Processes in Emergency Departments That Impact the Patient Experience

Topic: Nursing
Words: 1285 Pages: 13

Draft of Productivity Dashboard

In this part, the paper will mainly focus on identifying and analyzing the activities and processes in the emergency departments that impact the patient experience and how they create inefficiencies. The paper will be based on the case study of Ron’s experiences in the hospital. The efficiencies of activities and processes experienced by Ron will be analyzed against the national benchmarks. The difference will be subjected to further analysis to establish if they fall within the acceptable differentials. The difference will be the difference between the observed time and the national average. In determining the acceptable differential, the obtained differential will be divided by the observed time and multiplied by 100%.

The metrics and issues to be measured will include registration, co-payment, and waiting for the nurse. Others are checking for vital signs, waiting for the exam room, waiting for the physician, examination, testing order entry, request for referrals, and follow-up application schedules. These issues will be measured against the resources available at the ED, specifically, money, time and technology consumed and the outcome obtained. This will allow nurses and physicians to quickly check the stats for their performance and work efficiency.


An emergency department (ED) in any health care facility is responsible for providing surgical and medical interventions to patients who arrive at the hospital with immediate care needs. The department can also be called out to intervene in specific cases within the facility, such as heart attacks. There are various activities and processes performed at the ED that significantly impact the experience of patients. Going by Ron’s case study at the United General Hospital Emergency Room, it has emerged that the activities and processes that take place inside an ED include registration, co-payment, and waiting for the nurse. Others are checking for vital signs, waiting for the exam room, the physician, examination, testing order entry, referral request, and follow-up application schedules (Rachuba et al., 2018). Ron’s experiences at the United General Hospital Emergency Room clearly demonstrate that there are a lot of inefficiencies at the facility. In each of the ten activities and processes highlighted above, Ron spent more time than is stipulated in the National Average (NA).

Analysis of How Activities and Processes Create Inefficiency


Registration of patients in the emergency department is an essential step that significantly impacts the subsequent workflows and safety of patients. However, if patients are misidentified in this very initial stage, inefficiencies are prone to characterize the entire process (Sayah et al., 2016). This is because subsequent treatment decisions of the patient are based on the data collected during the registration process. A lengthy registration process in the emergency department is a key contributor to inefficiency as it is responsible for throughput delays.

The national average time for the patient registration process is 15 minutes. From the case study, it took Mary a total of 45 minutes to get Ron registered. This included 30 minutes of standing in the queue and 15 minutes of the actual registration process. This implies that there was a differential of 30 minutes. The delay in the process was caused by the fact that Ron’s details had to be entered into three computers (Swancutt et al., 2017). Moreover, the same nurse who did the registration was the one to escort patients to their examination rooms. This further delayed the registration time in the hospital.


Co-payment refers to the admissible amount of claim that both the insured patient and his insurer pay on a cost-sharing basis. It has been identified as a potentially significant tool that can assist patients in emergency departments to access health care with ease. However, if not properly executed, it can create unnecessary inefficiencies (Petrou & Ingleby, 2019). In Ron’s case, the inefficiency of the process came as a result of validation and credit card processing. The nurse juggled through multiple computers to check if Ron’s credit card was valid before processing it, a task that took 10 minutes. There are no national benchmark averages for co-payment time in emergency departments, although the lengthy duration witnessed in Ron’s case is to blame for co-payment ED inefficiencies at the hospital. The prolonged co-payment process negatively impacts the patient experience at the facility as it delays the treatment commencement, which, in turn, exacerbates pain (Stefanini et al., 2018). The hospital should have a seamless system that provides instant verification of co-payment details like credit cards.

Waiting for the Nurse

Ron entered the examination after waiting in line for 45 minutes, contrary to an early assurance by the nurse that the wait would last for 30 minutes. But even after entering the room, he was not attended to immediately, even though he had complained of intense pain. The examination nurse only took his vital signs after keeping him waiting for another 10 minutes. Ron and Mary became fatigued and hungry as a result of spending this amount of time in the queue (Sanjuan-Quiles et al., 2019). The national average waiting time before a patient can see a doctor is 18 minutes. Nationally, the average waiting time for a nurse is 40 minutes. This implies that Ron experienced a differential of more than one hour. This does not fall within the acceptable differential in the United States. Reducing the wait time does not only help the patient alleviate his pain and suffering but also assists the health care facility in reducing costs and avoiding congestion at the hospital.


After waiting for quite some time, Ron was finally ushered in to see a doctor. The examination process commenced after a 20-minute wait but had to be interrupted mid-way because of another emergency that the physician had to attend to. Ron waited for another 20 minutes before another physician came to attend to him. The examination process lasted for 5 minutes despite the long wait that preceded it. However, due to the short time that the physician took to examine Ron, he might have erred in diagnosing the real problem (Kim et al., 2019). This is because the X-ray produced a different result from the one concluded by the assistant physician. The national average time for examination in the US is 20 minutes and 4 seconds. There is a flexibility time of plus or minus 9 minutes. However, the 5 minutes taken by the assistant physician to examine Ron significantly fall below the national average by 15 minutes differential. One, therefore, doubts the effectiveness of the process that lasted for too short a time.

Test order entry

Test order entry from emergency departments can be done through a computerized system to improve quality and increase safety. It also ensures that the delivery of timely medications to the patient is achieved. Most patients in the ED are those that are either critically sick or in need of timely interventions. It is thus important to use techniques that are time-saving and help in the maximization of efficiency and turnaround time for tests. In the case study, the assistant physician used an iPod to enter Ron’s order for the test, an exercise that took 3 minutes. It is also important to note that the physician entered the results while still in the room. While this is relatively efficient, the mobility of the iPad can put the whole process in jeopardy (Alnajem et al., 2019). An iPod can easily be accessed by unauthorized personnel, who can doctor the results. There is no existing national average to benchmark the duration of time required to enter test results. Nonetheless, it depends on the content of the results to be entered, the devices used, and the system in place. The 3-minute inefficiency could have been caused by the sketchy data collected from the patient.


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Kim, J. H., Parameshwara, N., Guo, W., & Pasupathy, K. S. (2019). The Impact of Interrupting Nurses on Mental Workload in Emergency Departments. International Journal of Human-Computer Interaction, 35(3), 206-217. Web.

Petrou, P., & Ingleby, D. (2019). Co-payments for emergency department visits a quasi-experimental study. Public Health, 169, 50-58. Web.

Rachuba, S., Knapp, K., Ashton, L., & Pitt, M. (2018). Streamlining pathways for minor injuries in emergency departments through radiographer-led discharge. Operations Research for Health Care, 19, 44-56. Web.

Sanjuan-Quiles, Á., Hernández-Ramón, M. P., & Juliá-Sanchis, R. (2019). Handover of patients from prehospital emergency services to emergency departments. Journal of Nursing Care Quality, 34(2), 169-174.

Sayah, A., Lai-Becker, M., & Kingsley-Rocker, L. (2016). Emergency department expansion versus patient flow improvement: Impact on patient experience of care. The Journal of Emergency Medicine, 50(2), 339-348. Web.

Stefanini, A., Aloini , D., Benevento , E., Dulmin , R., & Mininno , V. (2018). Performance analysis in emergency departments: A data-driven approach. Measuring Business Excellence, 22(2), 130-145. Web.

Swancutt, D., Joel-Edgar, S., & Allen, M. (2017). Not all waits are equal: An exploratory investigation of emergency care patient pathways. BMC Health Services Research, 17(436), Web.

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