A Study of Communication and Perceived Quality of Care in the Emergency Department
Advisor: Ms.Munroe
Internship Location: Maimonides Medical Center
Onsite Mentor: Fiona Rivera, Special Projects Coordinator
Hundreds of patients pass through emergency departments frightened, confused, and in pain daily. How staff speak to those patients can matter just as much as how staff treat them. My project examines how provider-patient communication shapes perceived quality of care in a busy urban emergency department, with particular focus on whether emotional attunement and responsiveness to individual patient needs improve patient satisfaction. Drawing on a review of peer-reviewed literature from databases including PubMed and Google Scholar, I plan to administer a 10–15 question patient survey to 100–150 patients at Maimonides Medical Center's Emergency Department (ED). The survey has been tailored to capture specific communication dimensions, such as whether staff acknowledged patients' emotional states, invited questions, or altered explanations to individuals specifically. Rather than measuring general satisfaction alone, I will analyze the responses of my surveys for trends and correlations, while reviewing open ended responses for recurring themes. I expect this project to reveal which communication practices most strongly predict positive patient experiences, and to identify specific gaps in current ED interactions. My conclusion will be used to develop appropriate and applicable recommendations, such as staff training protocols or communication checklists, that could meaningfully improve the ED experience for future patients, with implications for hospital performance under value-based care models.
Project Blog
Week 0: Introduction
Introduction: Week 0 — Who I Am and Why This Project Matters to Me
Hi, my name is Wyatt Amedick and I'm a senior at BASIS Independent Brooklyn. For my Senior Project, I'll be studying how communication between medical staff and patients shapes perceived quality of care in an emergency department, specifically what aspects of communication, and at Maimonides Medical Center in Brooklyn.
My research question: how does communication between medical staff and patients shape perceived quality of care in the ED, and what specific practices can improve patient satisfaction and overall experience?
I've wanted to pursue a career in medicine for as long as I can remember, with a particular interest in cardiothoracic surgery. But before thinking about the operating room, I wanted to understand what it actually means to care for people, in the real world. That's what brought me to Maimonides, where I spent four months volunteering in the ED under the Health Scholars Program.
Those months changed how I think about medicine. I watched staff work incredibly hard clinically, while patients felt scared and ignored simply because no one told them how long they'd be waiting or acknowledged that they were frightened. I also saw staff members take thirty extra seconds to check in emotionally on a patient, and how much that mattered. Those moments are what pushed me toward this topic.
Maimonides isn't an abstract research site to me. I know its hallways and rhythms firsthand, which is exactly why I wanted to bring my project back there. Over the coming weeks, I'll be surveying patients, reviewing literature, and working toward a final presentation with concrete recommendations. I hope you'll follow along.
Project Proposal: https://docs.google.com/document/d/1Je2rGM5i_ARbGgfoNOuRMk9Hcll0RTxqR7kFyksqxaU/edit?usp=sharing
On-Site Location: Maimonides Medical Center Emergency Room, 4808 Fort Hamilton Pkwy, Brooklyn, NY 11219, https://maimo.org/treatments-care/emergency-medicine/
Week 1: Making Everything Official
This week was about taking everything I’d been planning and making it happen. I got in touch with Maimonides to hammer out the on-site details, which days I’d be coming in, where in the ED I’d be able to go, and how surveying patients would fit into a department that’s never unoccupied. There’s a lot to figure out when it comes to patient privacy and staff schedules, so I’m glad we got that sorted early rather than showing up and winging it.
I also got to sit down with the leader of volunteer services, and honestly that conversation was the highlight of the week. I went in thinking it’d be pretty routine, just a formality to get the green light. Instead she really dug into the project with me, asking good questions and pushing back where it made sense. She brought up things I hadn’t thought much about, like how a patient mid-triage is going to respond very differently to being approached than someone who’s been waiting for an hour. That kind of real-world perspective is hard to come by, and it genuinely changed how I’m thinking about a few things.
After that meeting I went back and made some tweaks to the survey. Some of the questions made total sense to me but probably would’ve been confusing to someone who’s stressed and sitting in an ED bed, so I cleaned up the wording and rearranged a few things so it flows better. I also threw in an additional short open-response question at the end for anyone who wants to say something the multiple choice doesn’t cover. I have a feeling those answers are going to be some of the most interesting ones.
Last thing: I registered for additional volunteer hours at Maimonides so everything is officially on the books. With the schedule set, the hours locked in, and a better survey ready to go, I’m feeling pretty good heading into next week when I will hopefully get to start talking to patients.
Week 2: Literature Review and More Communication
As I get closer to launching my project at Maimonides Medical Center, I decided to further ground my work in the existing research on physician-patient communication. The first article I reviewed was Hull and Broquet's 2007 piece in Family Practice Management. It covered the reality that some patient encounters are simply hard. As many as 15% of patient-physician encounters were rated as "difficult" by the physicians involved. With factors like patient anxiety, somatic symptom burden, and even physician stress and burnout all playing a role (AAFP). The article showed me concrete guidance, like active listening and remaining seated during visits, as well as closing with a direct check-in question. These methods are just as applicable in an emergency department as they are in primary care.
The second article I read, a study out of New York, was very helpful. It was conducted with a patient population similar to the one Maimonides serves. Finding that patients arriving at the ED experience sudden disruptions to their routine that can trigger anxiety and fear (PubMed Central) and that a one-size-fits-all communication approach simply doesn't cut it. I learned the different patient mindsets that shape what kind of communication drives satisfaction. That even a few targeted, mindset-matched messages can improve patient-centered communication even in a chaotic ED environment (PubMed Central). Finally, the third article I examined reinforced all of this by looking at the informational needs of patients in high-pressure care settings. Arguing that thoughtfully designed communication procedures benefit both the patients and staff at the systemic level.
Together, these three pieces build a clear picture. Clinicians must manage their own role in difficult encounters. That they need to tailor their communication to the individual patient, and operate within systems that support meaningful interaction. That framework is directly shaping how I plan to approach my time with patients in the ED. On that note, things are also moving forward on the administrative side. I've been communicating more with my on-site advisor about officially beginning work at Maimonides, discussing things like scheduling and orientation requirements. Unfortunately, I was unable to actually get on-site this week. However, the literature I read has given me a stronger foundation, and I'm eager to see how it will hold up in Maimonides' ED.
Works Cited:
Article #1: Hull, Sharon K., and Karen Broquet. “How to Manage Difficult Patient Encounters.” Family Practice Management, vol. 14, no. 6, 1 June 2007, pp. 30–34, www.aafp.org/pubs/fpm/issues/2007/0600/p30.html.
Article #2: Gabay, Gillie, et al. “Personalized Communication with Patients at the Emergency Department—an Experimental Design Study.” Journal of Personalized Medicine, vol. 12, no. 10, 1 Oct. 2022, p. 1542, www.mdpi.com/2075-4426/12/10/1542/htm, https://doi.org/10.3390/jpm12101542.Article #3: Hardavella, Georgia, et al. “Top Tips to Deal with Challenging Situations: Doctor–Patient Interactions.” Breathe, vol. 13, no. 2, 2017, pp. 129–135, pmc.ncbi.nlm.nih.gov/articles/PMC5467659/, https://doi.org/10.1183/20734735.006616.
Week 3: The End of The Beginning
This week, I was finally accepted into the Emergency Medicine Research Department at Maimonides. I am extremely grateful for the opportunity and I cannot wait to start. However, as I will be acting as representative of Maimonides while I interact with patients I must undergo the necessary training and sign forms beforehand. That was the main focus of this past week. Over the days, I worked through the online CITI Program courses Good Clinical Practice, Conflicts of Interest, Biomedical Research, and Clinical Trial Billing Compliance. I completed these courses under the affiliation of Maimonides and as an added bonus I can use the certifications I earn from their completion in other areas of my life. I am happy, and somewhat relieved, to say that I will be able to meet with the Research Administration Director of Emergency Medicine at Maimonides, Antonios Likourezos, and discuss with him in detail both my senior project and the nature of my on-site work for the coming weeks.
