Document Type


Publication Date

Spring 2022

Date of Final Presentation


Committee Chair

Sara Ahten, DNP, RN, NC-BC

Committee Member

Andrea Lambe, DNP, RN, CEN

Coordinator/ Chair of DNP Program

Pamela Gehrke, EdD, RN

Abstract/ Executive Summary

Problem Description: Emergency Department (ED) patients express decreased patient and family experience (PFE) scores when they feel disrespected (such as experiencing long wait times), experience ineffective communication, or have difficulty accessing care. These issues could lead to inequalities and adverse health care outcomes, especially among those of different races and ethnic backgrounds. The goal of this quality improvement (QI) project was to evaluate the PFE scores and the quality of care of the Hispanic population at a thirty-five-bed emergency department within a freestanding pediatric, academic medical center located in a large urban area.

Rationale: The theoretical framework guiding this QI project was the Leininger’s theory of culture care diversity and universality. This framework allowed for the understanding of cultural similarities and differences to encourage the delivery of culturally consistent care in the promotion of health and well-being. The QI project framework applied the Kellogg logic model for the systematic application of interventions to address the low patient and family experience scores among Hispanic population that utilize the ED.

Interventions: The project purpose applied a multi-tiered approach to examined the impact of ED staff education and training, implementation of interpretation devices, and a patient throughput algorithm (dynamic queuing) on dissatisfactory patient experiences scores within the local ED. The QI project assessed both primary and secondary sources of data to determine the impact of the interventions.

Results: The results identified that implicit bias/inclusion/anti-racism training, video-remote interpreting, and dynamic queuing can enhance patient experience scores. Dynamic Queuing is a standardized algorithm implemented in the electronic health record (EHR), to determine which patients should be placed in an exam room based on a weighted score comprised of their severity of illness and the total time in the emergency department waiting room.

Summary: The multi-tiered approach to addressing patient and family experience scores and the quality of care of the Hispanic population in the ED focused on education, training, interpretation, and overall throughput. The association between the interventions and the outcomes indicated positive results for the majority of the intended outcomes of the QI project; however, further study and correction of COVID-19 contextual elements are needed to solidify specific recommendations.

Conclusions: This QI project demonstrated the benefits of implementing of video-remote interpreting and dynamic queuing in the EHR provide benefits of enhancing patient experience and reducing barriers to care for Hispanic patients

Available for download on Tuesday, October 10, 2023