S3815893: Leah Mazzone
EMERGENCY DESIGN
Redesigning the waiting experience in Emergency Departments
“How might we reduce the impact of environmental stressors on patients while improving information flow through the use of a patient-centred app?�
DESIGN PROPOSAL
We need to improve the patient experience within Victorian Emergency Departments.
We are creating a patient-centred mobile application that reduces the impact of environmental stressors and improves communication systems within Victorian Emergency Departments.
The Victorian Government has acknowledged the need to improve the patient experience. Australian patients found the waiting time, environment and communication to be the most stressful parts of their experience.
Our proposed application mitigates these factors whilst providing transparency between hospitals and individuals, improving the overall patient experience.
3
CONTENTS 06
INTRODUCTION
08
PART 1: RESEARCH ACTIVITIES
10
RESEARCH
14
CURRENT PATIENT JOURNEY MAP
16
CASE STUDIES
22
PART 2: THE DESIGN INTERVENTION
24
PROPOSED PATIENT JOURNEY MAP
26
HOW WOULD IT WORK?
28
APPLICATION OVERVIEW
30
LOGO & IDENTITY
32
DIGITAL QUEUE MANAGEMENT SYSTEM
33
AUDIO VISUAL INTERVENTIONS
37
IMPROVING THE INFORMATION FLOW
38
FURTHER CONSIDERATIONS
39
CONCLUSION
40
REFLECTION
42
REFERENCES
4
Leah Mazzone Leah Mazzone is an Industrial Design
Leah recently worked for fashion
student fascinated with emerging
and wearable technology designer,
technologies and how they might aid
Nixi Killick. She also interned for
sustainable design practices. She
contemporary dance company
is particularly interested in how we
“Chunky Move� in the wardrobe
can design thoughtfully and without
department and with set and
waste.
exhibition designer, Anna Tregloan.
She comes from a background in
She is hopeful to merge these
graphic, prop and costume design.
skillsets into her current practice to
She completed her Bachelors of Fine
work on future sustainable wearable
Arts (Production Design Realisation)
technology.
in 2018.
01: RESEARCH ACTIVITIES
6
INTRODUCTION
The role of service design in facilitating healthcare is vital to creating functional healing environments within Australia. Around 20% of patients experience acute emotional distress upon Emergency Department (ED) admission (Faessler et al., 2019). This can have serious repercussions as stress has been linked to longer recovery times, health complications, and negative health outcomes (Schweitzer et al., 2004.). Our team aims to improve the patient experience within Victorian Hospitals by introducing a patient-centred app, that accompanies patients throughout their hospital stay. It aims to reduce the impact of environmental and sensory stressors on patients by redesigning the patient waiting experience. It does so by implementing a digitalised queue management system (DQMS), introducing audio-sensory distractions and improving communication flow. It executes these strategies to reduce uncertainties, occupy time and clarify information resulting in decreased perceptions of waiting times and patient anxieties.
7
THE CURRENT The Victorian Government identified
and Quality in Health Care, 2015)
enhancing the experience of ED patients
Reports concluded that small adjustments
and visitors as one of ten priorities in their
in the Australian Healthcare system could
2009 major policy on Emergency Care.
provide substantially improved care.
This occurred after a 2004 audit, consumer
These adjustments included changing the
research and literature reviews recognised
way health professionals engaged with
the need for state-wide improvement. It
patients, including inviting the patients to
recognised that physical environments can
be more involved in the decision making
significantly impact patient experiences
and discussion surrounding their treatment
and health outcomes and the importance
and care. (Victorian State Government
of a positive patient experience. (Victorian
Department of Human Services, 2009).
State Government Department of Human
• Standardising consumer information materials and fact sheets to ensure patients are better informed about their care • Improving and upgrading waiting room facilities • Consistent signage in all Victorian EDs • Improving recording measurements • Improved volume and accuracy of patient satisfaction
Services, 2009). Further Australian reports have since explained a positive patient experience is identified as a core component of an optimal health care system, leading to improving the health of the population and per capita costs of care. (Australian Commission on Safety
The question is, can a patient focused app help improve this system?
