The disconfirmation paradigm: throughput times and emergency department patient satisfaction

UMMS Affiliation

Department of Emergency Medicine

Publication Date


Document Type



Cross-Sectional Studies; Emergency Service, Hospital; Female; Humans; Interviews as Topic; Male; Middle Aged; *Patient Satisfaction; Prospective Studies; Questionnaires; Time Factors; Triage


Emergency Medicine


This study examined the relationship between throughput times, expectations, and patient satisfaction using the Disconfirmation Paradigm (DP), which proposes that dissatisfaction arises when service expectations are not met. Before discharge or admission, adult emergency department (ED) patients estimated how long they waited for three intervals (Perceived Times): triage to patient care area, patient care area placement to physician evaluation, and physician evaluation to disposition. Acceptable waiting times and satisfaction for the same intervals were then provided by the subject (Acceptable Times and Throughput Time Satisfaction, respectively). Perceived Times were subtracted from Acceptable Times to yield an index of Expectancy Disconfirmation. There were 1118 (72%) of 1550 eligible patients interviewed. Throughput Time Satisfaction predicted overall satisfaction (r = 0.56 to 0.62, p < 0.001). In turn, Expectancy Disconfirmation predicted Wait Time Satisfaction (r = 0.42 to 0.64, p < 0.001). Consistent with the DP, when throughput times exceeded expectations, dissatisfaction with those throughput times arose, leading to general dissatisfaction with the ED visit.

DOI of Published Version



J Emerg Med. 2007 Jan;32(1):7-13. Link to article on publisher's site

Journal/Book/Conference Title

The Journal of emergency medicine


At the time of publication, Edwin Boudreaux was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID