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New RCT – Does Uttering the “Q” Word Wreak Havoc in the Emergency Department?

July 21, 2022

Written by Joel Schirding

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Using the word “quiet” in the emergency department (ED) did not increase patient volumes nor did staff perceive there were increased volumes, unless the staff were already superstitious about the word “quiet.”

Why does this matter?
Perceptions of staff can go a long way in affecting patient care, and many in Emergency Medicine believe that if “quiet” is used, an otherwise bearable shift can collapse into total and unabated chaos. 

Using the Q word
The authors hypothesized that using “quiet” in the ED would not increase objective crowdedness; however, superstitious staff would perceive increased patient encounters and attribute this to the “non-believers.”

The study was conducted in a large, tertiary level one trauma center with 400+ staff.  The researcher randomly greeted staff using either a “quiet” or a “quiet”-free salutation.  Three hours later, they administered surveys asking 3 questions: how crowded the ED felt, how busy it felt after using “quiet”, and if they believed using “quiet” played any role.  A total of 506 surveys were completed, and while perceptions of both crowdedness and number of patients presenting increased after the word “quiet” was used, findings were not statistically significant.  However, in those staff that believed in the mysticism of “quiet,” they found a p <0.0001 for the first two questions.  Additionally, staff complained of the quality of the shift worsening after using “quiet” (i.e. plagues of lice, severe traumas, cardiac arrests).

So is this just hocus pocus? Sort of…yes.  The human mind is biased, and highlighting fewer patients triggers the mind to note, and frequently inflate, any increase in volumes.  This article shows how perceptions of staff are affected by deep-seated beliefs, such as the power of using the word “quiet”.  In the same way that a patient’s beliefs can cripple or bolster their resolve to fight a disease, ED staff are human and thus beholden to their own force-multiplying (or diminishing) mind tricks.

In the end, if using “quiet” worsens the perceptions of the work environment in my fellow staff, then I will gladly avoid it to keep the shreds of harmony alive that exist during my shift. Future research should also be done to see if this perception affects patient care negatively.

Reviewed by Dr. Ketan Patel

The use of the word “quiet” in the emergency department is not associated with patient volume: A randomized controlled trial. Am J Emerg Med. 2022 Jun;56:10-12. doi: 10.1016/j.ajem.2022.03.020. Epub 2022 Mar 16.

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