Impact of Patient-Centered Care Application on Emergency Department Waiting Times and Patient Satisfaction

Introduction

Patient centered care (PCC) refers to healthcare services being provided based on patient relevant holistic needs. PCC incorporates patients in decision making and addresses mental and socioeconomic perspective 1. The significance of this care model is reflected on how it affects health outcomes and resource utilization1,2. Multiple PCC models exist; however they share common processes that achieve effective communication, partnership, and health promotion3. Emergency departments represent a critical point of entry into the healthcare system, characterized by urgent clinical demands, high patient volumes, and time-sensitive decision-making. In such settings, the application of patient-centered care (PCC) is very important , as it has the potential to shape patients’ perceptions of care from the very first encounter.

Conceptually patient centeredness aims to improve patient experience, increase patient awareness through education, engage patient and family in the care plan, build trustful relationship, provide personalized care, and consider psychosocial aspect of care 8 . These elements are related to emergency care, where anxiety, uncertainty, and limited interaction time may heighten the importance of effective communication and individualized support. Globally, PCC has shown positive impact on health and quality outcomes in inpatient, Emergency care, and in primary care setting 9,10,11,12 . A systematic review in the The Middle East and North Africa (MENA )region found that PCC had a positive effect in certain studies, however the concept and practice was found to be limited by multiple barriers 4 .These barriers are relevant to patient education and beliefs, health professionals' attitudes and perception, and organizational environment 4 .

In Saudi Arabia, studies addressing PCC concept, practice, and impact are scarce. In one study, quality of physician–patient communication was a strong predictor of enhanced patient experience 5 . Other local studies addressed the impact of PCC on treatment outcome in rehabilitative setting and diabetes Control in primary healthcare 6,7 . Most studies didn't provide enough insight regarding the PCC practice status in the setting of emergency healthcare. Also the impact of PCC was identified in limited set of health quality outcomes. Emergency care has a crucial public health role due to its direct detrimental effect on people 13 .

Emergency departments (EDs) have an essential role in the provision of medical care to critically ill patients. PCC application in EDs positivly influence clinical outcomes , EDs waiting times ,and patient satisfaction 14,20 . In our region, emergency departments have suffered from long waiting times, delaying emergency patient care 20 . Therefore, identifying the current PCC practices in emergency setting and their impact on waiting times represents an opportunity for quality assessment and improvement of emergency care. Consequently, PCC implementation in emergency departments may play a vital role in improving patient satisfaction and increases the quality of care .

The current study aims to identify which Hospitals are utilizing PCC model in emergency care in Riyadh, Saudi Arabia. Also, the study aims to assess the impact of PCC practice on emergency department waiting times and patient satisfaction in Riyadh, Saudi Arabia.

Objectives:

• Identify hospitals that have applied a patient-centered care model.

• Identify the relationship between patient-centered care application and emergency department waiting times.

• Identify the relationship between patient-centered care application and patient satisfaction.

Methodology

This is a retrospective, nonexperimental study to evaluate the impact of patient-centered care model application on patient satisfaction and the EDs waiting times. This study was conducted to evaluate hospitals with the same types of patients, standardized organizational (quality), and a regulatory compliance program. These are Minisrty of Health (MOH) affliated hospitals and practice patient centered care model which is guided by (Saudi Standards for Human Centered Care) . The study included 34 hospitals , the Cluster (A) have (14) hospitals, Cluster B (9) hospitals and Cluster C (11) hospitals . Data source of EDs (waiting time) is (ADAA Seha) MOH database.The patient satisfaction scores were collected from PressGaney evaluations for these hospitals. Statistical nalysis were carried out using SPSS v26. Adescriptive data analysis was conducted to present the percentage of the application of PCC and patient satisfaction among cluster’s hospitals in Riyadh Region. In additon, this anlysis was used to show the mean of the four key indicators of the quality outcome in emergency healthcare among clusters. For infrential analysis, paired sample t test was used to explore how complaince to PCC made difference in patient satisfaction. Furthermore, Anlysis of variance ( ANOVA) was utlized to explore the differences in waiting time in ED, patient satisfaction and complaince to PCC.

Ethical Consideration

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and the national regulations governing research involving human subjects in Saudi Arabia. Ethical approval was obtained from the Ministry of Health Institutional Review Board (IRB), Riyadh, Saudi Arabia. The IRB reviewed and approved the study protocol, including the use of secondary administrative and survey data. As the study utilized retrospective, de-identified data with no direct contact with patients, the requirement for informed consent was waived by the IRB. All data were handled confidentially, stored securely, and used exclusively for research purposes. No personal identifiers were accessed or reported, ensuring full protection .

