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December 10, 2013

How to reduce tensions in the ED waiting room

Daily Briefing

    Simple design solutions piloted at two hospital EDs in the United Kingdom have been shown to alleviate patient anxiety and reduce acts of violence and aggression, Kristin Hohenadel writes in Slate's "The Eye."

    The London-based firm PearsonLloyd created the design intervention—called "A Better A&E"—in response to an inquiry by the United Kingdom's Design Council and National Health Service. The company assembled a multidisciplinary team of psychoanalysts, service designers, ED consultants, and social scientists to identify what incites patients to verbally or physically abuse hospital ED staff.

    "A lot of the frustration that leads to anger is just a lack of knowledge and a lack of understanding about how things work," explains PearsonLloyd director Tom Lloyd. He adds, "It's caused by patients not understanding the clinical language or the process or why someone who arrives after them is seen before them."

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    The proposed solution places simplified flowcharts throughout the waiting room and consultation areas that guide patients through the ED process and inform them how long it may take to proceed from check-in to assessment, treatment, and follow-up. The posters are supplemented by a more detailed leaflet that patients may carry with them.

    Additionally, the project introduces "bus stop-style" wait time screens, which show estimates in real time for "resuscitation," "major injuries," "minor injuries," and "see & treat" consultations. Designers also have proposed a mobile app that performs the same function, allowing patients to check ED wait times at local hospitals before they decided where to see care.

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    Separately, staff are asked to note cases of staff abuse on a purpose-designed chart so that it may be shared with management and used to identify trends that could facilitate procedure changes. "For example, you imagine it's drunk men on a Friday night who cause most of the problems, whereas it might actually be other people for perfectly legitimate reasons being confused by the system," Lloyd says.

    The result? Less aggression, frustration

    The new designs, which were piloted at two U.K. hospitals in London and Southampton, resulted in a 50% decline in aggressive incidents at both facilities. In addition, patients credited the new signage to feeling 75% less frustration over wait times.

    "[W]e wanted to create something that was cheap because if we'd designed the perfect waiting room, with great chairs and great lighting, then the chances of that being able to be rolled out in any hospital was next to zero," Lloyd says, adding, "We wanted a system that could be retrofitted at very low cost and quite high speed in almost any department in the country."

    And it's not just patients who benefit, Lloyd notes: The changes have also improved "staff morale, retention, and wellbeing, with stress-related staff absences falling significantly after the implementation of the solutions" (Hohenadel, "The Eye," Slate, 12/4; Dezeen Magazine, 12/2).

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    1. Current ArticleHow to reduce tensions in the ED waiting room

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