Running head: ED OVERCROWDING AT GRADY HOSPITAL – A PILOT STUDY

Identifying Key Factors of Emergency Department Overcrowding at Grady Memorial Hospital –

A Pilot Study

Haley A. Love, MPH Candidate

Frank H. Monteith Fellow

University of North Carolina at Greensboro

ED OVERCROWDING AT GRADY HOSPITAL 2

Table of Contents

Introduction…………………………………………………………………………..... p. 3 - 4

Literature Review…………………………………………………………………….... p. 4 - 9

Hypothesis………………………………………………………………………..…... p. 9 - 10

Methods……………………………………………………………………………... p. 10 - 11

Findings and Conclusion..…………………………………………………….....….. p. 11 - 12

Recommendations……………………………………………………………………...… p. 12

Works Cited………………………………………………………………………..... p. 13 - 14

Appendices……………………………………………………………….…………. p. 15 - 23
ED OVERCROWDING AT GRADY HOSPITAL 3

I. Introduction

Grady Health System is “one of the largest health systems in the United States” and is

“the premier Level 1 trauma center in metropolitan Atlanta, (Grady Health System, 2018; 2016).

Grady Memorial Hospital of Grady Health System is committed to providing comprehensive,

culturally competent care to the members of Georgia, with a specific focus on the underserved

residents of Fulton and DeKalb counties, (Grady Health System, 2018). To better serve the

individuals who utilize Grady’s healthcare services, Grady Health System is currently working

on ways to decrease overcrowding in the hospital’s emergency department (ED). According to

Erenler et al.,

“ED crowding can be defined as having more patients than treatment rooms or more

patients than staff should ideally care for, and overcrowding was defined as dangerously

crowded, with an extreme volume of patients in ED treatment areas which forces the ED to

operate beyond its capacity,” (2014).

ED overcrowding is an issue for several reasons. In addition to excessive wait times and

ambulance diversions, ED overcrowding facilitates patients being treated in hallways, violence,

low morale amongst ED staff, decreased capacity for EDs to respond to mass casualties, and

miscommunication amongst ED staff, resulting in error and misdiagnoses, (Paul, Reddy, &

DeFlitch, 2010; Moskop et al., 2009). Unfortunately, Grady Memorial Hospital is one of many

hospitals in the nation that are battling ED overcrowding. Therefore, to develop an effective

solution(s) for decreasing ED overcrowding at Grady Memorial Hospital, it is important to

utilize a multi-level approach when analyzing ED overcrowding, so that all possible causal

factors can be identified and addressed.

ED OVERCROWDING AT GRADY HOSPITAL 4

II. Literature Review

ED Overcrowding in the United States

A literature review of ED overcrowding in the U.S. was developed to gain a better

understanding of ED overcrowding at Grady Memorial Hospital. Four internet searches were

conducted using Google Scholar, with a different combination of terms used each time. For the

first search, the terms, “decreasing emergency room visits” were used. One article from this

search revealed that in the past 15 years from the onset of their study, the need for ED care in the

U.S. had increased, but the number of hospitals decreased, (Moskop, Sklar, Geiderman, Schears

& Bookman, 2009). More specifically, although ED visits increased from 96.5 million to 115.3

million per year, the number of hospital EDs decreased by 381, the number of hospitals

decreased by 535, and the number of hospital beds decreased by 134,000, (Moskop et al., 2009).

This literature search also revealed some underlying causes of ED overcrowding in the

U.S. In their study of ED visits in the U.S. from 1997 to 2007, Tang, Stein, Hsia, Maselli, &

Gonzales (2010) reported that a large proportion of ED visits were from “nonelderly adults with

Medicaid”, representing 253.3 per 1,000 people, (p. 668). Tang et al. (2010) explained that this

population experiences greater difficulties accessing primary care services, which is evident in

the increasing “ambulatory-care sensitive conditions seen in many adults with Medicaid,” (p.

668). Moskop et al. (2009) added that possible reasons for ED overcrowding are the increases in

the U.S. population and the number of people who are insured and uninsured, plus the fact that

technologies used to treat certain ailments are only available at hospitals, (p. 606). Tang et al.