8
Australian Triage system
SYSTEM Currently, Australian hospitals use a face-to-face triage and form completion system. The patient is then required to actively listen as they wait for their name to be called; this presents several issues. A paperbased system increases staff workload and shifts staff focus away from patient assessment which reduces efficiency.
This system also requires patients to listen for extended periods as they wait for their name to be called. This requires them to be actively present and unoccupied in a stressful environment. Studies have demonstrated the adverse effects this can have on patients. These include patients focusing on worrying about their condition, leaving before treatment and perceiving increased waiting times which add to anxiety levels. (Beukeboom et al., 2012).
9
IMPACT OF NOISE IN HOSPITALS Noise levels in hospitals have been
privacy or lead to communication errors. Good
documented as a worldwide issue. They
acoustic environmental design is critical for
have been found to consistently breach
stakeholder safety and wellbeing. Research
World Health Organisation (WHO) Standards
has found a variety of implementations such
on recommended maximum noise levels.
as noise reducing architectural features
Studies have found excessive noise to have
and music therapy can decrease anxiety
multiple negative impacts on stakeholders
and provide positive distraction for patients.
in healthcare environments. (Joseph &
(Bowman & Jones, 2016; Holm & Fitzmaurice,
Ulrich, 2007; Short et al., 2011) For patients,
2008)
this can include sleep loss, elevated blood pressure, slower healing times, and increased likelihood of rehospitalization.
For staff, this can include emotional exhaustion, miscommunication, increased fatigue and increased perceived pressure, stress and agitation. Acoustic environments, when poorly designed can also threaten
10
A study examining the noise levels within Victorian Emergency departments found the results to be particularly alarming. It’s findings showed that multiple locations within hospitals, particularly ED’s breached Australian and WHO standards over 90% of the time. The Chart (on the left) shows the breakdown of observed noise in Australian ED’s. Human conversation was the most significant, at 45%. (Short et al., 2011)
These studies findings supported the notion that noise levels in Australian Emergency departments are a significant contributor to a stressful, negative patient experience. Further investigation into noise reducing implementations to improve patient outcomes within Australian EDs is now needed (Joseph & Ulrich, 2007; Short et al., 2011).
11
LANGUAGE BARRIERS Current data shows
in patients, due to fear of missing
communication errors to be one of
medically critical information, and
the most significant issues within
rightly so (Meuter et al., 2015).
the Australian healthcare system (Australian Commission on Safety
Studies suggest providing higher-
and Quality in Health Care, 2015).
quality information to patients could reduce anxiety levels (Harrison et al.,
Evidence suggests patients
2015).
not fluent in English are more vulnerable to health complications
Could an app facilitate a clear and
due to these language barriers.
accessible information flow for
Language discrepancies increase
patients throughout hospitals?
levels of psychological stress
12
OPERATIONAL TRANSPARENCY Hospitals are very complex buildings. Poor navigational systems can lead to increased stress, confusion and dissatisfaction. They also take a hidden toll on Hospital’s, from lost time from staff members assisting patients and visitors. This complexity, when paired with patients experiencing stress and limited mobility, negatively impact patient’s experiences, add to a stressful experience and put pressure on their already vulnerable coping strategies. Wayfinding systems are what assist patients in navigating the Hospital. The image below displays the current Victorian Guidelines for Hospital signage (Victorian State Government Department of Human Services, 2009).
As of yet, few Australian Hospitals are yet to utilize digital tools to assist patients.
13
CURRENT PATIENT JOURNEY MAP
14
15
Based off of The Auckland Design for Health & Wellbeing Patient Journey map project.
