Despite the well-documented links between patient experience and health outcomes, providing high-quality experiences in the ED remains a challenge, and it has been shown that patients who enter the hospital through the ED often have lower overall satisfaction with their care. To understand this, one must understand the key drivers of patient experience in the ED, among which are communication, wait times and timeliness of care, empathy and compassion, technical competence, information dispensation, pain management, and the environment of care.

EDs are often challenged by limited physical space capacity and crowding, and subsequently by uncomfortable and chaotic care environments that lack physical privacy and in which effective communication is difficult. The impact of crowding is likely attributable to some of the associated challenges related to timely, compassionate care and the provision of adequate analgesia, both of which are key drivers of patient experience. As such, understanding the drivers of patient experience can help extrapolate the modifiable aspects of practice that will drive best practice in patient experience. These include excellent communication that demonstrates empathy, working as a high-functioning team, reducing or setting expectation regarding wait times, and clear discharge communication.

Communication and empathy are widely recognized key drivers of the patient experience. These learned skills are ones that enable physicians to ask questions in a way that is maximally effective, listen in a way that enables patients to feel heard, and speak in a way that provides clarity and demonstrates empathy. Several programs appear in the literature to help teach skills for effective communication, including one in EM and several in general internal medicine. Additionally, national academies have formed around the teaching and dissemination of health care communication, some with courses specific to ED providers. ^,

In addition to general patient-provider communication, specifically keeping patients updated on their care has been shown to be another driver of patient experience. To that end, providers should focus on creating systems either within their own clinical practice, or by leveraging other team members within the ED, to ensure that patients are kept informed about their care throughout their stay in the ED.

The perception of a high-functioning team has also been strongly associated with better overall patient experience. In the ED, however, it has been shown that patients often are not encouraged to ask questions and engage actively in decision making. To that end, engaging in experiences that cultivate the skills associated with high-functioning teams is recommended. Several different frameworks have been shown to be effective. ^, Examples of training curricula include Crisis Resource Management (CRM) and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). Both employ simulation-based training to cultivate nontechnical skills related to effective communication between team members. ^, The key principles include having strong leadership, situational awareness, a culture that allows for mutual support, and strong systems to support clear communication. In addition to improving teamwork and improving safety in the ED, these interventions have also been shown to increase ED staff satisfaction and team morale. ¹⁹

Wait times are a concern for virtually all patients, and a driver of patient experience. To that end, focusing efforts on throughput and efficiency are essential. In addition to systems solutions aimed at increasing care efficiency and decreasing actual wait time, there are also modifiable interventions that can be undertaken at the physician level. For example, setting expectations has been shown to be a powerful intervention related to wait times, with studies demonstrating that if patients are informed about the wait time, they are significantly more likely to report higher satisfaction with the time spent waiting.

In addition to expectation setting, another tactic that emergency clinicians in the ED can employ to cultivate a sense of presence with patients is sitting. This relatively straightforward technique has been shown to increase patients’ perception of the clinician’s skill in communication and listening, makes instructions easier to understand, and leaves patients with a more positive evaluation of the experience. Additionally, it is well known that providers who sit are perceived to have spent more time at the bedside, without having actually spent more time, than those who stand. To that end, we recommend that when possible, providers integrate sitting during the patient interview into their practice. This may require advocacy within their departments to ensure that stools are available in the room or leveraging make-shift seats using available equipment.