title: Talk-time in the emergency department: duration of patient-provider conversations during an emergency department visit.
abstract: BACKGROUND
  Analyses of patient flow through the emergency department (ED) typically focus on metrics such as wait time, total length of stay (LOS), or boarding time. Less is known about how much interaction a patient has with clinicians after being placed in a room, or what proportion of their in-room visit is also spent waiting.
  
  
  OBJECTIVE
  Our aim was to assess the proportion of time that a patient spent in conversation with providers during an ED visit.
  
  
  METHODS
  Seventy-four audio-taped encounters of patients with low-acuity diagnoses were analyzed. Recorded ED visits were edited to remove downtime. The proportion of time the patient spent in conversation with providers (talk-time) was calculated as follows: (talk-time = [edited audio time/{LOS - door-to-doctor time}]).
  
  
  RESULTS
  Participants were 46% male; mean age was 41 years (standard deviation 15.7 years). Median LOS was 126 min (interquartile range [IQR] 96 to 163 min), median time in a patient care area was 76 min (IQR 55 to 122 min). Median time in conversation with providers was 19 min (IQR 14 to 27 min), corresponding to a talk-time percentage of 24.9% (IQR 17.8%-35%). Multivariable regression analysis revealed that patients with older age, longer visits, and those requiring a procedure had more talk-time: total talk-time = 13 s + 9 s × (total time in room in minutes) + 8 s × (years in age of patient) + 482 s × (procedural diagnosis).
  
  
  CONCLUSIONS
  Approximately 75% of a patient's time in a care area is spent not interacting with providers. Although some of the time waiting is out of the providers' control (eg, awaiting imaging studies), this significant downtime represents an opportunity for both process improvement efforts and innovative patient-education efforts to make use of remaining downtime.
authors.affiliation: Department of Emergency Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: McCarthy
authors.affiliation: Department of Emergency Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Kirsten G
authors.initials: KG
authors.lastname: Engel
authors.affiliation: Department of Emergency Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Buckley
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Annsa
authors.initials: A
authors.lastname: Huang
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Francisco
authors.initials: F
authors.lastname: Acosta
authors.affiliation: Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stancati
authors.affiliation: Department of Emergency Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schmidt
authors.affiliation: Department of Emergency Medicine, Northwestern University, Chicago, Illinois.
authors.forename: James G
authors.initials: JG
authors.lastname: Adams
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Kenzie A
authors.initials: KA
authors.lastname: Cameron
mesh_terms: D000328:Adult; D000367:Age Factors; D003142:Communication; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000175:diagnosis / Q000628:therapy; D007902:Length of Stay / Q000706:statistics & numerical data; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D010817:Physician-Patient Relations; D013637:Tape Recording; D013997:Time Factors
keywords: communication; emergency medicine; patient–physician interaction