DESIGN PRECEDENTS: “THE O” Designed for MONA (The museum of Old and New art), “The O” acts as an intuitive digital companion for visitors. When visitors enter MONA they are each equipped with an iPod Touch and headphones or asked to download it as an app. It replaces to MONA’s wall texts, offering details about nearby artworks and the artists behind them audially instead. It also allows visitors to save their favourite works to their account and give feedback about the art they liked and disliked. The digital system is brilliantly integrated into the museum, enhancing the customer experience.
16
NOISE-REDUCING PANELLING
Current methods to promote better healing environments in Australian hospitals focus on architectural features such as noise reducing panels and calming nature-based arts (Beukeboom et al., 2012; Schweitzer et al., 2004.).
Many hospitals already use noise reducing panelling architecture. Woven image creates particularly interesting panels, as shown above. THey are generated by animated algorithms and designs for floor to ceiling wall applications. They provide acoustic benefits by reducing noise and also provide pleasant visual stimulus.
Although these contribute to a more positive experience, are there opportunities to reduce noise whilst also improving other issues within the patient waiting experience?
17
SKIPLINO
they are at the front of the line.
Skiplino is a Queue management system
and visually appealing animated graphics to
and app that allows businesses to manage
provide a pleasant customer experience.
customer queues efficiently. It can monitor
Services such as RMIT Connect offer a similar
real time queuing data, collect customer
feature, alerting customers they are next
feedback and efificently collate statistics.
in queue via SMS. The SMS offers a prompt
It allows customers to book their ticket
personal notification, that is harder to miss
and receive their number via SMS or the
and less obtrusive to the patient.
Skiplino also uses a soft pastel colour palette
app. The business can notify the customer they are next in line via notification.
Could a similar system be implemented
Customers can also book their spot in
within Hospitals, especially ED’s? The
queues before they’ve left their house, and
implementation of a digital queue
update their ETA via the app if they are
management system (DQMS) in hospitals
running late. Skiplino will then put them a
could reduce the risk and anxieties of patients
couple of spots behind in the queue. They
missing their spot in the long wait to see a
will then be notified via their device when
doctor.
18
CURRENT RESOURCES
The Victorian Government ED brochure (can be seen above) is part of an initiative to improve the patient experience. It is intended to better inform patients about the ED process. The current information provided by the State Government outlines how ED’s work within Victoria from a patient’s perspective.
Through utilizing the material in this brochure, we can ensure our information is aligned with State Government guidelines. Integrating this information within the app could also improve its accessibility to patients. Our app would aim to redesign this information in a more engaging, user friendly format.
19
PATIENT TOUCH Patient touch is a mobile application and platform that unifies clinical communications between frontline healthcare staff. Its aim is to get rid of multiple hospital staff communication devices that lead to confusion, miscommunication and overcommunication. It diverts all notifications into one inbox, within the phone. It aims to improve patient safety and satisfaction. The image below shows just how many communication devices run within Hospitals. It provides a useful dashboard that reports weekly statistics.
Can we create an app with similar goals to unify communication that focuses on information flow between hospitals and patients?
20
UBER EATS
and Uber lost customers because of it. The upgrade has improved the delivery estimate for users by
Uber Eats is a well-known and
breaking it into a five-step tracking
popular food delivery service,
bar for customers. It knew process
that recently underwent a design
features aesthetically pleasing
upgrade. Its goal was to be more
animations breaking the process
transparent and to humanize the
into five components and bring
experience of waiting for delivery.
more operational transparency to
Their design team found users to
customers. Which has been found
be frustrated from the uncertainty
that customer frustration has
of where their order was. This was
significantly eased since this was
especially so when the delivery
implemented. In turn, consumer
time would be pushed back and
confidence in the service has
customers wouldn’t know why
increased.
21
02: THE DESIGN INTERVENTION 22
PROPOSAL
I undertook this project because I saw this gap in the market on healthcare service design that focused on reducing perceived waiting times and improving communication flow within the patient experience.
We want to develop an intervention that improves the patient experience, by reducing the impact of environmental stressors and provide accessible information to patients.
The Australian healthcare system at present, struggles to meet all needs physical and mental needs of patients. New technology, such as mobile applications, offer an opportunity to assist healthcare systems. They have the potential to reduce the pressure off healthcare workers and better inform and engage patients.
“Well�, a patient-centred mobile application aims to do as such, by acting as a digital companion, accompanying patients throughout their stay. Its features target three main areas:
23
PROPOSED PATIENT JOURNEY MAP
24
This journey map focuses on a patient experiencing non life-threatening health concerns and is under the age of 40.
25
HOW WOULD IT WORK? 01
ASSESSMENT The patient first presents themselves to Triage upon arrival for assessment.
02
The Triage Nurse assesses them and asks patients with non lifethreatening conditions to download “Well”
03
The nurse fills out initial information on their database that generates a profile that “Well” can connects to whilst it downloads
04
The nurse prints a ticket with the patient’s QR code and number that will log them into “Well”
05 06
For patients without phones, an Ipad is provided for the duration of their stay. Some patients, particularly senior citizans, would not feel comfortable using a mobile application to assist their care. The old system would still need to be in place to assist patients who would not like to use “Well”.
WAIT When the patient opens the app, the first screen reads “Welcome to the Emergency Department”, allows them to choose their preferred language and enter their first name. “Well” can assist in translating information to patient’s who are not fluent in English.
26
07
08 09 10 11 12 13 14
They are instructed to put in their headphones for an audial guide if they would prefer.
Patients without headphones will be given a pair for the duration of their stay.
The patient’s first name is confirmed and notified that staff will now contact them electronically via a series of notifications from “Well’s” DQMS when they are next in line. The patient can engage with Well’s selection of music, meditations, white noise, stories and podcasts or listen to their own content without fear of missing their name call. The patient can read information on the ED process, FAQs or fill out supplementary information whilst waiting. CARE If the patient is admitted, in between waiting for doctors and test results, they can continue to engage with the app’s audial features. The patient can view an estimated wait time outlining approximately how long till the next doctor appointment, or the average time it takes for blood results to come through. The patient can now enter information such as dietary information, and access information such as Doctor names and Ward numbers. They can view an interactive map to help navigate wards and exits of the hospital.
27
APPLICATION OVERVIEW “Well’s” features can be broken down into three main components: Improving the waiting time, environment and information flow. It targets this by implementing a digitalised queue management system (DQMS), introducing audio-visual distractions and improving communication flow. It executes these strategies to reduce uncertainties, occupy time and clarify information resulting in decreased perceptions of waiting times and patient anxieties. The target audience is patients under 60 years of age with non life-threatening conditions.
1. SERIES OF NOTIFICATIONS SENT WHEN THE PATIENT IS NEXT IN QUEUE 2. ALLOWS PATIENT TO
01: DIGITAL QUEUE MANAGEMENT SYSTEM (DQSM)
DISENGAGE FROM SURROUNDING ENVIRONMENT 3. REMOVES PRESSURE OF MENIAL TASKS FROM STAFF
1. MUSIC, PODCASTS, WHITE NOISE, MEDITATIONS & STORIES 2. PLEASANT GRAPHICS 3. TRANQUIL COLOUR SCHEME 4. SIMPLISTIC “DIN” TYPEFACE 5. VISUAL DISABILITY FRIENDLY OPTION
02: AUDIAL VISUAL INTERVENTIONS
1. HOSPITAL TO PATIENT COMMUNICATION 2. 2. PATIENT-HOSPITAL INFORMATION 3. STAFF-STAFF INFORMATION
03: IMPROVING THE INFORMATION FLOW
4. TRANSLATION ASSISTANT 5. INTERACTIVE MAPS
29
WELL
LOGO IDENTITY For the logo name, I wanted to connect the goal of promoting wellness with the visual tranquility of water. The name “Well” stemmed from “The water well”. which seemed fitting for two reasons: Firstly, it ties in with the healing properties of water and the tales of ancient healing wells. Secondly, the well ties in with the ease-disease spectrum. A full well representing ease and an empty, representing dis-ease.
