Grab a Seat! Nudging Providers to Sit Improves the Patient Experience in the Emergency Department

Objective: We assessed whether provider sitting influenced patient satisfaction in an academic emergency department (ED) and if education and/or environmental manipulation could nudge providers to sit. Methods: This was a prospective, controlled pre-post trial of provider sitting and its influence on patient satisfaction within 2 urban, academic EDs. A 12-item survey was administered to a convenience sample of patients to assess for care satisfaction before, during, and after study interventions. Study interventions included (a) placement of branded folding seats and (b) an educational campaign. Only the intervention ED received folding seats. The primary outcome examined the influence of provider sitting on patient satisfaction. A secondary outcome examined the frequency of provider sitting. Results: During the entire study period, 2827 patients were surveyed; 63% were female and 65% were between the ages of 26 and 65. Sitting at any point during an ED encounter improved responses to satisfaction questions (polite [67% vs 59%], cared [64% vs 54%], listened [60% vs 52%], informed [57% vs 47%], time [56% vs 45%], P < .0001 for all measures). The odds of provider sitting increased 30% when a seat was placed in the room (odds ratio [OR] = 1.3, 95% confidence interval [CI]: 1.1-1.5). No change in provider sitting was observed in the control ED (OR = 1.0, 95% CI: 0.8-1.2). Conclusions: Placing a seat in a patient's room nudges providers to sit during an ED encounter. Education alone did not influence provider behavior. Sitting down resulted in significantly higher patient satisfaction scores during an ED visit.