(2010) stated that EDs have become the “safety net of the safety net” as the number of insured
ED OVERCROWDING AT GRADY HOSPITAL 5

people rises in addition to the illnesses they seek treatment for, which could’ve been prevented

through feasible primary care options, (p. 668).

ED Overcrowding at Safety Net Hospitals in the United States

According to the Institute of Medicine, a safety net hospital is comprised of “ ‘providers

that organize and deliver a significant level of both health care and other health-related services

to the uninsured, Medicaid, and other vulnerable populations,’ as well as providers ‘who by

mandate or mission offer access to care regardless of a patient’s ability to pay and whose patient

population includes a substantial share of uninsured, Medicaid, and other vulnerable patients,’ ”

(Office of the Assistant Secretary for Planning and Evaluation, 2013). Due to the status of Grady

Memorial Hospital as a safety net hospital, the second and third search of this literature review

focused on scholarly articles about ED overcrowding at other safety net hospitals in the nation.

The second search focuses on Cook County Hospital in Chicago, Illinois and the third search

focuses on Parkland Memorial Hospital in Dallas, Texas. These hospitals were chosen in

particular because both were and are large, public safety net and teaching hospitals, like Grady

Memorial Hospital.

In the second search, the terms, “cook county hospital” and “cook county hospital

overcrowding” were entered into the Google Scholar database. This search yielded very few

articles relating to ED overcrowding at Cook County Hospital. In fact, the search revealed that

Cook County Hospital is no longer functioning as a hospital and will be rehabilitated into a

shopping center, apartments, and other housing. However, one article, which was featured as a

component of the 2011 Academic Emergency Medicine Consensus Conference entitled

“Interventions to Assure Quality in the Crowded Emergency Department (ED)” held in Boston,

MA, stated that “…Cook County’s ER, …like everything at [Cook] County is so far…it’s
ED OVERCROWDING AT GRADY HOSPITAL 6

behind,” (Schiff, 2011). According to Dr. Schiff, Cook County Hospital’s ER was almost always

overcrowded due to a backup of inpatient overcrowding, (2011). Inpatient crowding or boarding

occurs “when a hospital is full, and emergency department patient who need inpatient care are

‘boarded’ in exam rooms or hallways until an inpatient bed is available,” (Kellerman, 2015). Dr.

Schiff adds that,

“…the causes of crowding are multifactorial. There is a widespread misconception

among the public, policymakers, and the lay press that crowding is primarily caused by large

influxes of patient arrivals to the ED, particularly among the uninsured and/or the poor.

However, studies conducted over the past decade have consistently found that the strongest

predictor of crowding is inpatient bed availability,” (Schiff, 2011).

During the third search, the terms, “parkland memorial hospital overcrowding” were

entered into the Google Scholar database. This search revealed that Parkland Memorial Hospital

is “the main teaching hospital at the University of Texas Southwestern Medical School and is the

largest public hospital in North-East Texas, serving primarily a low-income and indigent

population,” (Rosen, 2006). Dr. Robin Rosen of the Obstetrics and Gynecology Department of

UT Southwestern Medical Center asserts that understanding the reasons why individuals seek

health care services at EDs for nonemergent issues is key in helping to decrease ED

overcrowding. As a result, in 2006, a survey was dispersed at Parkland Memorial Hospital to

understand why women chose to seek services at their OB/GYN ED for nonemergent needs. The

results of the survey revealed that the major reasons participants used the OB/GYN ED for

nonemergent reasons were that “they had no other alternative (14%), had a high level of

confidence in the quality of the care they would receive (31%), availability of all necessary

diagnostic tests (9%), and not having to make a prepayment (8%),” (Rosen, 2006). Additionally,
ED OVERCROWDING AT GRADY HOSPITAL 7

“most subjects overrated the urgency of their condition (80% emergent) when compared to the

rating given by their health care provider (3% emergent),” (Rosen, 2006).

To highlight the severity of ED overcrowding, Edwin Rubenstein’s (2012) article titled,

“The ER Crisis and Immigration,” includes an anecdote detailing the harsh reality of

overcrowding in Parkland Memorial’s ED. In this anecdote, a 58-year old man came into

Parkland’s ED complaining of severe stomach pains, waited 19 hours and died of a heart attack,

(Rubenstein, 2012). In Walls and Bridges: Social Justice and Public Policy, Anthony J. Cortese

states that “in 1990 at Parkland Memorial Hospital, there was a 30% increase in trauma volume,

which threatened to overwhelm an already swamped situation, and thereby lessen the availability

of medical resources to other trauma-related conditions,” (2003). Cortese provides statistics on

the annual volume at Parkland Memorial Hospital, stating that “150,000 people are seen annually

in Parkland Memorial’s ED and 1,500 patients are seen in Parkland’s outreach clinics per year.”

