Wait Times Research Articles

Factors Influencing Time to Definitive Care in Hip Fracture Patients in a Rural Health System.

Current literature has not adequately addressed factors affecting wait times for hip fracture surgery in the rural setting. This study aims to assess the factors affecting admission, transit, and preoperative wait times that impact the timeliness of hip fracture surgery within a rural health system. A single-center retrospective cross-sectional study was conducted in a rural community comprising five community hospitals and two receiving hospitals. A trauma registry study included all hip fracture cases from 2019. Mean, standard deviation, median, and interquartile range were calculated for admission wait times, transit times to the receiving hospitals, and preoperative wait times in hours. Metrics based on means or medians were developed for these wait times. A total of 163 patients met the inclusion criteria. The emergency department wait times before and after admission to the community hospitals were 1 hour and 2.5hours, respectively. The transit times from the community hospitals, ranging from shorter to farther distances, to receiving hospitals were 40minutes and 1 hour, respectively. The preoperative wait time for admitted and transferred patients was 12hours. Our study outlines a methodology for establishing wait time metrics that impact surgical timeliness for hip fracture patients within a rural healthcare system. We recommend conducting comparable studies with larger sample sizes across different healthcare systems.

The effect of primary language on access to specialized orthopedic care

BackgroundLanguage barriers can negatively impact the quality of care for non-English speaking patients. Lack of access to health-care providers who speak multiple languages or interpreters in medical offices can result in delayed appointment times, delayed treatment, and increased complications. Access to shoulder surgeons with subspecialty training is limited and this has been established which may further exacerbate the problem with access for these patients. The purpose of this study was to determine the effect of primary language spoken on access to specialty shoulder care in South Florida. MethodsThree populous, diverse counties in South Florida were selected for data collection. Sixty-nine orthopedic offices were identified by Google search and selected via random number generator. Investigators used the Secret Shopper methodology to contact each office to schedule an appointment for a shoulder arthroplasty for a family member who spoke exclusively English or Spanish using a blocked phone number. The ability to schedule a new patient appointment with a fellowship-trained shoulder specialist, the waiting period for the scheduled appointment, and interpretation services for Spanish-speaking patients were collected. ResultsOf the 69 offices called, 35 met inclusion criteria. There were no significant differences in wait times for shoulder arthroplasty based on primary language spoken. There was no difference in wait time to see a shoulder specialist between Spanish (13.7 days) and English-speaking patients (12.9 days) (P = .835)). Wait times with a nonfellowship-trained orthopedic surgeon between Spanish and English-speaking patients was also not different (9.5 days and 11.96 days, respectively (P = .522). Similarly, no difference existed in phone call duration (P = .56), median income and wait times for a general orthopedic surgeon, with r = −0.26 (P = .105), or a shoulder specialist, with r = −0.19 (P = .22). Of the clinics accepting patients, 74.3% (n = 26/35) offered Spanish interpretation with 42.3% (n = 11/26) providing a multilingual physician, 26.9% (n = 7/26) a translating service, 23.1% (n = 6/26) had a staff member capable of translation, and 7.7% (n = 2/26) had an available professional interpreter. ConclusionWhile access to orthopedic specialty care may be similar for Spanish-speaking and English-speaking patients in South Florida, over 25% of clinics lack multilingual physicians or qualified interpreter access. This can negatively impact surgical decision-making, postoperative care and outcomes after shoulder surgery. It is essential the orthopedic community advocates for the proper resources to optimally assist surgeons and provide quality care for Spanish-speaking orthopedic patients.

Outpatient Factors Implicated in Timing of Delayed Elective Inguinal Hernia Repair in Premature Neonates: Single Center Analysis Brings Up a Touchy Issue and Balancing Metric

IntroductionAmong premature infants, the incidence of inguinal hernias (IH) has been reported to be as high as 10–30%. We performed this study to characterize the association between individual and systemic variables that may affect diagnosis to definitive operative repair of the premature neonatal IH in the outpatient setting. MethodsA single center cohort retrospective review analyzing IH repair in the premature neonatal (<37 GA) population was performed. Data was collected between 2013 and 2022. The cohort was defined as patients who underwent repair before the age of 1 and excluded patients with major medical comorbidities or underwent simultaneous major abdominal surgeries. ResultsOf the 836 premature neonates who underwent IH repair, the majority (73%) were repaired electively. Patients were characterized into risk cohorts a-priori. High-risk patients (HR, n = 43) were more likely to have Government insurance (67%). There was a significant difference in HR patient time to surgery between Government versus Commercial insurance, 10.6 versus 4.7 days, respectively (95% CI -11.09 to −0.4396, p = 0.0345). HR patients were also seen more frequently (clinic or emergency department) prior to operative repair (2.51 vs 1.72 95% CI –1.296% to −0.289%, p = 0.0021). A multivariate linear regression model demonstrated that risk class (p = 0.0244), touches (p < 0.0001), GA (p < 0.001), and prior authorization (p < 0.0001) were significantly associated with time to hernia repair. ConclusionsSystemic variables such as insurance type may increase average wait time for elective outpatient IH repair. This increase in wait time is associated with an increased number of healthcare visits. Therefore, timely access to surgical care prevents potential harm and may decrease health system burden. Type of StudyRetrospective comparative study/cohort study. Level of EvidenceIII.

Prospective Pilot Study: Tolerability of Outpatient Penile Plication Under Nursing-Administered Conscious Sedation vs Anesthesiologist-Administered Deep Sedation.

Penile plication is commonly performed for Peyronie's disease under general or spinal anesthesia. Conscious sedation (CS) offers decreased anesthetic risks, cost-effectiveness, and the ability to perform the procedure in outpatient settings with shorter wait times. We sought to compare tolerability of penile plication under deep intravenous sedation (DIS) administered by anesthesiologists and nursing-administered CS (NACS). Tolerability for penile plication was prospectively evaluated, excluding revision surgeries and those with hourglass or hinge deformities. DIS included midazolam and ketamine with infusion of propofol and remifentanil. NACS consisted of midazolam and fentanyl. Baseline characteristics, procedural information, and patient- and surgeon-reported pain assessments were collected. Patients were administered a standardized tolerability questionnaire on follow-up. Forty patients were enrolled (23 DIS; 17 NACS) with similar baseline characteristics. Median curvature of the DIS cohort was 55° (interquartile range = 43.75-76.25) and 45° (interquartile range = 45-60) in NACS. There was a 100% success rate with no procedure abortion or conversion to general anesthetic. On follow-up, all patients had functional curvature (<20°), and 100% of patients in the DIS and NACS cohorts reported that they would recommend CS to others. Over 93% of patients in both cohorts would choose CS over general anesthetic in the future, with no differences in perioperative and postoperative pain between groups. Penile plication with CS, whether administered by an anesthesiologist or nursing, is well tolerated with no differences in pain or complications. This indicates that outpatient penile plication with trained nursing staff administering CS can safely reduce costs, risks, and wait times.

The Effect of Insurance Type on Time to Anterior Cruciate Ligament Reconstruction in Pediatric Patients: A Critically Appraised Topic

Clinical Scenario: Delay in surgery for anterior cruciate ligament (ACL) injuries increases the risk of complications including secondary injuries. Previous research has shown individuals with public insurance have greater delays in care for a variety of health conditions. Clinical Question: In pediatric patients with ACL injuries, is the time from injury to surgery longer for patients with public insurance than patients with private insurance? Summary of Key Findings: Four studies met the inclusion criteria. All studies reported a greater wait time for surgery in pediatric patients with public insurance. Clinical Bottom Line: There is moderate evidence indicating that there is a delay in ACL surgery for pediatric patients with public insurance compared to those with private insurance. Strength of Recommendation: Grade B evidence exists that there is a delay in surgery for ACL injuries in pediatric patients with public insurance compared to those with private insurance.

Pengaruh Short Waiting Time, Interpersonal Communication, Environment, dan Service Quality Terhadap Tingkat Kepuasan Pasien di Poli Gigi RSUD Kanjuruhan, Kabupaten Malang, Jawa Timur

This study aims to determine the effect of the variable SHORT WAITING TIME, INTERPERSONAL CUMMUNICATION, SERVICE QUALITY , Service quality on patient satisfaction at RSUD Kanjuruhan’s Dental Clinic. The model of this research was tested on a population of outpatients who had received treatment using a purposive sampling technique and obtained a sample size of 389 people in the period 15 November 2023 – 15 February 2024. Data collection was carried out online via a Google Form questionnaire using a Likert scale of 1 -5. The analysis method uses the SEM-PLS (Structural Equation Modelling based on Partial Least Square) technique using the SmartPLS 4.0 application. The results of this study show that: (1) there is a significant positive effect between short waiting time and patient satisfaction at RSUD Kanjuruhan’s Dental Clinic, (2) there is a significant positive effect between interpersonal communication and patient satisfaction at RSUD Kanjuruhan’s Dental Clinic Poly, (3) there is the influence is not positive and not significant effect between environmentand patient satisfaction at RSUD Kanjuruhan’s Dental Clinic, (4) there is a significant positive effect between service quality and patient satisfaction at RSUD Kanjuruhan’s Dental Clinic

Recommendations for Recovery of the COVID-19 Pandemic-related Diagnostic, Screening, and Procedure Backlog in Ontario: A Survey of Healthcare Leaders.

The COVID-19 pandemic has resulted in a significant diagnostic, screening, and procedure backlog in Ontario. Engagement of key stakeholders in healthcare leadership positions is urgently needed to inform a comprehensive provincial recovery strategy. A list of 20 policy recommendations addressing the diagnostic, screening and procedure backlog in Ontario were transformed into a national online survey. Policy recommendations were rated on a 7-point Likert scale (strongly agree to strongly disagree) and organized into those retained (≥75% strongly agree to somewhat agree), discarded (≥80% somewhat disagree to strongly disagree), and no consensus reached. Survey participants included a diverse sample of healthcare leaders with the potential to impact policy reform. Of 56 healthcare leaders invited to participate, there were 34 unique responses (61% response rate). Participants were from diverse clinical backgrounds, including surgical subspecialties, medicine, nursing, and healthcare administration and held institutional or provincial leadership positions. A total of 11 of 20 policy recommendations reached the threshold for consensus agreement with the remaining 9 having no consensus reached. Consensus agreement was reached among Canadian healthcare leaders on 11 policy recommendations to address the diagnostic, screening, and procedure backlog in Ontario. Recommendations included strategies to address patient information needs on expected wait times, expand health and human resource capacity, and streamline efficiencies to increase operating room output. No consensus was reached on the optimal funding strategy within the public system in Ontario or the appropriateness of implementing private funding models.

Existing and Evolving Therapies for Arteriovenous Fistula and Graft Dysfunction

A functional vascular access (VA) is of paramount importance to patients on hemodialysis therapy. While arteriovenous fistula (AVF) remains the preferred VA, their long-term patency is unpredictable. A dysfunctional VA contributes to a high morbidity rate, an increased susceptibility to major adverse cardiovascular events, recurrent hospitalization, and a poor quality of life. The recent innovations in devices and technologies have significantly expanded our options to create and prolong VA patency. Endovascular devices such as WavelinQ and Ellipsys are recent additions to creating a VA. The endovascular creation of AVF helps reduce the wait time and potentially avoids or reduces the duration of catheter use. The bioengineered graft and immediate access arteriovenous graft offer reasonable alternatives in a select group of patients. There is growing evidence that covered stents and drug-coated balloons offer options to prolong the VA patency. Finally, the role of stem cell therapy in VA is currently being explored. This article presents a comprehensive review of the conventional and current developments in the management of a dysfunctional VA.

The lived experiences of transgender and gender-diverse people in accessing publicly funded penile-inversion vaginoplasty in Canada.

Canada's health care systems underserve people who are transgender and gender diverse (TGD), leading to unique disparities not experienced by other patient groups, such as in accessing gender-affirmation surgery. We sought to explore the experiences of TGD people seeking and accessing gender-affirmation surgery at a publicly funded hospital in Canada to identify opportunities to improve the current system. We used hermeneutic phenomenology according to Max van Manen to conduct this qualitative study. Between January and August 2022, we conducted interviews with TGD people who had undergone penile-inversion vaginoplasty at Women's College Hospital, Toronto, Ontario, since June 2019. We conducted interviews via Microsoft Teams and transcribed them verbatim. We coded the transcripts using NVivo version 12. Using inductive analysis, we constructed themes, which we mapped onto van Manen's framework of lived body, lived time, lived space, and lived human relations. We interviewed 15 participants who had undergone penile-inversion vaginoplasty; they predominantly self-identified as transgender women (n = 13) and White (n = 14). Participants lived in rural (n = 4), suburban (n = 5), or urban (n = 6) locations. Their median age was 32 (range 27-67) years. We identified 11 themes that demonstrated the interconnected nature of TGD peoples' lived experiences over many years leading up to accessing gender-affirmation surgery. These themes emphasized the role of the body in experiencing the world and shaping identity, the lived experience of the body in shaping human connectedness, and participants' intersecting identities and emotional pain (lived body); participants' experiences of the passage of time and progression of events (lived time); environments inducing existential anxiety or fostering affirmation, the role of technology in shaping participants' understanding of the body, and the effect of liminal spaces (lived space); and finally, the role of communication and language, empathy and compassion, and participants' experiences of loss of trust and connection (lived human relations). Our findings reveal TGD patients' lived experiences as they navigated a lengthy and often difficult journey to penile-inversion vaginoplasty. They suggest a need for improved access to gender-affirmation surgery by reducing wait times, increasing capacity, and improving care experiences.

The Effect of Preoperative Waiting Time on Prognosis and Outcome of Colorectal Cancer Patients: Retrospective Cohort Analysis

The Effect of Preoperative Waiting Time on Prognosis and Outcome of Colorectal Cancer Patients: Retrospective Cohort Analysis

613 Utilisation of Off-Site Theatre Capacity to Reduce the Waiting Time for NHS Patients with Chronic Deep Venous Disease in the Post Covid-19 Pandemic Environment

613 Utilisation of Off-Site Theatre Capacity to Reduce the Waiting Time for NHS Patients with Chronic Deep Venous Disease in the Post Covid-19 Pandemic Environment

Analyzing diagnostic and treatment wait times for lung cancer Patients: Key insights from a provincial registry study

BackgroundLung cancer (LC) remains the leading cause of cancer-related mortality globally, necessitating timely diagnosis and treatment to improve patient outcomes. This study aimed to evaluate the timeliness of care for LC patients at a public hospital in Almería, Spain, assess adherence to guidelines, and explore associations between timeliness and survival. MethodsA retrospective cohort study was conducted, reviewing medical records of LC patients diagnosed between 2019 and 2021. Quality indicators, adapted from prevailing guidelines, facilitated the assessment of care timeliness, with a focus on diagnostic and treatment wait times. Cox regression modeling was employed to explore survival associations, adjusting for covariates including age, performance status, stage, histology, and treatment modalities. ResultsOf 539 patients included, most (79.84 %) had initial specialist contact within 7 days, and 82.25 % received diagnosis within 30 days. However, delays were observed in treatment initiation, with surgery experiencing the longest median wait time (78 days). Survival analysis showed no significant difference between shorter and longer diagnostic (HR: 0.87, 95 % CI: 0.62–1.24) or treatment intervals (HR: 1.14, 95 % CI: 0.83–1.58). Multivariate analysis identified age, performance status, stage, histology, and treatment as prognostic factors. ConclusionThis study highlights the importance of timely diagnosis and treatment in improving lung cancer outcomes. Despite achieving diagnostic targets, treatment delays were common, particularly for surgical interventions. These findings underscore the need for enhanced coordination and efficient care pathways to minimize delays, ultimately improving survival rates and quality of life for lung cancer patients. Addressing these issues is crucial for optimizing lung cancer care delivery in the future.

