When Patients Are Impatient: The Communication Strategies Utilized by Emergency Department Employees to Manage Patients Frustrated by Wait Times

Abstract

Studies have documented the frustrations patients experience during long wait times in emergency departments (EDs), but considerably less research has sought to understand ED staff responses to these frustrations. In-depth interviews were conducted with 18 ED social workers, patient navigators, and medical staff members at a large urban hospital regarding their experiences and interpersonal strategies for dealing with frustrated patients. Staff indicated that patients often attribute delays to neglect and do not understand why their health problem is not prioritized. They voiced several strategies for addressing wait time frustrations, including expressing empathy for patients, making patients feel occupied and wait times seem more productive, and educating patients about when health issues should be treated through primary care. All staff members recognized the need for engaging in empathic communication with frustrated patients, but social workers and patient navigators were able to dedicate more time to these types of interactions.

ACKNOWLEDGMENTS

This study was supported by the Department of Health and Human Services Health Resources and Services Administration (award 1 D1DHP16338-01-00). The authors thank Casey Black, Lauren Baggett, and Ashley Council for their assistance with data collection. Elizabeth L. Cohen is now at the Department of Communication Studies, West Virginia University. Melissa S. Plew is now at Department of Communication Arts, Georgia Southern University.

Notes

¹For our purposes, emergency department is defined broadly as the division within hospitals that specializes in response and treatment of patients requiring urgent and acute care. The emergency department is staffed by employees who provide a wide range of emergency medical services, including 911 operators, paramedics, social workers, and triage nurses.

²For the remainder of visits, no triage was performed or the time for triage was unknown or undocumented.

³In total, 32 interviews were conducted as part of the larger study on medical professional perceptions on use of emergency services for less-urgent health problems and included staff members from the hospital ED as well as neighboring primary care clinics. The interviews from the 12 individuals who were not currently employed by the ED were not analyzed for this study.

⁴Paramedics, emergency medical technicians, and 911 dispatchers spend less time in the hospital than the other ED employees, but we determined that their experiences transporting less-urgent patients and handling patient frustration in the field qualifies them to speak on this study's topic.

⁵At the time of the interviews, the ED was piloting two programs designed to encourage less-urgent patients to visit a primary care provider instead of the ED. For one program, three patient navigators were hired to help schedule primary care appointments for less-urgent patients and to follow up with them to help ensure that they attended. The second program involved training EMTs and paramedics to ask less-urgent patients if they would prefer to be taken to a hospital-affiliated primary care clinic instead of the ED. Both programs had been operating for less than a year.