For the motif, I worked with a few main ideas: a waterdrop, water well, a wave and the “essence” of water.
I chose the water “orb” on the left as it wasn’t as distincly water focused. It conveyed a well-rounded and relaxed atmosphere, illustrating the calming effect the application is supposed to induce.
Below are some iterations of “Well’s” home page.
31
1: DIGITAL QUEUE MANAGEMENT SYSTEM “Well” implements a DQMS allowing the patient to disengage from the ED environment and facilitates a more comfortable waiting experience. This system lets patients be alerted to their turn via lead up notifications and enables patients to digitally fill in secondary information whilst waiting.
Shifting the waiting environment to a digitalised check-in system has the potential to reduce patient stress levels and improve information flow.
Partial automation of the check in system shifts unnecessary and repetitive workload off trained healthcare workers, to better focus on patient assessment.
The interface’s DQMS enables patients to engage with other stress
2: AUDIO-VISUAL INTERVENTIONS Another stress reducing feature of the app is allowing greater patient control of the audio-visual environment.
The app aims to reduce the negative audial impact on patients by providing pleasant audio environments for the patient to engage with. The interface includes music, podcasts, meditation sessions and white noise, enabling patients to disengage from the noisy waiting room environment.
A side benefit of this audial intervention could be a reduction in waiting room noise. More patients may be less less likely to be talking with others whilst they listen for their name. This could improve staff communication and reduce noise stressors for patients not using the interface.
33
COLOUR PALETTE The interface colour scheme will comprise of an analogous palette of green and blue hues. This may provide issues for patients with visual impairments so contrasting text, or a visual disability-friendly option, may need to be incorporated.
Stakeholders may prefer the app to represent specific hospital colour schemes, so this will need to be an option included as well. Colour is a powerful tool for navigation and communication and “well” will be designed to use colour as an engaging component in communicating key information to patients.
Colour is a critical component in customer interaction with an interface’s elements, by helping users engage and understand its content (Dalke et al., 2006).
3: IMPROVING THE INFORMATION FLOW “Well” provides a number of digital communication resources to support the patient journey. It is designed to deliver important information in a more accessible, centralised and simplified user-centred platform.
It targets information flowing between staff, hospital to patient and vice versa.
Hospital to patient communication resources: -Estimated wait times. This will provide a general guide outlining where the patient is within their journey, similar to Uber Eats’ method. Greater operational transparency has been shown to reduce perceived wait times and patient anxieties with minimal consequences in healthcare settings. (Soremekun et al., 2011). -Interactive map. -Outlines of basic procedures, such as the Emergency Department process, and how procedures such as CT scans and blood tests within the hospital environment work. -Personalised information. This includes Doctor names, room numbers and mealtimes.
36
Patient to Hospital resources: -Personalised information: Dietary requirements, preferred names. -Customer experience surveys. These have been identified as integral to improving the healthcare system and the patient experience. Staff to staff information: -Provides a user-centred platform for doctors to cross check information. This is critical as most errors within Australian hospitals occur from miscommunication between wards.
Language translation -Providing a user centred digital platform enables the information to be translated into multiple languages. This will enable patient’s whose first language is not English, to have a greater sense of security.
37
FURTHER CONSIDERATIONS It should be noted that providing iPhones and headphones to patients who have not brought their own could pose a challenge. This could be costly to hospitals and provide hygiene issues. However the proposed benefits, such as reduced length of patient stay, and improved patient health outcomes may even these initial concerns out.
Further consideration into patients with visual and hearing imparments need to be considered.
Initial integration of the system needs to be considered carefully. If this is not done well, Triage Nurse’s will find themselves with more work, having to explain why patient’s should download this app. This may be rushed, resulting in less patient’s being willing to download.
The integration of “Well” with the current Triage system needs more development. Some patients, especially of the older demographic, may not feel comfortable using the app. “Well” needs to integrate seamlessly and complement the current system.