Implementing the Certainty Factor Method in a Dental Disease Expert System

Health, including dental and oral health, is a fundamental human necessity often overlooked by many. Dental and oral diseases can affect anyone unexpectedly, underscoring the critical need for timely professional advice from dentists based on symptoms presented by patients. Various factors contribute to the reluctance in seeking dental consultations, including inadequate awareness of oral health importance, financial constraints, and discomfort from lengthy wait times. This research proposes an Expert System utilizing the Certainty Factor method to diagnose dental diseases efficiently. The Certainty Factor method quantifies the certainty or uncertainty of facts within expert systems. Through computational analysis of multiple symptoms, the system accurately diagnosed a patient with Tooth Faktur disease with a high certainty level of 98.8%. Such an expert system promises to significantly aid dental professionals in diagnosing diseases promptly, facilitating appropriate treatment interventions.

Can Nationwide Central Appointment Systems Reduce Waiting Times in Turkish Public Hospitals?

Health service delivery is an important component of a well-functioning health system. To achieve a competitive healthcare system, healthcare should be provided on time to avoid delays that could harm the patient. In this respect, patient wait time is an important indicator of health services delivery performance. Countries develop national or regional booking systems to manage patient wait times and healthcare delivery resources more efficiently. In this study; the effect of a national booking system on outpatient wait times in Turkish public healthcare settings was investigated. This study was conducted using anonymized national outpatient data sets for the year 2016 with permission from the Republic of Turkey Ministry of Health. The data was analyzed after pre-processing and transformation. As a result of the study, patient wait times were calculated, analyzed and evaluated according to province and facility care levels (secondary or tertiary). Results showed that in 2016, only 30.69% of outpatient visits had appointments and that the average waiting time for patients with appointments was 11.18% shorter than for patients without appointments. The results of this study fill a gap in the literature as almost no studies have investigated this issue due to a lack of administrative and clinical data and will provide important evidence for the improvement of health service delivery systems.

Bridging distances and saving costs: insights from a pilot project of telerheumatology in a rural area of Pakistan.

Enhancing access to healthcare remains a formidable challenge in rural regions of low- and lower-middle-income countries. Amid evolving healthcare challenges, telerheumatology provides opportunities to bridge gaps and expand access to rheumatology care, particularly in remote areas. We describe a pilot telerheumatology program and its cost-, time-, and travel-saving potential in a remote rural setting in northern Pakistan. The telerheumatology program commenced at the Pakistan Institute of Medical Sciences Islamabad, providing services through video consultations to a basic health unit in the Gilgit-Baltistan region. Patients visiting from the Gilgit-Baltistan region willing to participate were recruited in the program. Demographics and logistical metrics were recorded in a dedicated registry. A total of 533 consultations were carried out from April 2022 to April 2023. The majority of the patients were female (318/533, 59.7%). The median age of patients was 50 ± 15.7 years. The average wait time for consultation was 20 ± 13 min. The average travel time to reach telecentre was 59 ± 53 min. The average travel cost to reach telecentre was 379 ± 780 PKR (1.85 ± 3.81 USD). The average duration of consultation was 15 ± 5 min. The most common diagnosis for consultation was knee osteoarthritis (237, 44.5%), chronic low back pain (118, 22.1%), and rheumatoid arthritis (42, 7.9%). On average, patients saved 787 ± 29 km of distance, 15 ± 1 h of traveling, and 6702 ± 535 PKR (33 ± 3 USD) that would have been required to travel to our tertiary care hospital. Telerheumatology substantially reduced travel time, distance, and cost for patients. It has the potential to deliver outpatient rheumatology consultation in an economically efficient manner, effectively breaking geographical barriers and expanding access to essential services for patients in remote areas.