In addition to the signing of forms and acquisition of certifications, I have also made some tweaks to the survey I plan to administer to patients, stuff like streamlining the format and making it look more visually appealing. I have also added another language to the scope of my surveys, Spanish, this will allow me to truly know that no patient's opinion will go unheard due to a language barrier. Moving forward, I will be organizing the specifics on my on-site work, specifically times I will be coming in, who I will be working with or under, and cutting through any additional red tape involved with conducting my research. I hope you all continue to follow me through my project and I am very excited to finally transition to its hands-on chapter.
Week 4: Research Takes Shape
I have unfortunately been unable to begin on-site work at the Maimonides ED the fourth week of my project, however, I have made significant progress behind the scenes. My focus has been on understanding and navigating the IRB (Institutional Review Board), which must review and approve my study before I can approach any patients. The IRB is the institutional entity charged with providing ethical and regulatory oversight of research involving human subjects, and the appropriate approvals must be in place before any research protocol can be implemented (ORWH). In short, no one can fill out my surveys until the board signs off. That process takes time (depending on complexity of the study).
Alongside that, I've been further diving into literature, and a few findings have shifted how I'm thinking about my survey design. One of the more standout findings I read comes from research on wait time perception: actual waiting time does not predict overall patient satisfaction in the ED, but the perception of waiting time and quality of information delivery do (PubMed). In other words, a patient who waits two hours but feels kept in the loop can leave more satisfied than one who waits thirty minutes and hears nothing. A separate mixed-methods study put it even more plainly in its title: “Patients just don't want to feel forgotten”. Providing timely, clear updates about delays can significantly improve their satisfaction (PubMed Central). These findings are pushing me to make sure my survey doesn't just ask whether patients received information, but whether that communication made them feel like someone was paying attention to them as a person. I also found research suggesting roughly 12% of medical errors are attributed to communication problems, and that continuous overload in the ED is responsible for reducing staff sensitivity to the emotional needs of patients (PubMed Central). That last point resonates the most with be, because I witnessed it during my months volunteering. The staff were not indifferent, they were overwhelmed.
Moving forward, I'll be editing my survey again in the context of the knowledge I gained this week and preparing the documentation needed for IRB submission, such as a data collection sheet. Once that approval comes through, I'll be heading into the ED under a PI (Principal Investigator) to begin collecting responses, aiming for 100-150 surveys over 2-3 weeks. I hope you'll keep following along as this project finally moves into its hands-on chapter.
Works Cited:
“Institutional Review Board | Office of Research on Women’s Health.” Orwh.od.nih.gov, orwh.od.nih.gov/toolkit/human-subjects-protections/institutional-review-board.
Thompson, David A, et al. “Effects of Actual Waiting Time, Perceived Waiting Time, Information Delivery, and Expressive Quality on Patient Satisfaction in the Emergency Department.” Annals of Emergency Medicine, vol. 28, no. 6, Dec. 1996, pp. 657–665, https://doi.org/10.1016/s0196-0644(96)70090-2
Aswathy Geetha Manukumar, et al. ““They Just Don’t Want to Feel Forgotten”: A Mixed-Methods Research on Patient Satisfaction with Wait Times in Emergency Departments.” Journal of Patient Experience, vol. 12, 1 Apr. 2025, https://doi.org/10.1177/23743735251333213
Abidova, Alina, et al. “Predictors of Patient Satisfaction and the Perceived Quality of Healthcare in an Emergency Department in Portugal.” WestJEM 21.2 March Issue, vol. 21, no. 2, 27 Jan. 2020, pp. 391–403, https://doi.org/10.5811/westjem.2019.9.44667
Week 5: A New Badge and New Faces
This week, things finally started to feel real. On Monday, I made my way to the volunteer office at Maimonides to pick up a new ID badge and jacket, reflecting my official transfer to the Emergency Medicine Research Department. It's a small thing on the surface, but walking out of that office wearing that jacket was a proud moment for me, it made the whole project feel tangible in a way it hadn't before.
