Problem Identification and Rationale
The research at hand focuses on the emergency room setting as the primary area of interest. Emergency rooms are among the most operationally complex settings in the field of modern healthcare due to the concentration of procedures required for the successful delivery of care and the immense number of patients treated. It should also be noted that this complexity is steadily increasing. According to Sayah, Rogers, Devarajan, Kingsley-Rocker, and Lobon (2014), the number of emergency departments in the United States decreased by 27% in the last decade, while the number of annual visits to the emergency rooms increased by 41%.
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Understandably, such disproportionate dynamics put emergency departments under additional stress, undermine their operational efficiency, and further aggravate the issue of wait time in the emergency room.
The problem of emergency room wait time is a major barrier to the delivery of quality care. This problem is only exacerbated by the fact that the setting is characterized by a high number of patients in need of rapid response. In fact, according to Khankeh, Khorasani-Zavareh, Azizi-Naghdloo, Hoseini, and Rahgozar (2013), up to 78% of patients referred to the emergency department require the delivery of immediate care. Indeed, numerous health conditions common for the setting, such as injuries, have a mortality rate of up to 85% in the first 20 minutes after the event (Khankeh et al., 2013).
Finally, the emergency room is where patients first encounter the healthcare team, receive vital information on immediate care, and form their first impression of the quality of services. Therefore, long wait time in the emergency room has several major adverse effects. First, it dramatically increases the risk of a negative health outcome for the patients, which can range from minor adverse health effects to death in the most serious cases. Second, it creates the possibility that certain patients will not receive care at all since the evidence shows that some people leave when the wait time has exceeded their accepted limit (Khankeh et al., 2013). Finally, long wait times adversely impact the level of patient satisfaction and, by extension, are related to employee dissatisfaction as well (Sayah et al., 2014). As seen from the information presented above, long wait times in the emergency room are a significant issue in nursing practice.
To address the problem and based on the available literature, the following five research questions were formulated:
- How does reduced wait time in the emergency room improve mortality rates among its patients compared to other factors such as quality of care?
- How significant is the impact of prolonged wait time on patient satisfaction in comparison to other factors such as quality of care among patients referred to an emergency room?
- Do emergency departments with dedicated healthcare teams reduce the likelihood of patients with less severe health issues leaving without receiving care in comparison to departments with traditional staffing approaches?
- Do emergency departments with established patient education programs for patients with non-immediate health issues have reduced wait times in comparison to departments without such programs?
- Do emergency departments that incorporate queuing theory have reduced wait times in comparison to departments that lack a systematic approach to the issue?
Of these five questions, the first two explore the effects of a reduction in emergency room wait time. At the same time, the remaining three are intended for finding optimal strategies that would help achieve the said reduction. While it is tempting to follow the intuitive idea that reduced emergency room wait times necessarily result in significant improvements in patient outcomes, such an approach is inconsistent with the principles of evidence-based practice (Davies, 2011).
Thus, from a logical perspective, the first two questions are more relevant because they will allow the researcher to predict the expected outcomes of a reduction in wait time and, possibly, weight against the time and resources required to introduce it. Next, both patient satisfaction and mortality rates are important indicators of emergency department performance, which means that the researched problem is significant. Besides, both indicators are measurable through well-established instruments and frameworks. Therefore, the problem is researchable and quantifiable. Finally, the topic of patient satisfaction has been extensively studied in the current literature, which opens up the possibility for the research team to corroborate their findings or undergo a systematic review to reduce the time and financial expenses associated with the study (Houde, 2009).
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Thus, despite the lack of prior experience in the field in question, the second research question is the most feasible and should be a priority in studying the issue of reducing emergency room wait time.
PICOT Question and Variables
The preliminary PICOT question is as follows: “In patients referred to the emergency room, how significant is the impact of reduced wait time on patient satisfaction in comparison to other factors such as quality of care?” The variables are as follows:
- P – Population refers to all patients referred to the emergency room and in the process of waiting for the delivery of care.
- I – Intervention refers to the reduced wait time. Since an extended wait time is a recognized problem, the reduction is expected to improve the perception of care by the patients.
- C – Comparison refers to the quality of care. While the adverse impact of extended wait time on patient satisfaction is a practical certainty, it is possible to hypothesize that its effect is either negligible or canceled out by the quality of the delivered care. Thus, a comparison with other potential influences is needed.
- O – Outcome refers to patient satisfaction. One of the most important indicators of any healthcare provider’s efficiency, patient satisfaction is known to have a noticeable effect on the long-term results of the delivered care and the sustainability of the delivery.
The final variable of timeframe (T) is not included as one of the variables in this study. Since the research will be in the form of a systematic review of the literature, there is neither the need nor the opportunity to establish a meaningful timeframe for the study. Instead, the research team will aim to generalize the findings of previous studies and produce an overview of the situation that could be applied to as many emergency healthcare settings as possible (Krainovich-Miller, Haber, Yost, & Jacobs, 2009).
The list of keywords that will be used to conduct the literature search for this research question is as follows: emergency room, wait time, patient satisfaction, patient perception, perceived wait, patient satisfaction factors, quality of care, nursing roles, triage system, and patient satisfaction predictors.
The first three keywords directly represent the issue at hand and are required to specify the main topic of the search. The next three terms will help the researchers narrow down the search to specific types of patient satisfaction and locate sources in which several aspects of patient satisfaction are discussed. For instance, the keyword “perceived wait” will help locate studies on the comparison of perceived and actual wait times, which can clarify the significance of wait time duration. The next three keywords represent commonly used methods of improving patient satisfaction and are thus useful for a more focused search (Handley, 2011). Finally, the keyword “patient satisfaction predictors” will point to sources in which multiple predictors are reviewed and compared, ensuring the sources’ relevance to the research question.
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75-80. Web.
Handley, A. (2011). Fast-track to efficiency. Nursing Standard, 25(20), 18-19. Web.
Houde, S. C. (2009). The systematic review of the literature: A tool for evidence-based policy. Journal of GerontologicalNursing, 35(9), 9-12. Web.
Khankeh, H. R., Khorasani-Zavareh, D., Azizi-Naghdloo, F., Hoseini, M. A., &Rahgozar, M. (2013). Triage effect on wait time of receiving treatment services and patients satisfaction in the emergency department: Example from Iran. Iranian Journal of Nursing and Midwifery Research, 18(1), 79-83. Web.
Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. K. (2009). Evidence-based practice challenge: Teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186-195. Web.
Sayah, A., Rogers, L., Devarajan, K., Kingsley-Rocker, L., &Lobon, L. F. (2014). Minimizing ED waiting times and improving patient flow and experience of care. Emergency Medicine International, 2014, 1-8. Web.