Emergency department waiting times are among the most searched health topics in Portugal, and the suggestion always follows: if people are waiting for hours, why not fill that time with something better?
We get the question often. The honest answer has two parts, and the first is unwelcome.
The waiting room is the worst place
It is not a matter of willingness. Five things fail at once:
1. There is nobody to supervise. This is the obstacle that comes before all others. The system's intended purpose requires supervised use, and in a waiting room nobody is available to supervise. Without that it is not a session — it is a lent device.
2. The patient needs to see and hear what is happening. They are waiting to be called. Equipment that covers vision and hearing is exactly the opposite of what that moment requires, and the first missed call ends the experience for everyone.
3. Clinical status is not yet established. A waiting room holds people with nausea, dizziness, unassessed head injury, intoxication. It is the population where least is known about who can use it, and triage was not designed to answer that question.
4. Hygiene and turnover. Equipment shared between strangers, with a cleaning routine between each, in a room seeing dozens of people an hour. The arithmetic does not work.
5. It does not solve the problem. And this matters most: the waiting time is unchanged. Emergency waiting is a problem of capacity, flow and staffing. No equipment touches it. Anyone selling you virtual reality as an answer to waiting times is selling something else under the wrong name.
Where the answer is yes
Inside the same department there are moments with all the conditions the waiting room lacks — a professional present, the patient already seen, and a concrete goal.
1. Painful or frightening procedures. Suturing, line placement, cannulation, foreign body removal, burn dressing. This is where the most consistent literature in health sits: distraction during the procedure, particularly in children. We have written about needle fear and about paediatrics.
2. Waiting on a trolley already inside the department, with the patient assigned to a team. Here there is supervision and continuity. It is different from the general waiting room, even if the word "waiting" is the same.
3. Patients under prolonged observation. When someone stays for some hours under observation with an assigned team, the same reasoning as an inpatient stay applies.
What to ask before going ahead
If you run an emergency department and want to try, three questions settle most of the conversation:
- Who runs the session, on each shift? If the answer is "whoever can", there is no project. It is the first of the six yeses.
- At exactly which moment, and for which patients? "In the ED" is not a use case. "During suturing, in children aged 4 to 12" is.
- Where does the equipment live, and who cleans it between patients? In an emergency department this weighs more than anywhere else.
A note on what to measure
If you run a pilot, do not measure waiting time. It will vary for reasons unconnected to you, and attribution is impossible. Measure what is close to the procedure: how often it had to be repeated, whether restraint or sedation was needed, and what the team observed. We develop that in the ROI that cannot be proven.
In short
- In the waiting room, no. Supervision, environmental awareness, adequate triage and hygiene all fail — and none of it is workable around.
- Waiting time does not change. It is capacity and flow, not technology.
- During procedures, yes — and that is where evidence is most consistent, particularly in children.
- "In the ED" is not a use case. The exact moment is.