Cortese explains why so many people are seeking services from Parkland Memorial’s outreach

clinics, stating that “due to the lack of primary care for the underprivileged, public clinics are the

only option for many patients,” (Cortese, 2003).

ED Overcrowding at Grady Memorial Hospital

Lastly, I researched emergency department overcrowding at Grady Memorial Hospital. I

used the terms, “emergency department overcrowding Grady Hospital” and “emergency room

overcrowding Grady Hospital,” on Google Scholar. There weren’t many articles on this subject,

but one article by Dr. Kellermann detailed the possible causes of ED overcrowding at level 1

trauma centers with more than 300 beds. Because Grady Memorial Hospital is a state and

nationally certified level 1 trauma center with 957 hospital beds, I found the information

provided in Dr. Kellermann’s article applicable to Grady Memorial Hospital, (American Hospital
ED OVERCROWDING AT GRADY HOSPITAL 8

Directory, 2018). Dr. Kellermann states that some possible causes of ED overcrowding are

decreased hospital staff (i.e. physicians and nurses) and decreased access to emergency services

due to the Emergency Medical Treatment and Active Labor Act (EMTALA), (Kellermann,

2006). EMTALA requires that “patients be screened, and their conditions stabilized regardless of

their ability to pay,” (Paul et al., 2010; Moskop et al., 2009). EDs must also provide care to

“acutely ill and injured patients 7 days a week, 24 hours a day,” (Paul et al., 2010). However,

because there is no funding to pay for EMTALA, many EDs and trauma centers have been

forced to close due to their inability to provide necessary resources for medical care, (Paul et al.,

2010). Additionally, EMTALA “created a perverse incentive for hospitals to tolerate emergency

department crowding and divert ambulances…,” (Kellermann, 2006).

According to ER Wait Watcher’s website, patients who visit Grady Memorial Hospital’s

ED, wait approximately 1 hour and 14 minutes in the emergency room before they are seen by a

physician, (2018). Additionally, patients wait approximately 11 hours and 56 minutes in Grady’s

ED before they are admitted into the hospital, (ER Wait Watcher, 2018). After being admitted

into the hospital, patients wait an additional 7 hours and 7 minutes waiting to be taken into their

room (ER Wait Watcher, 2018).

Top 3 Causes of ED Overcrowding at Grady Memorial Hospital

Based on a review of the literature, the top 3 causes of ED overcrowding at Grady

Memorial Hospital are excessive wait times in the ED, inpatient boarding, and not having

enough resources to address the medical needs of patients (i.e. number of nurses, physicians,

beds, time and money etc.). The causal factors of ED overcrowding at Grady Hospital were also

identified and analyzed using the Socio-ecological Model of Health Promotion to identify

interpersonal, institutional, community and/or policy level factors that affect ED overcrowding at
ED OVERCROWDING AT GRADY HOSPITAL 9

Grady Memorial Hospital. Excessive wait times for patients in the ED is an institutional factor.

Developments in diagnostic procedures which increase assessment times and consequently

patient wait time, like excessive wait times for radiological investigations contribute to ED

overcrowding, (Richardson & Mountain, 2009; Boyle, Beniuk, Higginson, & Atkinson, 2012).

Inpatient boarding is also an institutional factor. Boyle et al. (2012) and Forero, McCarthy &

Hillman (2011) have identified inpatient boarding, as the main cause of ED overcrowding, (p. 2;

p. 1).

A lack of adequate resources in the ED is an institutional factor. Not having important

resources, like a sufficient number of inpatient beds in hospital EDs to meet the high volume of

patients, contributes to ED overcrowding (Richardson & Mountain, 2009). According to Forero

et al., (2011), a “finite-capacity system with variable demand cannot sustain both full utilization

and high availability,” (p. 2). Other resources that contribute to ED overcrowding are staffing of

medical and nursing staff, as well as delays in lab results…,” (Boyle et al., 2012).

