title: Satisfaction with the emergency department environment decreases with length of stay.
abstract: OBJECTIVE
  To determine the emergency department (ED) environmental factors associated with patient satisfaction.
  
  
  METHODS
  A prospective, observational study in a university-affiliated tertiary-referral ED and associated observation unit (OU). The ED environment was evaluated with a structured questionnaire, scored using a 100-mm visual analogue scale. Patients who stayed in the ED over 8 h (long-stay ED; LSED) were compared with those who stayed less than 4 h (short-stay ED; SSED) and with a control group admitted to the OU.
  
  
  RESULTS
  A total of 233 patients was enrolled, overall satisfaction in SSED was 81% (95% CI 70.1 to 88.7), 69% in LSED (95% CI 57.4 to 78.7) and 84% in OU (95% CI 73.6 to 91.0). The most important environmental factors were cleanliness (median importance 95, interquartile range (IQR) 81-98) and communication with medical staff (94, IQR 80-98) and family (92, IQR 74-98). The least important factors were access to nature (38, IQR 19-65), a natural light source (50, IQR 24-74) and ability to sit out of bed (52, IQR 26-75). Factors rated high for importance but low for satisfaction were ED noise levels (median difference 40, IQR 3-70), ED trolley comfort (19, IQR 6-50) and food quality (12, IQR -4-29).
  
  
  CONCLUSIONS
  Patients who spend over 8&emsp14;h in the ED are less satisfied with their environment than either those who spend less than 4 h or patients in an OU. Importantly, distinct, amenable factors can be identified. These should be addressed to improve patients' overall ED management and satisfaction.
authors.affiliation: Emergency Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Walsh
authors.forename: J C
authors.initials: JC
authors.lastname: Knott
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006272:Health Facility Environment / Q000592:standards*; D006784:Hospitals, Teaching; D006801:Humans; D007802:Language; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D011446:Prospective Studies; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014218:Triage / Q000706:statistics & numerical data