CONCLUSION
Further potential includes integrating it within multiple sectors of Victorian hospitals.
There is not enough support for patient and staff wellbeing within Victorian hospitals. The waiting experience, environment and staff-patient communication are areas of particular concern. Greater control over the patient’s environment, sensory experience and access to information, is a powerful opportunity to elicit positive change.
Through diminishing the effect of environmental stressors and reducing perceived waiting times, “Well” aims to improve the patient experience.
We have the potential to evolve Victorian hospitals towards a modern healing environment that caters for all.
39
GENERAL I really enjoyed and valued this project. I have been hoping to develop my research, writing and referencing
BOOKLET
skills and I have become much more
I am a little disappointed with the
confident in them due to this. I didn’t
booklet as I had hoped to format
comprehend how much I would enjoy
it better. I again, fell into my usual
researching, and before this project, I
tendency of getting overwhelmed
would not have known where to start.
with ideas but got caught up and
Upon reflection, I now understand why
overcomplicated it. On the other hand
the three assessments are laid out the
though, I did improve my InDesign,
way they are. They helped me build
Photoshop and Illustrator skills, which
my knowledge and ideas. In future I
I always appreciate working on.
think I would use this format again, first starting with design precedents,
DESIGN IMPLEMENTATION
critical annotations and summarising
I enjoyed researching into app design.
them into one document.
Its something I haven’t ventured into before, and never considered
I had not heard of critical annotations
but found it quite enjoyable. I would
before this subject but now am quite
have liked to have spent more time
excited to use them in future, as they
on my design implementation and
help me summarize my findings well.
customer journey map but found that
This is especially important for me,
formatting this booklet to took up all
as I find I get really excited reading
of my time. I’m still quite happy with it
multitudes of papers, but until now,
as I hadn’t made a customer journey
haven’t known how to collate my
map before and feel comfortable
findings, other than within confused
creating improved versions in future.
Word documents.
Constructing a current and future
REFLECTION journey map helped me visualise how
that job to fall on the Triage Nurse.
the app would work in real-time much
Accessibility for people with disability
better than my previous attempts. It
and elderly citizens also need to
helped me realise plot holes and gaps
be further considered. However, I
in my ideas, that I didn’t know were
don’t think figuring some of these
there. In future, I’d like to create one
larger issues out was necessarily the
earlier in my process, most likely at
intention for this assessment.
the end of the research stage as I found it very valuable.
I would like to undertake another service design subject in upcoming
This exercise helped me understand
years if possible as I’d like to learn
other considerations I didn’t have time
more. I hadn’t considered service
to go into detail within this timeframe.
design as a potential interest until
This included how the app would
I started skimming the surface of it
connect to the Hospital’s database,
within this subject and would really
which poses major privacy concerns.
like to delve deeper in future. This was
Another issue, was that patients
the first project that presented the
aren’t necessarily going to be willing
opportunity to focus on designing for
to download an app, especially when
healthcare, which I have always found
in various levels of pain and distress.
particularly interesting. This subject indicated to me that I would like to
An advertising plan would have to
continue exploring this healthcare
be rolled out to explain its benefits,
design within my future studies.