III. Hypothesis

Based on the information presented in the literature review and the analysis of the causes

using the Socio-ecological Model, the top 3 causes of ED overcrowding at Grady Memorial

Hospital are institutional factors. However, it would be more impactful to choose another factor

that can realistically be addressed, given the available resources of this research endeavor.

According to the Socio-ecological Model, multi-level factors influence one another. Thus,

addressing an interpersonal factor, patient-provider communication, will influence at least one of

the aforementioned institutional factors and potentially decrease ED overcrowding at Grady

Memorial Hospital.
ED OVERCROWDING AT GRADY HOSPITAL 10

IV. Methods

Data Collection Plan

The Theory of Planned Behavior and Strategic Planning is the framework used for data

collection, data analysis and recommendations for the development of a deliverable. Data was

collected using a mixed methods approach, including surveys and informal conversations. A

convenience sample was used to determine where the surveys would be dispersed and who to

converse with. The surveys were used to collect data from primary care providers who are

partners with Grady Hospital and their patients regarding patient-provider communication.

Informal conversations were held between the stakeholders of Grady Hospital and myself. These

stakeholders are characterized by their attendance at various events hosted by the FDHA and

currently seeing a primary care provider or having seen one in the past.

Surveys

Several organizations that offer primary care services and are partners of Grady Hospital

were emailed a request to disseminate the survey in their facility. The first organization that

responded to the email and granted permission to disseminate the surveys was a women’s clinic

in Atlanta, Georgia, so this is where the surveys were disseminated. Two versions of the survey

were created; one version was typed in English and another copy of the survey was translated

and typed in Spanish using Google Translate. I printed out 20 copies of each type of survey and

placed them on the receptionist’s desk in the waiting area of the clinic. The surveys were

collected each week for a month, however there were no surveys completed during this time. See

Appendix A for the list of survey questions.

Informal Conversations
ED OVERCROWDING AT GRADY HOSPITAL 11

Informal conversations were held with providers from the same organizations where the

surveys were dispersed, and with stakeholders of Grady Hospital who attended various events

hosted by the FDHA and who have or have had a primary care provider. The researcher engaged

in informal conversation with 5 individuals total. Each conversation was no longer than 5

minutes. Providers and patients answered two questions. The questions that providers were asked

differed from the questions patients were asked and no sensitive information was discussed from

either party. The conversation was conducted in a public setting and participants were not audio

or video recorded. The researcher took notes during each conversation. Due to the absence of

quantitative data and the nature of the study’s findings, qualitative data was not analyzed. See

Appendix B for the list of interview questions.

Presentation of Findings

The findings of the pilot study were incorporated into a research paper and an informative

infographic. Findings were reported electronically, via email and verbally to the Chief Operating

Officer (COO) of the Fulton-DeKalb Hospital Authority and via email to a professor at the

University of North Carolina at Greensboro.

V. Findings and Conclusion

Based on the findings of the literature review, patient-provider communication is not a

major contributing factor to ED overcrowding. The literature review revealed that excessive wait

times in the ED, inpatient boarding, and not having enough resources to address the medical

needs of patients are the top 3 major contributing factors to ED overcrowding at Grady Memorial

Hospital. Thus, the researcher was forced to reject the hypothesis of this pilot study. The nature

of the informal conversations supports the rejected hypothesis, so the researcher disregarded the

qualitative data from the informal conversations. There was no quantitative data because there
ED OVERCROWDING AT GRADY HOSPITAL 12

were no survey responses to collect. If there were any survey responses, the researcher would

have to disregard the responses, because the nature of the survey supports the rejected

hypothesis.

VI. Recommendation

Currently, there is not much research on ED overcrowding at Grady Memorial Hospital,

especially on how excessive wait times, inpatient boarding and not having enough resources to

address the medical needs of patients contributes to ED functioning. To effectively address ED

overcrowding at Grady Memorial Hospital, more research should be done on these top 3 factors.

