Improving Patient Satisfaction in the Emergency Department Waiting Room Through Enhanced Communication Strategies: A...

This quality improvement project aimed to improve the emergency department waiting room experience by standardizing communication to increase transparency and expectation management, targeting an increase in Net Promoter Score from 33.5 to ≥ 35.4 within 3 months. Emergency department waiting room dissatisfaction is largely driven by uncertainty, including unclear wait times, inconsistent updates, and a limited understanding of triage and emrgency department flow, highlighting the need for structured communication.

A 3-month, single-site quality improvement project in an urban emergency department used iterative plan-do-study-act cycles and included all emergency department encounters (n = 17,444). The bilingual intervention included orientation pamphlets (print- and quick response code-based), standardized triage verbalization of the longest wait, and a looping bilingual waiting-room display that was implemented during operational transitions. Outcomes were monthly Press Ganey Net Promoter Score and the "Nurse/Staff Responds to Concerns" driver score, which were analyzed using run charts and descriptive statistics. Fidelity audits and television presentation visibility were used to track performance. Balancing measures included prolonged waits (>44 minutes), National Aeronautics and Space Administration workload index, and emergency service index acuity.

Net Promoter Score declined from 33.5 to 29.9 post-go-live and then increased to 38.9, exceeding the goal. The driver score increased from 58 to 65. In addition, fidelity also improved. Triage compliance increased from 58.8% to 91.3%, registration compliance increased from 87.1% to 96.2% and then decreased to 93.8%, and television presentation visibility increased from 89.5% to 100%. Workload and acuity remained stable (P = .96 and P = .24, respectively). Prolonged waits decreased significantly from 1950 to 1269, with ∼35% reduction (P < .001).

This low-technology, multimodal communication bundle was feasible and embedded into routine workflow and was associated with an improved patient experience without increasing workload, and organizational approval was obtained for scaled pamphlet printing. Concurrent reductions in prolonged waiting times likely confounded satisfaction gains; next steps include spread testing and exploring automation to reduce staff-dependent variability.