Date of Doctor of Nursing Practice Project Completion
Spring 2026
Faculty Advisor
Dr. Christen Goolsby
Abstract
Purpose: This QI project aimed to improve ED waiting room experience by standardizing communication to increase transparency and expectation management, targeting an increase in Net Promoter Score (NPS) from 33.5 to ≥35.4 within three months.
Background: ED waiting room dissatisfaction is driven by uncertainty (unclear wait times, inconsistent updates, and limited understanding of triage and ED flow), supporting structured communication over individual clinician delivery.
Methodology: A 3-month, single-site QI project in an urban ED used iterative PDSA cycles and included all ED encounters (n=17,444). The bilingual intervention included orientation pamphlets (print/QR-based), standardized triage verbalization of the longest wait, and a looping bilingual waiting-room display, implemented during operational transitions, introducing potential confounding. Outcomes were monthly Press Ganey NPS and the “Nurse/Staff Responds to Concerns” driver score, analyzed using run charts and descriptive statistics. Fidelity audits and TV visibility tracked performance; balancing measures included prolonged waits (>44 minutes), NASA-TLX workload and ESI acuity.
Results: NPS declined post–go-live (33.5→29.9) then increased to 38.9, exceeding the goal. The driver score increased from 58 to 65. Fidelity improved (triage compliance 58.8%→91.3%; registration compliance 87.1%→96.2%→93.8%; TV visibility 89.5%→100%). Workload and acuity remained stable (p=.96; p=.239). Prolonged waits significantly decreased (1,950→1,269; ~35% reduction; p< .001).
Implications for Practice: This low-technology, multimodal communication bundle was feasible, embedded into routine workflow, and associated with improved patient experience without increasing workload, with organizational approval for scaled pamphlet printing. Concurrent prolonged wait reductions likely confounded satisfaction gains; next steps include spread testing and exploring automation to reduce staff-dependent variability.
Keywords
Emergency Department, Patient Satisfaction, Quality Improvement, Communication, Net Promoter Score, Waiting Room
Recommended Citation
Wael P. Karaki, "Improving Patient Satisfaction in the Emergency Department Waiting Room Through Enhanced Communication Strategies: A Quality Improvement Initiative" (2026). Doctor of Nursing Practice Final Project Abstract. 160.
https://digitalcommons.library.tmc.edu/dnp_abstract/160