Once there is more information on how each of these factors contributes to ED overcrowding at

Grady Memorial Hospital, it is possible that a multi-level approach could be used to address this

issue and ensure the health of everyone who visits Grady’s ED.
ED OVERCROWDING AT GRADY HOSPITAL 13

Works Cited

(2018). Identification and characteristics. American Hospital Directory. Retrieved from:

https://www.ahd.com/free_profile/110079/Grady_Memorial_Hospital/Atlanta/Georgia/

Bodenheimer, T. (2008). Coordinating care-a perilous journey through the health care

system. New England Journal of Medicine, 358(10), 1064.

Boyle, A., Beniuk, K., Higginson, I., & Atkinson, P. (2012). Emergency department crowding:

time for interventions and policy evaluations. Emergency Medicine International, 2012.

Cortese, Anthony J. (2003). Walls and bridges: Social justice and public policy. Albany, NY:

State University of New York Press.

Erenler, A. K., Akbulut, S., Guzel, M., Cetinkaya, H., Karaca, A., Turkoz, B., & Baydin, A.

(2014). Reasons for Overcrowding in the Emergency Department: Experiences and

Suggestions of an Education and Research Hospital. Turkish Journal of Emergency

Medicine, 14(2), 59–63. http://doi.org/10.5505/1304.7361.2014.48802.

Forero, R., McCarthy, S., & Hillman, K. (2011). Access block and emergency department

overcrowding. Critical Care, 15(2), 216.

Grady Health System. (October 2016). Community Health Improvement Plan.

Grady Health System. (2018). About. Retrieved from:

https://www.gradyhealth.org/specialty/emergency-department/.

Kellermann, A. L. (2006). Crisis in the emergency department. New England Journal of

Medicine, 355(13), 1300-1303.

Moskop, J. C., Sklar, D. P., Geiderman, J. M., Schears, R. M., & Bookman, K. J. (2009). `
ED OVERCROWDING AT GRADY HOSPITAL 14

Silberner, J. (2006, June 15). Uninsured patients, few beds keep ERs maxed out. National Public

Radio, Inc. Podcast retrieved from:

https://www.npr.org/templates/story/story.php?storyId=5486114.

Office of the Assistant Secretary for Planning and Evaluation. (2013). Definition of safety net

hospitals. Environmental Scan to Identify the Major Research Questions and Metrics for

Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals, 5.

Paul, S. A., Reddy, M. C., & DeFlitch, C. J. (2010). A systematic review of simulation studies

investigating emergency department overcrowding. Simulation, 86(8-9), 559-571

Propublica. (n.d.). ER wait watcher. Retrieved from:

https://projects.propublica.org/emergency/hospital/110079.

Rosen, R. (2006). Emergency department utilization by women with nonemergent obstetric and

gynecologic complaints. APHA Scientific Session and Event Listing.

Richardson, D. B., & Mountain, D. (2009). Myths versus facts in emergency department

overcrowding and hospital access block. Medical Journal of Australia, 190(7), 369.

Rubenstein, E. S. (2012). The ER crisis and immigration. The Social Contract, 23(1), 41-45.

Schiff, G. D. (2011). System dynamics and dysfunctionalities: levers for overcoming emergency

department overcrowding. Academic Emergency Medicine, 18(12), 1255-1261.

Tang, N., Stein, J., Hsia, R. Y., Maselli, J. H., & Gonzales, R. (2010). Trends and characteristics

of US emergency department visits, 1997-2007. Jama, 304(6), 664-670.

ED OVERCROWDING AT GRADY HOSPITAL 15

Appendices
Appendix A
Patient-Doctor Communication Survey
Thank you for participating in this survey measuring communication between primary care
doctors and patients. This survey is a part of a project led by a graduate student from the
University of North Carolina at Greensboro. The results of this survey will be used to understand
ways to improve patient care. The survey should take about 10 minutes to complete. Each survey
will remain anonymous and your responses will be kept confidential. Please note: Your
responses to the following questions will not affect the medical care you receive.

1. During the past year, how many times have you visited your primary care doctor?
Circle one option.
a. 0-3 visits.
b. 4-7 visits.
c. 8-10 visits.
d. 10 or more visits.
e. I don’t know.

2. I chose my primary care doctor based on:

Check all that may apply to you.

My insurance.

What hospital the doctor was affiliated with.

Where the doctor’s practice was located.

The friendliness of the office staff.

I heard great things about the doctor from friends, family, and co-workers.

Other_____________________________________________________________________.

