Emergency Design. Leah Mazzone. Design for Health. Semester 1, 2020

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.

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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

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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

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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.

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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?

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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).

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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

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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).

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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

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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.

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CURRENT PATIENT JOURNEY MAP

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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.

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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?

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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.

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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.

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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?

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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.

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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:

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PROPOSED PATIENT JOURNEY MAP

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This journey map focuses on a patient experiencing non life-threatening health concerns and is under the age of 40.

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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.

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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.

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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

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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.

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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.

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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.

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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.

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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.

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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

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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

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