Instruments for optimizing patient care in the outpatient emergency unit, with a focus on perception of care

Overcrowding in emergency departments (EDs) is a common problem worldwide, often resulting in long wait times, decreased quality of care, patient dissatisfaction with the service, and increased costs. The impact on caregivers is also significant, with an increased risk of burn-out, absenteeism, and high staff turnover. The two leading contributors of overcrowding at our ED are the input (volume of patients arriving) and throughput (time to process and/or treat patients). The main causes of input overcrowding are non-urgent cases, frequent users, and the poor and uninsured who lack primary care, mainly migrants. We first identified the time spent waiting to see a doctor as one of the most important variables associated with patient satisfaction in the ED. Thus, we investigated patients’ perception of wait time and developed a novel tool permitting to change the perception of wait time, with the hypothesis that it would impact on satisfaction. As communication is a key factor for patient satisfaction and better adherence to treatment, we then took into account the fact that 10% of our patients do not share a common language with caregivers in the outpatient emergency patient of Geneva University Hospitals (HUG), as well as those with intellectual deficiencies and deaf persons. This led to the development of novel communication methods, such as BabelDr, a speech-enabled fixed-phrase translator for emergency settings, and its extension, PictoDr, which allows communication exclusively through pictographs. Several other innovative tools are currently under development, such as the use of avatars for the deaf. This privat docent thesis represents the results of the author’s research, which focuses on instruments to optimize patient care and enhance patient and caregiver satisfaction in the outpatient emergency unit.