From there, I sat down with Antonios Likourezos, the Research Administration Director of Emergency Medicine, to discuss my study in detail: its goals, its methodology, and how we're actually going to pull it off within the walls of a busy hospital. It was an incredibly productive conversation, and it came with some necessary adjustments. One of the biggest changes was that the survey will be administered in English only. Offering it in additional languages would require official translations and a separate layer of institutional approval, which would push back my timeline significantly. We also discussed the additional complications my study might face, that my project must be deemed non-human subject research in order to avoid the months long review process for human subject research. Fortunately, Antonios and his team were confident that due to the anonymous nature of the survey, it would be considered non-human subject research. The language changes are a bit of a disappointment given my original goal of ensuring every patient's voice could be heard regardless of tongue, but they were necessary alongside the additional changes to move the study forward.
Throughout the week, I continued meeting with Mr. Likourezos and his colleagues in Emergency Medicine Research to map out exactly what will be needed to submit the study for IRB review. I also filled out additional forms to gain access to Maimonides' computer system, among other institutional documents. On top of all that, I'm grateful to share that a doctor in the Emergency Medicine department has generously agreed to serve as the Principal Investigator for my study, Dr. Daniel Novak, an attending emergency medicine physician at Maimonides. Having a PI is a requirement for IRB submission, and finding someone willing to take that on, for my high school research study, is extremely significant to me.
Next week, I'll be meeting over Zoom with everyone involved in the process to go over the study together, and if all goes well, IRB approval should follow shortly after. The finish line for the approval process is finally in sight. Once we cross it, the real work begins.
Weeks 6-7: IRB Submission and The Final Green Light
Week 6: IRB Submission
Week 6 was less lively than others. I spent the first two days in online meetings with Antonios and the Emergency Medicine Research team at Maimonides, finalizing all documentation for IRB (Institutional Review Board) review, the formal oversight process required before any research within Maimonides can begin. We went through the consent forms, survey instrument, and study protocol. On Wednesday, we submitted everything. There's something both satisfying and nerve-wracking about submitting something you've worked this long toward.
With the remaining two days freed up, I decided to dig into a question that had been sitting in the back of my mind: how does a suggestion from a researcher actually make its way into official ED policy? I spent those days reading about the process.
A study by Shaikh et al. (2018) published in Cureus examined how ED administrators build and roll out new policies, identifying five broad steps: problem identification, building a policy team, policy construction, implementation and monitoring, and actively addressing barriers. My project could contribute to that first step, the good data that clearly identifies a problem, data that motivates change. But the barriers are real. The same study found that four main obstacles consistently emerge in ED policymaking: education and knowledge transfer, a lack of change culture, resource limitations, and cumbersome bureaucratic structures. On top of that, research on ED quality improvement programs found that clinicians were often resistant to interventions proposed by external sources, even in contexts of high workload and dissatisfaction.
None of this discourages me, it just means I will frame my recommendations in terms of what ED administrators actually care about: patient outcomes and measurable satisfaction metrics. That sums up week 6.
Week 7: A Timeline Check-In, Culminating in The Final Green Light
Week 7 brought two important updates. I started by meeting with my faculty advisor, Ms. Munroe, to map out the project timeline for the coming weeks. It was a grounding conversation we talked through the realistic sequence from IRB clearance through data collection, analysis, and final presentation, and made sure I had a clear idea of how to use the remaining weeks purposefully. Having that structure laid out really helped ease the worry I had about planning the next few weeks.
Later in the week, I checked in with Antonios and the Emergency Medicine Research team about the IRB process. I was told the standard review timeline runs about ten days, which honestly concerned me. With a fixed project endpoint, every week of waiting is a week not spent in the field collecting data and ten days felt like a significant chunk of time to lose.