Result

Hospitals were categorized into groups based on geographic zones within Riyadh region. The result in table (1) shows , a total of 34 were included in the analysis: 14 hospitals Group ( A ), 9 in Group ( B ), and 11 in Group ( C ). The application of patient-centered care varied among the hospitals in different Groups. Notably, 67.6% of the hospitals received an "excellent" score, while 20.6% received a "very good" score based on (Saudi Standards for Human Centered Care) .Also, the result revealed a significant relationship between hospitals Groups (A,B,C) and the compliance to the patient-centered care model ( χ²(6) = 15.4, p = .017).

Table 1: compliance levels of Person-centered care criteria
Group	Excellent	Very good	good	Weak
A	10	2	0	2
B	9	0	0	0
C	4	5	2	0
Total	23	7	2	2

The patient journey in the emergency department begins with the "door to doctor" time and culminates with "disposition." The following table (2) , illustrate the time taken for patients to receive the necessary care in emergency departments across hospitals in the three Groups over four years (2021 – 2023). The practical implications of the observed time differences, particularly in the context of emergency care where even small reductions in waiting time may influence patient flow, perception of care, and overall satisfaction.

Table 2: Waiting time in Emergency Department
KPIs	Hospital Groups	2021	2022	2023
Door to doctor	A	0:14	0:12	0:11
B	0:22	0:30	0:20
C	0:08	0:07	0:07
Doctor to Decision	A	1:21	0:46	0:41
B	1:28	0:49	0:41
C	0:45	0:15	0:15
Decision to disposition	A	1:01	0:59	0:45
B	1:36	1:32	1:02
C	0:34	0:27	0:23
Door to disposition	A	2:16	1:42	1:39
B	2:52	2:28	2:18
C	1:15	0:44	0:48
*the mean score of waiting time KPIs in emergency department

Table (3), shows a general upward trend in patient satisfaction across all hospital groups between 2021 and 2024, indicating overall improvement in patient experience over time. Hospital Group A demonstrated the most consistent and substantial increase, rising from 63.92 in 2021 to 79.74 in 2024, suggesting steady enhancements in service delivery. Hospital Group B, however, showed a fluctuating pattern, with a slight decline in 2022 before gradually improving to 70.09 in 2024, which may reflect operational challenges or variable performance during the early years. Hospital Group C also exhibited marked improvement, particularly between 2022 and 2023, ultimately reaching 79.47 in 2024, indicating significant progress in patient experience. The patient satisfaction scores have shown a steady increase over the past four years. The lowest satisfaction score was recorded in 2021 for Group ( A ) hospitals, while the highest was in Group (B ). By 2024, patient satisfaction in both Group ( A ) and Group ( C ) hospitals reached 79.

Table 3: Patient Satisfaction Scores in Hospitals Groups
Hospital Groups	Satisfaction\Years
2021	2022	2023	2024
	A	63.92	66.16	72.23	79.74
B	67.94	64.98	69.25	70.09
C	65.15	69.13	77.47	79.47

Satisfaction score:

• Also, the study revealed a significant difference in satisfaction scores between 2021 and 2023. A paired sample t-test was ( t(33) = -5.9, p < 0.05). Additionally, there were significant differences in patient satisfaction in 2024 among hospitals groups ( F = 5.3, p = .01 ) . The result indicated that satisfaction means were higher for hospitals groups ( A ) and ( C ).

Waiting time score:

This study revealed no differences in EDs waiting time among hospitals groups in 2021. However, significant differences were observed in 2022 that Doctor to Decision was ( F = 3.6, p = .03) ; Decision to Disposition (F = 4.3, p = .022) and Door to Disposition ( F = 5.3, p = .01). In 2023, significant differences were noted in Door to Disposition (F = 4.2, p = .023). In 2024, there were no significant differences in EDs waiting time related to Door to Doctor times (F = 1.7, p = .21).

The result indicated that Group (C ) had shorter patient trip times in the emergency department across all three measures compared to the other Groups.

The correlation between satisfaction and waiting time

The result showed a correlation between patient satisfaction and EDs waiting time for 2023 . In the first quarter, a negative weak correlation was found between EDs waiting time and patient satisfaction. The same negative (r = -0.031; weak correlation was observed in the second quarter for Door-to-Doctor (r = -0.159) and Doctor-to-Decision outcomes (r= -0.108) . Overall, these findings suggest that shorter times for patients receiving emergency care are associated with higher satisfaction rates.

The complaince to PCC and patient satisfaction:

• The result showed no significant differences in patient satisfaction based on the compliance to applying of patient-centered care among the groups. On the other hand, there was a relationship between compliance and Satisfaction. The Pearson correlation coefficient between Compliance and Satisfaction is (r = 0.066), indicating a weak positive relationship. The p-value is (0.765), which is far above the conventional significance threshold of 0.05.This suggests that the weak positive relationship observed is not statistically significant, and it could have occurred by chance.

