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The disconfirmation paradigm: throughput times and emergency department patient satisfaction
Emergency Medicine Publications and Presentations
  • Tara N. Cassidy-Smith, University of Medicine and Dentistry of New Jersey
  • Brigitte M. Baumann, Cooper University Hospital
  • Edwin D. Boudreaux, University of Massachusetts Medical School
UMMS Affiliation
Department of Emergency Medicine
Publication Date
Document Type
Cross-Sectional Studies; Emergency Service, Hospital; Female; Humans; Interviews as Topic; Male; Middle Aged; *Patient Satisfaction; Prospective Studies; Questionnaires; Time Factors; Triage

This study examined the relationship between throughput times, expectations, and patient satisfaction using the Disconfirmation Paradigm (DP), which proposes that dissatisfaction arises when service expectations are not met. Before discharge or admission, adult emergency department (ED) patients estimated how long they waited for three intervals (Perceived Times): triage to patient care area, patient care area placement to physician evaluation, and physician evaluation to disposition. Acceptable waiting times and satisfaction for the same intervals were then provided by the subject (Acceptable Times and Throughput Time Satisfaction, respectively). Perceived Times were subtracted from Acceptable Times to yield an index of Expectancy Disconfirmation. There were 1118 (72%) of 1550 eligible patients interviewed. Throughput Time Satisfaction predicted overall satisfaction (r = 0.56 to 0.62, p < 0.001). In turn, Expectancy Disconfirmation predicted Wait Time Satisfaction (r = 0.42 to 0.64, p < 0.001). Consistent with the DP, when throughput times exceeded expectations, dissatisfaction with those throughput times arose, leading to general dissatisfaction with the ED visit.

DOI of Published Version
J Emerg Med. 2007 Jan;32(1):7-13. Link to article on publisher's site
At the time of publication, Edwin Boudreaux was not yet affiliated with the University of Massachusetts Medical School.
Related Resources
Link to Article in PubMed
PubMed ID
Citation Information
Tara N. Cassidy-Smith, Brigitte M. Baumann and Edwin D. Boudreaux. "The disconfirmation paradigm: throughput times and emergency department patient satisfaction" Vol. 32 Iss. 1 (2007) ISSN: 0736-4679 (Linking)
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