Thankfully, I received news that changed everything: my project had been officially classified as a healthcare operation by Maimonides Administration, meaning it does not require the full IRB review process. This is an important distinction because projects deemed part of normal healthcare operations, rather than traditional research generating new generalizable knowledge, aren't subject to the same review requirements. I cannot overstate what a relief this is. The data collection phase can now move forward immediately. After weeks of literature review, survey design, documentation, and waiting, I am finally cleared to do the work that sits at the heart of this project, getting into the ED and hearing directly from patients about their experiences.
Sources:
Anaraki, Nahid Rahimipour, et al. “A Qualitative Study of the Barriers and Facilitators Impacting the Implementation of a Quality Improvement Program for Emergency Departments: SurgeCon.” BMC Health Services Research, vol. 24, no. 1, 27 July 2024, https://doi.org/10.1186/s12913-024-11345-w
Week 8: Finally in the Field, and Learning the Hard Way
This week marked a significant turning point in my Senior Project: I finally made it into the Emergency Department at Maimonides Medical Center. Getting there, though, required a fair amount of groundwork first.
The week when I reached out to Antonios and his team at Maimonides to nail down the logistics of administering my surveys. We discussed what my actual interactions with patients would look like: how to approach them, what to say, and what the general flow of a session would be.
On Wednesday, I made a visit to the Emergency Medicine office at Maimonides. I met with the team, asked a few lingering questions, and printed out physical copies of my survey.
Thursday was the day I'd been looking forward to: my first real session in the ED. Unfortunately, it didn't go as planned. Over four hours, I was unable to survey a single patient. Because of my eligibility criteria, I can only approach patients who are waiting to be discharged, meaning they've already been seen and cleared by a physician but haven't yet left. That window of time, I quickly discovered, represents a much smaller fraction of the patient population than I had originally anticipated. The ED is a busy, unpredictable environment, and most patients are somewhere in the middle of their care, not at the end of it.
Friday went considerably better. I returned and managed to collect five responses. It wasn't a large haul, but it was a start. More importantly, I'm beginning to develop a feel for how to identify patients in that discharge-waiting window before it closes and what frequency I should check in with ED doctors to ask if they have any patients waiting for discharge. Timing, I'm learning, is everything. I also received some welcome news this week: I've been given clearance to operate outside of the Emergency Medicine office's standard hours. Given how much time this process requires, waiting, watching, and hoping a qualifying patient appears, that extended access is very valuable. More hours in the department means more opportunities to catch that brief but crucial window.
Week 8 has been a lesson in expectation management. Research in a real clinical setting is messier and slower than it looks on paper, but I'm adapting. Five surveys in one day is progress, and I'm getting better at this with each visit.
Week 9: Into the Routine
Week 9 was spent almost entirely in the field. Each day after school I headed to Maimonides, walking the ED from around 1:00–2:00 PM until 6:00–6:30 PM, collecting survey responses. At this point I've developed a sort of mental interaction chart for how to move through the department effectively. The approach I've found to work the best is to first check in with the doctors in the RCU, the fast-track section of the ED, then move to southside, the section for non-critically ill patients, and ask whether either has any patients waiting on or already cleared for discharge. It took some trial and error to land on, but it's become the most consistent method I have for finding eligible respondents.
I also met with Ms. Munroe this week to discuss my project's final deliverable, which is a separate component from the final presentation. It was a productive conversation that gave me a clearer sense of what's expected of me as my project enters its final stretch.
Thursday brought a new complication. It was the day I received the highest number of patients declining to take my survey, and on top of that, I encountered a notably high number of eligible patients who were non-English speakers. Between refusals and language barriers, it became clear that the pool of patients I can realistically collect responses from is even smaller than I discovered in past weeks. It's a limitation I'll need to address directly in my final work.
