title: Waiting in the Accident and Emergency Department: Exploring Problematic Experiences.
abstract: OBJECTIVE
  To investigate the relation between perceived waiting times and patients' overall ratings of accident and emergency departments (A&Es) and to explore which patients view waiting times as problematic.
  
  
  METHODS
  A cross-sectional survey was held in 21 A&Es in the Netherlands. From each A&E, a random sample of patients was investigated. Patients younger than 18 years and patients who had arrived by ambulance were excluded. Respondents' perceived waiting times and overall quality ratings of their A&E visit were collected and correlated. Respondents were divided into a "no problem" or "problem" group on the basis of the perceived waiting time before treatment. Logistic regression analyses were performed to explore factors potentially related to problematic waiting experiences, such as the amount of information received while waiting and perceived pain and acuity.
  
  
  RESULTS
  The study included 3483 patients. Longer perceived waiting time was associated with a decrease in overall rating and increased reports of problematic experiences. Multivariate analysis showed that problematic waiting experiences were significantly associated with perceived pain (odds ratio [OR] 1.1), higher perceived acuity (emergency/urgent/nonurgent ORs: 2.7/2.2/1.0) and limited information before treatment. The OR for patients who did not receive any information about what to expect during a visit to the A&E versus patients who were completely informed was 3.3. For uninformed versus completely informed patients, the OR for information about how quickly patients needed to be helped with their health problem was 3.4.
  
  
  CONCLUSIONS
  Providing information before treatment, controlling the perception of pain, and managing perceived acuity not only reduced problematic experiences concerning perceived waiting time but also improved experienced quality of care.
authors.affiliation: From the Netherlands Institute of Health Services Research, Utrecht, the Department of Health Services Research, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, and the Dutch Network for Acute Care, Tilburg, The Netherlands.
authors.forename: Nanne
authors.initials: N
authors.lastname: Bos
authors.affiliation: From the Netherlands Institute of Health Services Research, Utrecht, the Department of Health Services Research, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, and the Dutch Network for Acute Care, Tilburg, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: van Stel
authors.affiliation: From the Netherlands Institute of Health Services Research, Utrecht, the Department of Health Services Research, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, and the Dutch Network for Acute Care, Tilburg, The Netherlands.
authors.forename: Augustinus
authors.initials: A
authors.lastname: Schrijvers
authors.affiliation: From the Netherlands Institute of Health Services Research, Utrecht, the Department of Health Services Research, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, and the Dutch Network for Acute Care, Tilburg, The Netherlands.
authors.forename: Leontien
authors.initials: L
authors.lastname: Sturms
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain; D017060:Patient Satisfaction; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D061665:Time-to-Treatment; D014218:Triage