Support for a waiting room time tracker: a survey of patients waiting in an urban ED.

BACKGROUND: Emergency Department (ED) crowding and inpatient boarding lead to lengthy wait times for patients, which may cause them to choose to leave without being seen. A new initiative to improve communication with patients is to provide an estimated wait time with a "time tracker" display, but it is unclear whether ED patients would welcome this. OBJECTIVE: To estimate the proportion of ED patients who would favor a time tracker display. METHODS: This survey-based study was conducted from March to July 2010 at an urban academic center. After being triaged, patients were asked to answer a multiple-choice questionnaire, asking their preference toward a time tracker display. RESULTS: Of the 375 patients who were approached, 340 (91%) participated. Two hundred fourteen of them (63%) preferred an ED with a time tracker, 53 (16%) were unsure, and 73 (21%) did not prefer an ED with a time tracker. Patients with low-acuity conditions (Emergency Severity Index [ESI] 4 or 5) were 1.2 times more likely (95% confidence interval 1.0-1.4) to favor a time tracker than those with higher acuity (ESI 3). Preference was not related to race, age, insurance status, or employment. CONCLUSIONS: The majority of patients in our study preferred an ED with a time tracker display (63% for vs. 21% against). Support for a time tracker was higher among patients triaged with lower ESI levels (4 or 5). A time tracker is viewed positively by many patients and may be a beneficial addition in the ED waiting room.

Zyxin controls migration in epithelial-mesenchymal transition by mediating actin-membrane linkages at cell-cell junctions.

Development is punctuated by morphogenetic rearrangements of epithelial tissues, including detachment of motile cells during epithelial-mesenchymal transition (EMT). Dramatic actin rearrangements occur as cell-cell junctions are dismantled and cells become independently motile during EMT. Characterizing dynamic actin rearrangements and identifying actin machinery driving these rearrangements is essential for understanding basic mechanisms of cell-cell junction remodeling. Using immunofluorescence and live cell imaging of scattering MDCK cells we examine dynamic actin rearrangement events during EMT and demonstrate that zyxin-VASP complexes mediate linkage of dynamic medial actin networks to adherens junction (AJ) membranes. A functional analysis of zyxin in EMT reveals its role in regulating disruption of actin membrane linkages at cell-cell junctions, altering cells' ability to fully detach and migrate independently during EMT. Expression of a constitutively active zyxin mutant results in persistent actin-membrane linkages and cell migration without loss of cell-cell adhesion. We propose zyxin functions in morphogenetic rearrangements, maintaining collective migration by transducing individual cells' movements through AJs, thus preventing the dissociation of individual migratory cells.

How long are patients willing to wait in the emergency department before leaving without being seen?

INTRODUCTION: Our goal was to evaluate patients' threshold for waiting in an emergency department (ED) waiting room before leaving without being seen (LWBS). We analyzed whether willingness to wait was influenced by perceived illness severity, age, race, triage acuity level, or insurance status. METHODS: We conducted this survey-based study from March to July 2010 at an urban academic medical center. After triage, patients were given a multiple-choice questionnaire, designed to ascertain how long they would wait for medical care. We collected data including age, gender, race, insurance status, and triage acuity level. We looked at the association between willingness to wait and these variables, using stratified analysis and logistic regression. RESULTS: Of the 375 patients who were approached, 340 (91%) participated. One hundred seventy-one (51%) were willing to wait up to 2 hours before leaving, 58 (17%) would wait 2 to 8 hours, and 110 (32%) would wait indefinitely. No association was found between willingness to wait and race, gender, insurance status, or perceived symptom severity. Patients willing to wait >2 hours tended to be older than 25, have higher acuity, and prefer the study site ED. CONCLUSION: Many patients have a defined, limited period that they are willing to wait for emergency care. In our study, 50% of patients were willing to wait up to 2 hours before leaving the ED without being seen. This result suggests that efforts to reduce the percentage of patients who LWBS must factor in time limits.