety, staff anxiety, and improved patient care. Patient self-history recording could be carried out at home or in the waiting room via a check-in kiosk or a portable tablet computer. This formative simulation study has potential to impact service provision and approaches to digitalization at scale.
Although an essential part of customer-centered design is the customers themselves, in some circumstances, talking with them is not always an option. What can designers do in such situations to better understand peoples' physical, cognitive, and emotional needs? In this paper, we discuss our attempts to elicit customers' needs and emotions without talking with them. We discuss how we: 1) used customer surrogates (in the form of direct-experience storyboarding, personas and narratives) to understand customers' frustrating and pleasurable experiences with a national, public library; 2) communicated the customer experience to stakeholders and helped them empathize with customers; and 3) relied on the personas and narratives to develop design recommendations.
Family members' perceptions of professional support expected of critical care nurses were examined for differences related to cultural affiliation using the "Professional Support Questionnaire for Critical Care Nurses Working with Family Members" (PSQ). The PSQ was administered face-to-face to family members waiting to visit a critically ill relative admitted to the intensive care unit. ANOVA and post hoc tests were computed to compare 90 family members' expectations for professional nursing support during a relative's critical illness across three cultural groups-African American, Hispanic, and White. There were significant differences in family members' responses on certain PSQ items across cultural groups. Despite these differences, family members' expectations of professional support from critical care nurses were generally universal-suggesting equitable care, dignity, and respect should be universal values. There is a need for critical care nurses to develop interventions that respect some cultural uniqueness as well as address the universal needs of family members coping with the ICU admission of a critically ill family member. (C) 1999 John Wiley & Sons, Inc.
This study investigated the impact of music on customers, persons waiting for surgery patients, in a hospital’s surgery waiting room; an inherently stressful environment. These persons are customers of the hospital in that they are using the hospital’s services, are typically involved in the decision to use the hospital for the patient’s surgery, and are often responsible for financial payments. In self-reports from persons using the waiting room, the use of music was related to decreased stress and increased relaxation in comparison to times when no music was utilized. This improved mood state was not, however, correlated with better evaluations by these individuals of the quality of the hospital’s services or of improved perceptions that the hospital was meeting expectations concerning its overall service delivery. These findings contribute to the ongoing research concerning the role of atmospherics or ambience of a service system in customers’ quality/satisfaction evaluations.
We spend upwards of 90% of our lives within buildings, yet we know much more about the effects of ambient environmental conditions on human health than we do about how buildings affect our health. This article employs the heuristic of psychological stress to generate a taxonomy of architectural dimensions that may affect human health. Specific interior design elements illustrating each of these architectural dimensions are provided. There is little existing evidence that specific design features directly impact human health. The aim of this article is to provoke further thinking and research on this possibility.@ 1998 Academic Press
This descriptive study explored the initial experience of critical injury from a spouse's perspective. A case study was used to examine the Lazarus stress and coping paradigm. The subject was 43-year-old Caucasian woman, with three young children. Semistructured interviews were conducted 1 month following critical injury. Analysis of data confirmed the cognitive, behavioral, and emotional coping processes as suggested by Lazarus. From the spouse's description, three distinct phases of the critical care experience also emerged: notification, arrival at the hospital, and waiting periods. Cognitive, behavioral, and emotional coping processes were clustered according to the spouse's distinct phases of this experience. A 3 x 3 matrix provides a description of the coping processes during the initial critical care period and offers direction for nursing interventions.
Few studies have comprehensively focused on caring as perceived by the critical care family. This study explores and describes positive types of nurses' behaviors and critical care families' perceptions of these nursing behaviors as caring. Grounded theory methodology was used to enter the world of the critical care family and to elicit the meanings of caring behaviors in nurse-family interactions in the critical care waiting room.