I prefer not to tell.

3. Why are you visiting your doctor?

Check all that may apply to you.
ED OVERCROWDING AT GRADY HOSPITAL 16

Back Problem. Psychological Condition.

Cholesterol. Skin Condition.

Chronic Illness. Upper Respiratory Condition.

Diabetes. Yearly Exam [Regular Check Up].

Headache/Migraine. None of these apply to me.

High Blood Pressure. Other____________________________

___________________________________.
Joint Condition.
I prefer not to tell.
Neurological Condition.

4. During the past year, how many times have you visited or have been admitted to the
emergency room?
Circle one option.
a. 1-5.
b. 6-10.
c. 11-20.
d. 20 or more times.
e. I have not been admitted to the emergency room in the past year.

5. When you visit your doctor, what is your level of expectation for how your doctor will
communicate information in a way you understand?
Circle one option.
a. No expectation.
b. Low expectation.
c. Moderate expectation.
d. High expectation.

6. How satisfied are you with your doctor’s understanding of your concerns?
Circle one option.
a. Not at all satisfied.
b. Fairly satisfied.
ED OVERCROWDING AT GRADY HOSPITAL 17

c. Satisfied.
d. Very satisfied.

7. How long does your doctor usually spend with you during your appointment?

Circle one option.

a. 1-5 minutes.
b. 6-10 minutes.
c. 11-15 minutes.
d. More than 15 minutes.
e. The length of my appointment varies/changes.
f. I don’t know.

8. From your own experience, what makes it difficult to communicate with your doctor?
Check all that may apply to you.

My doctor speaks too quickly for me.

My doctor uses terms that I am not familiar with.

My doctor has time constraints.

Gender differences.

Racial or Cultural differences.

Other___________________________________________________________.

I am content with my doctor’s communication and listening skills.

9. How likely would you be to change your primary care doctor because of your level of
satisfaction with their communication and listening skills:

Circle one option.

a. Extremely unlikely.
b. Unlikely.
c. I don’t know.
d. Fairly likely.
e. Extremely likely.
ED OVERCROWDING AT GRADY HOSPITAL 18

10. What is your gender?

Circle one option.

a. Female.
b. Male.
c. Other __________________________________________________________________.
d. I do not want to tell my gender.

11. What is your age?

Circle one option.

a. 18-25.
b. 26-33.
c. 34-41.
d. 42-49.
e. 50-57.
f. 58-66.
g. 67 or older.
h. I do not want to tell my age.

12. What is your ethnicity/race?

Circle one option.

a. African-American/Black.
b. Latino or Hispanic.
c. Asian.
d. Caucasian/White.
e. Native Hawaiian or other Pacific Islander.
f. Mixed or Multiple Ethnicity/Race.
g. Other________________________________________________________.
h. I do not want to tell my ethnicity/race.

Please return this survey to the box on the receptionist’s desk.

Encuesta de Comunicación Entre El Paciente y El Médico

Gracias por participar en esta encuesta que mide la comunicación entre los médicos de atención
primaria y los pacientes. Esta encuesta es parte de un proyecto dirigido por un estudiante
ED OVERCROWDING AT GRADY HOSPITAL 19

graduado de la Universidad de Carolina del Norte en Greensboro. Los resultados de esta

encuesta se utilizarán para entender formas de mejorar la atención del paciente. La encuesta debe
tomar alrededor de 10 minutos para completarse. Cada encuesta permanecerá anónima y sus
respuestas serán confidenciales. Tenga en cuenta que sus respuestas a las siguientes
preguntas no afectarán la atención médica que recibe.

1. Durante el año pasado, ¿cuántas veces ha visitado a su médico de atención primaria?

Marque con un círculo la opción.
a. 0-3 visitas.
b. 4-7 visitas.
c. 8-10 visitas.
d. 10 o más visitas.
e. No estoy seguro.

2. Elegí a mi médico primario basado en:

Marque todos los que apliquen a usted.

…mi seguro.

…el hospital al que estaba afiliado el médico.

…la ubicación de la oficina del médico.

…la amabilidad del personal.

Escuché grandes cosas sobre el médico de amigos, familiares y compañeros de trabajo.

Otro___________________________________________________________________.

No quiero decir.