The complaince to PCC and ED waiting time:

• The provided data includes results from Independent Samples t-tests to compare group means between the compliance to PCC and waiting time . the test revealed that waiting time interval of Door to Doctor is Not significant difference while Door to Disposition The mean difference (1:09) is statistically significant.

• This result provides Pearson correlation coefficients to explore relationships between variables related to the compliance to PCC and waiting time . the test shows significant positive correlations with; Doctor to Decision (r = 0.501, p = 0.015); Decision to Disposition (r = 0.417, p = 0.048) and was Door to Disposition (r = 0.478, p = 0.021). The result show Door to Doctor (r = -0.221) indicates a weak negative correlation.

Disscussion :

Recent studies emphasize that patient-centered care not only improves satisfaction but also positively impacts health outcomes 15,16 . Other studies indicated that the quality of interactions during care and staff training in communication skills can also influence overall patient satisfaction 17,18 .

A study conducted in Saudi Arabia highlighted that prolonged patient waiting times and dissatisfaction pose a risk to poor health outcomes 20 . A study conducted in Saudi Arabia involving 100 patients found no significant difference in waiting time satisfaction scores between patient groups. Additionally, demographics and illness perception had no notable impact on satisfaction. The study also revealed that the majority of participants (70%) preferred having an estimated waiting time 21 .

Regarding PCC appplication specifically within emergency departments (EDs) ,an article by Walsh et al. (2022) conducted a systematic review on patient-centered care in such setting. The findings suggested that incorporating patient-centered practices can lead to better health outcomes, increased patient satisfaction, and more effective use of resources 19 . Our study found a strong application of patient-centered care across hospitals involoved in the study.Additionally, found a correlation between emergency care times and satisfaction where efficient care leads to improved patient experiences.

However, we found a lack of statistically significant differences in patient satisfaction based on patient-centered care model application suggesting a need for deeper exploration into PCC qualitative aspects and other factors affecting patient experience in these hospitals. In this study the results of Independent Samples t-tests that used to compare group means for compliance with PCC and waiting times. The analysis shows no significant difference in the "Door to Doctor" waiting time, while the "Door to Disposition" interval has a statistically significant mean difference. Pearson correlation coefficients were used to examine relationships between compliance with PCC and waiting time variables. The analysis reveals significant positive correlations for Doctor to Decision, Decision to Disposition , and Door to Disposition. A weak negative correlation is observed for Door to Doctor.

In summary, multiple research highlighted the positive effects of patient-centered care (PCC) on patient satisfaction and health outcomes. Our study showed strong PCC implementation in the participating hospitals and found a correlation between emergency care times and patient satisfaction. However, there is the need for further exploration of qualitative aspects of PCC application and other influencing factors. The current study is inherently limited by design to capture depth and complexity of this topic and challenged by inability to control for confounding variables that could have affected study results and findings.

Limitations

PCC is a self-assessment tool, and given the limitations in the generalizability of the results, we recommend replicating this study in diverse cultural settings to evaluate the impact of PCC implementation on waiting times and ED patient satisfaction levels. The early phase of PCC standards implementation necessitated the use of this approach. Factors such as variations in hospital service types, geographical capacity, and population demographics may influence the effectiveness of PCC, satisfaction levels, and waiting times. The press Ganey surveys, while widely used and validated, may not fully capture all dimensions of patient experience and may be subject to response bias.

Recommendation

We need for broader, multi-center studies to enhance generalizability, as well as qualitative research to explore how these standards are implemented in practice.

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Appendex A : Tables

Table 1: compliance levels of Person-centered care criteria
Group	Excellent	Very good	Good	Weak
A	10	2	0	2
B	9	0	0	0
C	4	5	2	0
Total	23	7	2	2

Table 3 Patient Satisfaction Scores in Hospitals Groups
KPIs	Hospital Groups	2021	2022	2023
Door to doctor	A	0:14	0:12	0:11
B	0:22	0:30	0:20
C	0:08	0:07	0:07
Doctor to Decision	A	1:21	0:46	0:41
B	1:28	0:49	0:41
C	0:45	0:15	0:15
Decision to disposition	A	1:01	0:59	0:45
B	1:36	1:32	1:02
C	0:34	0:27	0:23
Door to disposition	A	2:16	1:42	1:39
B	2:52	2:28	2:18
C	1:15	0:44	0:48
*the mean score of waiting time KPIs in emergency department

Hospital Groups	Satisfaction\Years
2021	2022	2023	2024
	A	63.92	66.16	72.23	79.74
B	67.94	64.98	69.25	70.09
C	65.15	69.13	77.47	79.47