At one point during the week I ran into Dr. Daniel Novak, the PI for my study, while collecting surveys in the ED. He mentioned another potential eligibility category I hadn't considered. Patients who had been admitted to the hospital have already completed their time in the ED. I was hopeful this could actually expand my eligible patient pool, but when I followed up with the ED patient representative, I was told there was no reliable way to locate those patients quickly for my specific goals. Unfortunately, that closed the door on what had felt like a promising expansion of my respondent pool.
In Week 10, I'll begin working on both my final presentation and final deliverable while continuing to collect survey responses during my daily visits to Maimonides.
Week 10: Nearing The End
This week was a productive one in all areas.
On Tuesday night, I headed to Maimonides for another round of survey collection, as usual. It ended up being one of my best field sessions yet. Over the course of five hours, I collected nine surveys, which is a lot considering how unpredictable discharge times are. What made this session stand out, though, was the people I got to connect with. Since the doctors and nurses I typically interact with weren't on shift, I ended up working with a different rotation, which gave me the chance to build new relationships I wouldn't have otherwise had. The more time I spend in the ED the more my relationships with its staff grow, and as those relationships have grown collecting surveys has transformed from a waiting game to a shadowing opportunity, on top of data collection.
I did not expect my time at Maimonides to develop into this but it is making my experience both educational and fun.
I also met with Ms. Munroe this week to outline the goals for my senior project deliverable. We agreed on a video that will capture the full arc of this experience. It will cover the trials and setbacks I faced along the way, what went well, my experience with the project, my time at Maimonides, and advice for any future seniors considering a similar path with their project. I’m excited to produce something I can communicate my experience through in a more expressive and candid way. Which words on paper cannot fully expess.
On top of everything else, I made solid progress on my final senior project presentation. I finished the introduction and worked on the presentation's body, particularly the sections dedicated to my process in the field. Getting those sections done early was important, since they represent the core of everything I've been doing. Moving forward, I will be shifting my focus from survey collection to completing both my presentation and deliverable. However, If an opportunity presents itself I will go collect more surveys.
Post 11: Concluding, Refelcting On My Senior Project
Over the past several months, I have been investigating how provider-patient communication shapes perceived quality of care in the Emergency Department at Maimonides Medical Center. What started as an idea rooted in my volunteer experience at Maimonides grew into a full research project. Complete with a literature review, IRB navigation, a custom mixed-methods survey instrument, and in-person data collection on the ED floor. Now that data collection is complete and the final deliverables have been submitted, this post is my chance to look back on everything and share what I actually learned.
The research process was a lot harder to execute than I expected, especially on the fieldwork side. Weeks 8 and 9 made that clear pretty quickly. Identifying eligible patients, meaning those awaiting discharge and willing to participate, was slower and more unpredictable than the numbers on paper had suggested. Refusal rates, language barriers, and the general pace of an active emergency department all pushed back against the timeline I had imagined. At the same time, those challenges were the most educational part of the whole project. Every session left me with a better understanding of what clinical research actually looks like in practice, something no textbook had given me before.
The data itself piqued my interest. Across the 37 surveys collected, communication quality emerged as the strongest predictor of patient satisfaction, consistently outweighing wait time when patients reflected on their experience. Patients who felt emotionally acknowledged by staff were significantly more likely to rate their care as excellent. That finding aligns with the prior research I had reviewed, but seeing it reflected in responses from real patients in a real ED felt different from reading about it in a journal article. It made the project feel worthwhile.
Looking back at the full arc of this project, from when I submitted IRB documentation to standing in the ED hallway with a clipboard, I am glad I chose a topic that was grounded in something I had already experienced firsthand. Ms. Munroe, Antonios Likourezos, and Fiona Rivera were all essential to making this possible, and I am grateful for the access and support Maimonides extended throughout. I have attached by final presentation slides and deliverable for my project below. Thank you everyone for following me and my journey throughout this project.
Final Presentation: Senior Project Final Presentation
Final Deliverable: https://drive.google.com/file/d/1ijUHBP2ie_Y0v1i4wpRwowykkf-mg5Af/view