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“Patience, n. A minor form of despair, disguised as a virtue.”

Ambrose Bierce, The Devil's Dictionary

Waiting is a significant part of life. Some of that waiting may not register as troublesome—the average American will sit at stoplights for 6 months over the course of a lifetime and spend 5 years waiting in line. But people do notice many types of waiting, and can become annoyed. A survey by the NCR Corporation identified the 9 most frustrating waits. Registering a car or renewing a driver's license topped the list, followed by checking out at a retail store. Number 3 on the list was registering at a hospital or clinic. This ranking alerts emergency care providers to the importance of managing waits in the emergency department (ED) in relation to patient satisfaction. This chapter examines the psychology of waiting, as well as the lessons learned that can be applied in the ED to manage waits and increase patient satisfaction.

Providers of emergency care can easily become oblivious to the concerns of waiting patients. Waiting seems a normal part of the process. Clinicians are busy. The triage process and capacity constraints dictate that some patients seeking care will wait, and some patients will wait longer than others. But patients aren't indifferent to having to wait, and the length of waits correlates directly with patient satisfaction, as Figure 39-1 shows clearly. The longer patients have to wait, the unhappier they are, and patient-satisfaction scores will reflect that reality.

Figure 39-1.

Patient satisfaction by time spent in the ED.

The issue of patient attitudes toward waiting in an ED is applicable not only in the United States but also globally. Despite demographic differences and differences in outcome measures, patients' perception of their experience in EDs across the world demonstrates an overall dissatisfaction with long waits for care. These negative perceptions of waits are in fact responsible for sweeping changes in the delivery of care, reimbursement, and provider behavior. In the United Kingdom, for example, researchers found that “perceived waiting time was consistently associated with overall satisfaction” and that “dissatisfaction with waits is reflected in an increasing number of patients who leave without being seen.” Further, for every 2.8 patients who are seen, an additional one will leave without being seen in a British ED.1

How Long Is Long?

A key factor in the psychology of waiting is why a patient perceives a wait as excessive. Healthcare researchers have established different measures of “long wait.” In England, the National Health Service defines excessive waiting as spending more than 4 hours in the ED (from arrival to departure).1 In Canada, the government defines it as a “situation in which demand for service exceeds the ability to provide care within a reasonable time, causing ...

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