Multifactor dynamic coupled model for building fire evacuation: Case study of the Karamay Friendship Palace fire

Occupant evacuation during a building fire is a complex system that includes several highly coupled subsystems, such as building characteristics, occupant characteristics, fire behavior, and evacuation behavior. To study the interaction mechanism between these subsystems to maximize occupant safety during fire evacuation in a building, a multifactor dynamic coupled model based on the Fire Dynamic Simulator and floor field cellular automata model for occupant evacuation in a fire was established. In the model, the dynamic impact of smoke diffusion on occupant movement direction and speed, decrease in occupant health points caused by smoke and trampling, and changes in occupant exit choices in the presence of closed exits were considered in detail. The catastrophic fire accident in the Friendship Palace of Karamay, Xinjiang, China, in 1994 was used as the analysis case, in which the spatial model of the Friendship Palace was reconstructed according to real data and architectural design methods. The safety exits open or closed, radius Rtra, possibility of information transmission Psuc, and wait time twait were discussed to study the influence of these parameters on the evacuation process and results. The study shows that the model could reproduce a fire accident well with Rtra = 4, Psuc = 0.5, and twait = 30. The closed exits increased evacuation time by over 120.3 % and resulted in 439 deaths. These conclusions are important for providing better estimates, guiding architectural designs, and enhancing building safety management.

Ultrasound in bone fracture diagnosis - a comparative meta-analysis and systematic review.

This meta-analysis evaluates the diagnostic accuracy of ultrasound (US) for bone fractures over the past 47 years,comparing it to established imaging standards. We adhered to PRISMA 2020 guidelines to searchMedline, EMBASE, and the Cochrane Library using tailored search strategies. The primary outcome, US diagnostic performance,was analyzed across various subgroups including clinical relevance, patient age, and anatomical considerations. TheQUADAS-2 tool was employed to assess study quality and minimize bias. From 5,107 initially identified studies,75 met the inclusion criteria, encompassing 7,769 participants and 3,575 diagnosed fractures. The majority of studies wereprospective (79%) and compared US primarily with plain radiography (76%) and CT scans (19%). Of these, 61 studies wereamenable to systematic analysis, revealing US to have a sensitivity and specificity of 91% (95% CI: 90%-92%) and 91.3%(95% CI: 90.5%-92.1%), respectively. Likelihood ratios were favorable, with a positive value of 9.955 and a negative valueof 0.087, and an odds ratio of 132.67. The area under the curve stood at 0.9715, indicating high diagnostic accuracy despitesignificant heterogeneity (I²=81.3% for sensitivity, 89.3% for specificity). The evidence supports US as a highlyaccurate diagnostic tool for bone fractures, rivalling standard imaging methods like CT and radiography. Its notable diagnosticefficacy, combined with advantages in reducing pain, wait times, and radiation exposure, advocates for its broader application.Further validation in large-scale, randomized trials is essential to integrate US more fully into clinical guidelines for fracturemanagement.

Improving parental self-efficacy in parents of children awaiting neurodevelopmental assessment: A parent group waiting list intervention

Background: Increased parental self-efficacy has been found to have positive effects on parental skills and stress levels, as well as behavioural outcomes for children. This is particularly relevant in relation to neurodivergent children and young people, who tend to present with more behavioural challenges related to emotion regulation difficulties. To assist with the issue of long wait times, a pilot parent group intervention was delivered to parents of children awaiting neurodevelopmental assessment who were presenting with emotion regulation difficulties. The aim of this study was to increase parental self-efficacy. Method: Psychoeducational parent group sessions were delivered online over five sessions to nine families. The sessions included psychoeducation around emotion regulation difficulties and strategies for managing these at home. Results: Parental self-efficacy scores significantly increased following intervention. Conclusions: Parental self-efficacy can be increased via group psychoeducation sessions aimed at understanding and improving emotion regulation.