3. ¿Por qué estas visitando a tu médico?

Marque todos los que apliquen a usted.

Problema de espalda. Diabetes (abuso de azúcar).

Colesterol. Dolor de cabeza / Migraña.

Enfermedad crónica. Hipertensión / Alta presion

sanguínea.
ED OVERCROWDING AT GRADY HOSPITAL 20

Condición conjunta. Examen anual.

Condición neurológica. Ninguno de estos se aplica en mí.

Condición psicológica. Otro__________________________

________________________________.
Condición de piel.
No quiero decir.
Respiratorio superior condición.

4. Durante el año pasado, ¿cuántas veces ha visitado o ha sido admitido en la sala de

emergencias?

Marque con un círculo la opción.

f. 1-5 visitas.
g. 6-10 visitas.
h. 11-20 visitas.
i. 20 o más visitas.
j. Nunca visité la sala de emergencias el año pasado.

5. Cuando usted visita a su médico, ¿cuál es su nivel de expectativa de cómo su médico le

comunique la información en una manera que usted entienda?

Marque con un círculo la opción.

e. Ninguna expectativa.
f. Baja expectativa.
g. Moderada expectativa.
h. Alta expectativa.

6. ¿Qué tan satisfecho está con la comprensión de sus preocupaciones por parte de su médico?

Marque con un círculo la opción.

e. Nada satisfecho.
f. Bastante satisfecho.
g. Satisfecho.
h. Muy satisfecho.

7. ¿Cuánto tiempo su médico suele pasar con usted durante su cita?

Marque con un círculo la opción.

ED OVERCROWDING AT GRADY HOSPITAL 21

g. 1-5 minutos.
h. 6-10 minutos.
i. 11-15 minutos.
j. 15 o más minutos.
k. La duración del tiempo varía.
l. No sé.

8. Según su propia experiencia, ¿qué hace que sea difícil comunicarse con su médico?
Marque todos los que apliquen a usted.

Mi médico habla rápidamente para mí.

Mi médico usa términos con los que no estoy familiarizado.

Mi médico tiene limitaciones de tiempo.

Diferencias de género.

Diferencias raciales / culturales.

Otro______________________________________________________________________.

Yo estoy contento con mi médico de la comunicación y las habilidades de escucha.

9. ¿Qué tan probable sería que usted puede cambiar su médico de atención primaria debido a su
nivel de satisfacción con la comunicación y las habilidades de escucha?

Marque con un círculo la opción.

f. Extremadamente improbable.
g. Improbable.
m. No sé.
h. Bastante probable.
i. Extremadamente probable.

10. ¿Cuál es su género?

Marque con un círculo la opción.

a. Masculino.
b. Hembra.
ED OVERCROWDING AT GRADY HOSPITAL 22

c. Otro____________________________________________________________________
.
d. No quiero decir mi genéro.

11. ¿Cuantos años tiene?

Marque con un círculo la opción.

a. 18-25.
b. 26-33.
c. 34-41.
d. 42-49.
e. 50-57.
f. 58-66.
g. 67 o más.
h. No quiero decir mi edad.

12. ¿Cuál es su grupo étnico/raza?

Marque con un círculo la opción.

a. Afro-Americano/Negro.
b. Latinos o Hispanos.
c. Asiático.
d. Caucásico/Blanco.
e. Nativo de Hawai o de otras islas del Pacífico.
f. Mixto o Varios Etnia/Raza.
g. Otro____________________________________________________________.
h. No quiero decir mi grupo étnico/raza.

Por favor regrese esta encuesta a la caja en el escritorio de la recepcionista.

Appendix B
Interview Questions for Service Providers
1. Walk me through a typical day, starting as soon as you enter the office, ending after your
last patient encounter.
2. Describe how you communicate health information to your patients.
ED OVERCROWDING AT GRADY HOSPITAL 23

3. From your own experience, do you believe that patients communicate their health
concerns effectively (i.e. being truthful about condition, presenting concerns about health
before the condition worsens, etc.) to their primary physicians?

Interview Questions for Patients

1. Walk me through a regular visit to the doctor’s office, starting from the time you enter
the exam room to the time you leave.
2. Have you ever experienced a situation where you didn’t understand what the doctor was
telling you? If so, walk me through what happened and how you addressed this issue.