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How Can We Better Manage Patients’ Perception of Wait Time in the Emergency Department (ED)?

Question

Sometimes, once the decision has been made to admit the patient to an inpatient bed, there is not a bed available. It can take hours to get the patient to the unit. Some nurses find it difficult to continue to tell the patient the bed is not yet ready, so they avoid going in to talk with the patient/family. Do you have suggestions for how to best manage wait time in the ED, specific to key words for nurses to use?

Answer

Holding patients in the ED is no longer the exception, but a common practice. In the ED, we sometimes avoid communication with our patients at a time when communication is most needed.

As one CEO shared with me, it really is amazing what patients will forgive you for if you just explain, explain, explain. Tell them why the lab results are taking so long. Explain that it takes time for the media infusion to be absorbed before taking a CT scan, etc. When employees introduce themselves, make eye contact, smile, and explain, patients will even forgive you for a five-hour wait in the ED.

Some other ideas: consider setting a standard for how often someone checks on the patients who are waiting to be admitted. Every 30 minutes or every hour would be a good goal. Have RNs chart these communications so that you can verify.

Your desire for key words in this situation is warranted, so that all patients will hear the same message from staff. Use the wording from your patient satisfaction tool to craft key words that let the patients know that you care about them and that they are not an inconvenience. Also, use these key words to manage up the unit a given patient is being moved to.

Consider something like, “I just wanted to check on you to make sure you don’t need anything while you wait to go upstairs. The nurses on six south are so wonderful; they will make sure you get very good care!” Or consider, “I am sorry your bed is not ready yet, but can I do something for you while you wait? I know the nurses in the CCU are working so hard to get a bed for you—they are just great!”

I worked with one ED that often held patients for days and instead of making the patients feel unwelcome and a burden, they would smile and tell the patients, “We like you so much we are keeping you another day!”