September 13, 2019

Was your hospital stay :) or :(? Penn Medicine wants to know.

Daily Briefing

    Color-coded button terminals featuring emojis that reflect a range of sentiments could be an effective way to get real-time patient and provider satisfaction data, according to a study from Penn Medicine published last week in the Annals of Emergency Medicine.

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    Study details

    For the study, researchers placed three terminals around the ED of an urban hospital. The terminals featured four buttons with animated faces—or "emojis"—on them. The facial expressions on the button ranged from very positive (signified by a green button with a happy face) to very negative (signified by a red button with a frowning face).

    Researchers placed the terminals at three different locations in the ED to capture data from three specific groups: doctors, nurses, and patients. One terminal was set up near physician workstations, another at a nurses' workstation, and the other at the exit to draw responses from patients.

    During the five months of the study, the terminals recorded almost 14,000 sentiments. About 68% came from the two provider terminals. The terminal near the nurses' workstation recorded the most sentiments across all three terminals, accounting for 53% of the total sentiments. On average, the terminals together recorded 108 sentiments each day.

    While the researchers said the study was primarily aimed at determining the feasibility of using the terminals, they did find some associations. For example, the patient exit terminal recorded more positive responses, outnumbering negative responses by 25% on average. The patient terminal averaged 23.6 positive responses and 17.7 negative responses per day, while the nursing terminal averaged 23.2 negative and 15.6 positive responses per day.

    Further, the researchers observed that negative sentiments from providers were associated with a higher number of patients waiting to be seen as well as an increased number of boarded patients in the ED. According to Anish Agarwal, an assistant professor of emergency medicine at Penn Medicine and lead study author, this might be explained by capacity issues limiting providers' ability to see patients.


    Raina Merchant, director of the Penn Medicine Center for Digital Health and senior author on the study, said the study "suggests that we can collect real-time provider and patient feedback that we haven't previously been able to identify. This can allow for support when things are going well and addressing challenges when they occur."

    Similarly, Agarwal said the study "begins to shed light on simple, fast ways of identifying trends and providing high-level information on how patients and providers are feeling in real time."

    Now that the terminals have been shown to be useful, Agarwal said he hopes to dive deeper into the data with future research to determine why shifts in sentiment occur and how to quickly respond to them.

    "Frictionless feedback is key in helping drive quality improvement in healthcare, and we need to explore more ways in which we can expand it," he said. "I would argue that the day-to-day frustrations—and joy — clinicians experience likely contributes to their long-term satisfaction or burnout. So we need to rethink how we engage with providers and patients" (Park, Becker's Health IT & CIO Report, 9/6; Penn Medicine release, 9/4; Agarwal et al., Annals of Internal Medicine, 9/4).

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