because the last thing needed is for
41
REFERENCES Australian Commission on Safety and Quality in Health Care. (2015). Evidence check: Patient’s experiences in Australian hospitals. Sax Institute. https://www.safetyandquality. gov.au/sites/default/files/migrated/Patients-Experiences-in-Australian-Hospitals-rapidreview-of-the-evidence.pdf Beukeboom, C. J., Langeveld, D., & Tanja-Dijkstra, K. (2012). Stress-reducing effects of real and artificial nature in a hospital waiting room. Journal of Alternative and Complementary Medicine, 18(4), 329–333. https://doi.org/10.1089/acm.2011.0488 Bowman, S., & Jones, R. (2016). Sensory Interventions for Psychiatric Crisis in Emergency Departments-A New Paradigm. J Psychiatry Ment Health, 1(1). https://doi.org/10.16966/ jpmh.103 Dalke, H., Little, J., Niemann, E., Camgoz, N., Steadman, G., Hill, S., & Stott, L. (2006). Colour and lighting in hospital design. Optics and Laser Technology, 38(4–6), 343–365. https://doi.org/10.1016/j.optlastec.2005.06.040 Dijkstra, K., Pieterse, M., & Pruyn, A. (2006). Physical environmental stimuli that turn healthcare facilities into healing environments through psychologically mediated effects: systematic review. Journal of Advanced Nursing, 56(2), 166–181. https://doi.org/10.1111 /j.1365-2648.2006.03990. Ekwall, A. (2013). Acuity and anxiety from the patient’s perspective in the emergency department. Journal of Emergency Nursing, 39(6), 534–538. https://doi.org/10.1016/j. jen.2010.10.003 Faessler, L., Brodbeck, J., Schuetz, P., Haubitz, S., Mueller, B., & Perrig-Chiello, P. (2019). Medical patients’ affective well-being after emergency department admission: The role of personal and social resources and health-related variables. PLOS ONE, 14(3), e0212900. https://doi.org/10.1371/journal.pone.0212900 Harrison, R., Walton, M., & Manias, E. (2015). Patients’ experiences in Australian hospitals: a rapid review of evidence. https://doi.org/10.1071/ah16053 Holm, L., & Fitzmaurice, L. (2008). Emergency Department Waiting Room Stress. Pediatric Emergency Care, 24(12), 836–838. https://doi.org/10.1097/PEC.0b013e31818ea04c Karlin, B. E., & Zeiss, R. A. (2006). Best Practices: Environmental and Therapeutic Issues in Psychiatric Hospital Design: Toward Best Practices. Psychiatric Services, 57(10), 1376–1378. https://doi.org/10.1176/ps.2006.57.10.1376
Ortiga, J., Kanapathipillai, S., Daly, B., Hilbers, J., Varndell, W., & Short, A. (2013). The Sound of Urgency: Understanding Noise in the Emergency Department. Music & Medicine, 5(1), 44–51. https://doi.org/10.1177/1943862112471999 Schweitzer, M., Gilpin, L., & Frampton, S. (2004). Healing spaces: Elements of environmental design that make an impact on health. Journal of Alternative and Complementary Medicine, 10(1), 71-88. https://doi.org/10.1089/acm.2004.10.s-71 Short, A. E., Short, K. T., Holdgate, A., Ahern, N., & Morris, J. (2011). Noise levels in an Australian emergency department. Australasian Emergency Nursing Journal, 14(1), 26–31. https://doi.org/10.1016/j.aenj.2010.10.005 Soremekun, O. A., Takayesu, J. K., & Bohan, S. J. (2011). Framework for analyzing wait times and other factors that impact patient satisfaction in the emergency department. Journal of Emergency Medicine, 41(6), 686–692. https://doi.org/10.1016/j. jemermed.2011.01.018 Taylor, D. M., Wolfe, R. S., & Cameron, P. A. (2004). Analysis of complaints lodged by patients attending Victorian hospitals, 1997–2001. Medical Journal of Australia, 181(1), 31–35. https://doi.org/10.5694/j.1326-5377.2004.tb06157. Victorian State Government Department of Human Services. (2009) Improving the Patient Experience Program. Health Victoria. https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/acute-care/ emergency-care/patient-experience-in-eds/improving-the-ed-experience Vuilleumier, P. (2005). How brains beware: Neural mechanisms of emotional attention. In Trends in Cognitive Sciences, 9(12), 585-594. https://doi.org/10.1016/j.tics.2005.10.011 Weiland, T. J., Jelinek, G. A., Macarow, K. E., Samartzis, P., Brown, D. M., Grierson, E. M., & Winter, C. (2011). Original sound compositions reduce anxiety in emergency department patients: A randomised controlled trial. Medical Journal of Australia, 195(11), 694–698. https://doi.org/10.5694/mja10.10662
43