Development of an economic and information system for the optimization of city traffic flows

The paper presents a critical analysis of current approaches to reorganizing urban transportation routes. It proposes addressing the problem of optimizing traffic flows as a multidimensional issue encompassing social and economic aspects. An economic-information model for continuous monitoring and optimization of urban traffic flow configurations based on the criterion of congestion wait time has been developed. The calculation of the economic consequences of such waiting time is proposed. The developed system has practical significance and can be applied in managing traffic flows as an economic subsystem of the city within its socio-economic system. Urban transportation infrastructure in Ukraine faces significant challenges due to social changes, including increasing passenger flow, extended waiting times, and the need to adhere to modern urban planning standards. Current trends involve redistributing street and road space based on principles of equal access and safety. This includes pilot actions, intermediate reconstruction, and comprehensive reorganization of urban space and transportation routes. Proposed methods for enhancing transportation infrastructure include improving government management, implementing proactive management strategies, executing investment projects, establishing public-private partnerships, temporarily reducing tax burdens, developing comprehensive solutions for consumers, and optimizing transportation pricing. These strategies aim to address the pressing problems in Ukraine's transport sector and facilitate sustainable development and growth. The study focuses on the financing of infrastructural projects in Dnipro city through the municipal budget. It proposes integrating economic-mathematical models into a unified economic-information system for optimizing traffic flows, allowing for continuous monitoring and improvement. This system emphasizes minimizing congestion wait times and can adapt to dynamic changes in traffic patterns, ensuring efficient and effective urban traffic management. By implementing this system, the city can enhance its transportation network, contributing to overall economic efficiency and better quality of life for its residents.

Patient Comments and Patient Experience Ratings Are Strongly Correlated With Emergency Department Wait Times.

Hospitals and clinicians increasingly are reimbursed based on quality of care through financial incentives tied to value-based purchasing. Patient-centered care, measured through patient experience surveys, is a key component of many quality incentive programs. We hypothesize that operational aspects such as wait times are an important element of emergency department (ED) patient experience. The objectives of this paper are to determine (1) the association between ED wait times and patient experience and (2) whether patient comments show awareness of wait times. This is a cross-sectional observational study from January 1, 2019, to December 31, 2020, across 16 EDs within a regional health care system. Patient and operations data were obtained as secondary data through internal sources and merged with primary patient experience data from our data analytics team. Dependent variables are (1) the association between ED wait times in minutes and patient experience ratings and (2) the association between wait times in minutes and patient comments including the term wait (yes/no). Patients rated their "likelihood to recommend (LTR) an ED" on a 0 to 10 scale (categories: "Promoter"=9-10, "Neutral"=7-8, or "Detractor"=0-6). Our aggregate experience rating, or Net Promoter Score (NPS), is calculated by the following formula for each distinct wait time (rounded to the nearest minute): NPS=100* (# promoters - # detractors)/(# promoters+ # neutrals+ # detractors). Independent variables for patient age and gender and triage acuity, were included as potential confounders. We performed a mixed-effect multivariate ordinal logistic regression for the rating category as a function of 30minutes waited. We also performed a logistic regression for the percentage of patients commenting on the wait as a function of 30minutes waited. Standard errors are adjusted for clustering between the 16 ED sites. A total of 50 833 unique participants completed an experience survey, representing a response rate of 8.1%. Of these respondents, 28.1% included comments, with 10.9% using the term "wait." The odds ratio for association of a 30-minute wait with LTR category is 0.83 [0.81, 0.84]. As wait times increase, the odds of commenting on the wait increase by 1.49 [1.46, 1.53]. We show policy-relevant bubble plot visualizations of these two relationships. Patients were less likely to give a positive patient experience rating as wait times increased, and this was reflected in their comments. Improving on the factors contributing to ED wait times is essential to meeting health care systems' quality initiatives.