The Comfort Cart Initiative: A Quality Improvement Intervention to Improve Patient Satisfaction in the Emergency Department

Authors

• Heidy Cladimir Ayala, University of Texas Health at HoustonFollow

Author Biographical Info

Heidy C. Ayala was born in El Salvador and grew up in a family of six. In 2001, at the age of 14, her life changed dramatically when a devastating earthquake struck her country. Following this tragedy, she immigrated to the United States in pursuit of educational opportunities and a brighter future.

Education has always held a special place in Heidy's life because of the sacrifices her parents made. They grew up during a time when access to formal education was extremely limited. Without school buildings in their community, they learned to read and write under the shade of a mango tree, using pieces of charcoal as pencils and wooden boards as their writing surface. Despite the hardships they endured, they believed that education was the key to a better future. They made it their mission to ensure that their children would have opportunities they never had and encouraged Heidy to take full advantage of every educational opportunity available to her.

Determined to honor her parents' sacrifices, Heidy embraced every step of her educational journey. She began her nursing career as a Licensed Vocational Nurse (LVN) before earning her Associate Degree in Nursing (ADN), followed by her Bachelor of Science in Nursing (BSN). She is currently pursuing her Doctor of Nursing Practice (DNP) degree with a Family Nurse Practitioner (FNP) concentration at the Cizik School of Nursing at The University of Texas Health Science Center at Houston (UTHealth). Her educational path reflects her belief that learning is a lifelong journey.

As a registered nurse, Heidy has dedicated her career to providing compassionate, patient-centered care in the Emergency Department. Through her clinical experience, she developed a passion for improving the patient’s experience and advancing healthcare through evidence-based practice and quality improvement initiatives. Her doctoral quality improvement project focused on implementing a Comfort Cart in the Emergency Department to improve patient satisfaction and promote patient-centered care.

Beyond her professional accomplishments, Heidy is a devoted wife and mother. She has been married to her husband for more than 20 years, and together they have raised five children. Balancing the responsibilities of family life while pursuing advanced education has strengthened her resilience, perseverance, and determination. She hopes to inspire her children by demonstrating that hard work, faith, and education can overcome even the greatest challenges.

Heidy's professional interests include emergency medicine, quality improvement, healthcare leadership, chronic disease management, and preventive care. As a future Family Nurse Practitioner, she is committed to providing compassionate, evidence-based, and equitable healthcare while advocating for underserved populations and improving health outcomes within her community.

Heidy's journey from a young girl in El Salvador inspired by her parents' determination to an immigrant pursuing new opportunities in the United States, to a registered nurse, doctoral nursing student, wife, and mother of five reflects the power of perseverance, education, and service. She hopes to honor her family's legacy by making a lasting impact on the lives of her patients, mentoring future nurses, and inspiring others to pursue their dreams regardless of the obstacles they face.

Date of Doctor of Nursing Practice Project Completion

Summer 8-1-2026

Faculty Advisor

Dr. Susan Stafford

Abstract

The Comfort Cart Initiative: A Quality Improvement Intervention to Improve Patient Satisfaction in the Emergency Department

Purpose

The Comfort Cart QI project aimed to improve Emergency Department patient, parent, and guardian satisfaction by 10% over an 8-week implementation period.

Background

In healthcare, patient satisfaction is an important indicator of the quality of care provided, and many literature reviews suggest it is closely associated with patient-centered care.

 Methodology

The Comfort Cart intervention is an evidence-based quality improvement project employing a pre- and post-intervention design, conducted over an 8-week period, in the Emergency Department. The project was guided by Kolcaba's Comfort Theory and implemented using the Plan-Do-Study-Act (PDSA) quality improvement framework.

The project was conducted among all ED patients who were admitted to the ED, agreed to participate, and met the inclusion criteria. Patient satisfaction data were collected using a Patient Satisfaction Four-Question Survey.

Results

During the Comfort Cart intervention, 100 Patient Satisfaction Four-Question Surveys were completed. Based on survey data, patient satisfaction scores increased from 54% to 74%, a 20% improvement that surpasses the initial goal. The ED adopted the Comfort Cart intervention, and it is now part of the comfort measures.

Implications

The Comfort Cart was successfully integrated into the Emergency Department workflow and improved patient satisfaction. Despite the fast-paced ED environment, the intervention supported patient-centered care and enhanced the patient experience. Future implementation in other healthcare settings is recommended.

Keywords

Quality improvement, Comfort Cart, Emergency Department, Patient satisfaction, Patient-centered care, Comfort measure

Recommended Citation

Heidy Cladimir Ayala, "The Comfort Cart Initiative: A Quality Improvement Intervention to Improve Patient Satisfaction in the Emergency Department" (2026). Doctor of Nursing Practice Final Project Abstract. 216.
https://digitalcommons.library.tmc.edu/dnp_abstract/216