Date of Graduation

Summer 8-14-2026

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

MSN project

First Advisor

Sierra Dias McEvoy, MSN, RN, CNL, CEN

Abstract

Objective: Nearly 70% of patients in the emergency department (ED) at Hospital X are never roomed and instead wait in the main waiting area for evaluation, results, or disposition. Frequently, without structured updates on their plan of care, expected wait time, or next steps. This communication gap leaves patients feeling forgotten and disengaged from their own care. It is associated nationally with lower satisfaction, increased anxiety, and higher rates of patients leaving without being seen. Context: Hospital X is a mid-sized, community-based acute-care hospital in the Bay Area, California, serving a diverse patient population, with an ED that regularly experiences high census and extended non-roomed wait times, especially evenings and weekends. Aim: To improve communication consistency by 10%  for non-roomed ED patients through structured, low-cost, AIDET®-based interventions targeting root causes identified via fishbone analysis. Intervention: Following a fishbone analysis of root causes, a two-part intervention was implemented: AIDET®-based staff communication training with role-specific script cards, and installed wait-time, patient-facing care pathway materials, and brochures in the waiting room and at the front desk. Outcomes were measured via Press Ganey for communication-related survey items and a custom pre- and post-intervention observation survey. Process measures included training completion and poster placement, with staff-reported workflow burden tracked as a balancing measure. A cost-benefit analysis found total implementation and training costs of $2,213.63, against projected annual cost avoidance of $10,409.23, yielding an estimated annual net benefit of $8,195.60 and a cost-benefit ratio of 4.7. Results: Implementation ran over 30 days from June 29, 2026, to July 29, 2026; formal analysis of pre- and post-intervention data is completed as this cycle closes. Press Ganey results from Hospital X show an increase from 61.4% to 72.7%, while our post-in-service observation staff surveys reported an increase to 15.4% of patients feeling “informed about delays” in their care. Conclusion: Structured, low-cost communication interventions grounded in root cause analysis show potential to improve how informed patients were about delays while waiting. Sustaining these gains will require continued reinforcement, staff buy-in across shifts, and future PDSA cycles addressing equipment- and environment-related barriers this cycle could not resolve.

Keywords: emergency department, patient communication, quality improvement, patient satisfaction, informed delays

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