Satisfied patients exiting the emergency department (SPEED) study

Background/Objective: Patient satisfaction has been associated with patient perceptions of emergency department (ED) wait intervals, but not necessarily actual wait intervals. The objective was to address the associations of actual versus perceived wait intervals in ED patients and the association of overall satisfaction with perceived and actual wait intervals. Methods: The authors performed a prospective, cross-sectional study using a volume-stratified sample of adult ED patients presenting to an urban, university teaching hospital. Patient wait intervals were monitored using a computerized tracking system. Patients were confidentially surveyed regarding their overall satisfaction with care and perceptions of wait intervals after a disposition decision was made by the treating physician. The Spearman's rho (two-tailed, alpha = 0.05) was used to evaluate the association between patient satisfaction and perceived wait intervals, estimated wait intervals, and measured wait intervals. Associations between these measures of wait intervals were similarly assessed. Results: One hundred twenty-six eligible patients (including 15 admissions) completed the survey. The median wait interval (interquartile range [IQR]) was 14 (7 to 22) minutes to a room. Overall satisfaction was more strongly associated with the perception that the wait interval to a room was shorter than expected (r = 0.44; p = 0.00001) than with the estimated wait interval (r = 0.03; p = 0.97) or the measured wait interval (r = -0.06; p = 0.49). Patients had a median wait interval of 13 (3 to 26) minutes in a room until seen by a physician. Overall satisfaction was more strongly associated with the perception of the physician wait interval's being shorter than expected (r = 0.37; p = 0.00001) than with the estimated wait interval (r -0.09; p = 0.32) or the measured wait interval (r 0.05; p = 0.58). Similar findings were found for the total time in the ED. For both the wait for a room interval and the wait for a physician interval, the measured wait intervals were more strongly associated with the estimated wait intervals (r = 0.63 and r = 0.34, respectively) than with the perception that the wait intervals were shorter than expected (r = -0.20 and r = -0.17, respectively). Conclusions: Efforts to improve ED patient satisfaction should focus on improving patients' perceptions that wait intervals are appropriate rather than simply shortening wait intervals per se.