# Improving Patient Satisfaction and Reducing Agitation in Overcrowded Outpatient Waiting Areas Through Environmental and Educational Audiovisual Interventions: A Single-Centre Quality Improvement Project

## TL;DR

A low-cost audiovisual intervention in a busy outpatient clinic significantly reduced patient agitation without affecting waiting times.

## Contribution

A scalable, low-cost strategy using audiovisual content to improve patient experience in overcrowded outpatient settings.

## Key findings

- Verbal altercations decreased by 81% after implementing audiovisual interventions.
- The reduction in agitation was sustained across all weekdays and patient volumes.
- Waiting times and patient throughput remained unchanged despite the intervention.

## Abstract

Background: Overcrowding and prolonged waiting times in outpatient departments (OPDs) are frequently associated with patient dissatisfaction, agitation, and conflict, particularly in high-volume public healthcare settings. Structural and workforce constraints often limit the feasibility of reducing waiting times in the short term, necessitating alternative strategies to improve patient experience and reduce agitation. This study was conducted as a quality improvement initiative aimed at enhancing patient experience in a high-volume public sector outpatient setting.

Methods: We conducted a single-centre quality improvement (QI) initiative using a Plan-Do-Study-Act (PDSA) framework over an eight-week period in a high-volume Internal Medicine OPD of a tertiary care public hospital in South India. Weeks 1-4 constituted the pre-intervention phase and Weeks 5-8 the post-intervention phase. The intervention involved the installation of televisions in OPD waiting areas displaying curated, non-disruptive, family-friendly audiovisual content along with short health awareness videos in the local language. All patients attending the OPD during the study period were included, with the sample size determined by consecutive attendance. Weekly OPD attendance and reported verbal altercations were recorded. Altercation rates were calculated per 1,000 OPD visits, and pre- and post-intervention weekly means were compared using descriptive statistics and inferential analysis.

Results: Mean weekly OPD attendance remained comparable between the pre- and post-intervention periods (2,228 vs. 2,253 patients/week). Mean reported verbal altercations decreased significantly from 39 per week during the pre-intervention phase to 7.25 per week post-intervention, representing an approximate 81% reduction (p < 0.01). When adjusted for patient volume, altercation rates declined from approximately 17.5 to 3.2 per 1,000 OPD visits. The reduction was sustained across all weekdays, including traditionally high-volume days. Average waiting times remained unchanged.

Conclusion: A low-cost environmental and educational audiovisual intervention was associated with a substantial and sustained reduction in reported patient agitation without altering patient throughput or waiting times. Simple, scalable quality improvement strategies that enhance the waiting-area experience may meaningfully improve patient-centred care in resource-constrained outpatient settings.