The Emergency Department Patient Experience: In Their Own Words.

In this paper, the authors review the verbatim comments from patients' post-emergency department discharge survey results and highlight the impact that doctors and nurses have on the patient's experience. This paper also explores the benefits of delivering a positive experience on patients, clinicians, and healthcare systems. Many interventions that have worked are simple to implement and do not tend to require significant capital investment while having the potential of improving emergency department encounters for all those involved. There are always limitations, selection biases, and issues with generalizability in reviewing retrospective and subjective survey response data.

The risk-outcome-experience triad: Mortality risk and the hospital consumer assessment of healthcare providers and systems survey.

BACKGROUND: Studies have shown an association between the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) scores and clinical quality. The mortality risk on admission predicts adverse events. It is not known if this risk also portends a suboptimal patient experience. OBJECTIVE: To determine if the admission mortality risk identifies an experience of care risk. DESIGN: A retrospectively assembled cohort in which individual HCAHPS survey responses were linked to the admission risk of dying. SETTING: Five community hospitals of various sizes in Michigan. PATIENTS: There were 17,509 HCAHPS medical and surgical respondents; 2513 (14.4%) were at high risk of dying. MEASUREMENTS: Odds ratio (OR) (high-risk patients to low-risk patients) for providing a top box score for HCAHPS dimensions, controlling for hospital and the standard HCAHPS patient mix adjustment factors. RESULTS: High-risk respondents were less likely to provide the most favorable response (unadjusted) for all HCAHPS domains, although the difference was not significant (P = 0.09) for discharge information. Multivariable analyses indicated that high-risk patients were less likely to report a top box experience for doctor communication (OR: 0.85; 95% confidence interval [CI]: 0.77-0.94) and responsiveness of hospital staff (OR: 0.77; 95% CI: 0.69-0.85), but were more likely to have received adequate discharge information (OR: 1.30, 95% CI: 1.14-1.48). CONCLUSIONS: Patients at high risk of dying who completed surveys were less likely to report favorable physician communication and staff responsiveness. Further understanding of these relationships may help design a care model to improve both outcomes and experience. Journal of Hospital Medicine 2016;11:628-635. © 2016 Society of Hospital Medicine.

Mind the (knowledge) gap: the effect of a communication instrument on emergency department patients' comprehension of and satisfaction with care.

OBJECTIVES: We developed a communication instrument to be used in the Emergency Department (ED) and hypothesized that use of this guide would increase patient comprehension of and satisfaction with care. METHODS: This multi-site trial enrolled 643 patients in treatment and control groups. Comprehension of care was assessed by chart review and satisfaction measured via validated survey. RESULTS: Use of the instrument was not associated with improvements in patient knowledge about their care, with a mean of 4.6 (95% CI: 4.8-5.8) comprehension defects in the control group and 4.4 (95% CI: 3.9-4.9) in the treatment group. There was no significant effect on patient satisfaction 76.4% versus 76.9%, p=0.34. Elderly patients in both groups were found to have 1.1 (p<0.01) more knowledge gaps than younger patients. CONCLUSION: Patients frequently misunderstand medical care in the ED. Comprehension decreases with increasing age. An isolated communication instrument does not improve satisfaction with or understanding of the care received. PRACTICE IMPLICATIONS: Providing a structured place for providers and patients to record details of care does not seem to improve satisfaction with or comprehension of care. Interventions that focus on communication skills and face time with patients may prove more effective.

A Delphi Method Analysis to Create an Emergency Medicine Educational Patient Satisfaction Survey.

INTRODUCTION: Feedback on patient satisfaction (PS) as a means to monitor and improve performance in patient communication is lacking in residency training. A physician's promotion, compensation and job satisfaction may be impacted by his individual PS scores, once he is in practice. Many communication and satisfaction surveys exist but none focus on the emergency department setting for educational purposes. The goal of this project was to create an emergency medicine-based educational PS survey with strong evidence for content validity. METHODS: We used the Delphi Method (DM) to obtain expert opinion via an iterative process of surveying. Questions were mined from four PS surveys as well as from group suggestion. The DM analysis determined the structure, content and appropriate use of the tool. The group used four-point Likert-type scales and Lynn's criteria for content validity to determine relevant questions from the stated goals. RESULTS: Twelve recruited experts participated in a series of seven surveys to achieve consensus. A 10-question, single-page survey with an additional page of qualitative questions and demographic questions was selected. Thirty one questions were judged to be relevant from an original 48-question list. Of these, the final 10 questions were chosen. Response rates for individual survey items was 99.5%. CONCLUSION: The DM produced a consensus survey with content validity evidence. Future work will be needed to obtain evidence for response process, internal structure and construct validity.

You've got mail and need follow-up: the effect and patient perception of e-mail follow-up reminders after emergency department discharge.

OBJECTIVES: The hypothesis was that a reminder about recommended primary care physician (PCP) follow-up, sent via e-mail to patients discharged from the emergency department (ED), would increase the proportion of patients who followed up with their PCPs within the recommended time frame. Patient receptiveness to e-mail follow-up reminders was also assessed. METHODS: This was a mixed methods clinical intervention study with subjects randomized either to receive the usual care discharge instructions only or to also receive a reminder e-mail message the day after the ED visit. The reminder e-mail contained the subject's PCP's name and address and the recommended PCP follow-up time interval. A blinded review of outpatient PCP medical records was conducted to determine whether and when follow-up occurred. Researchers attempted to contact patients with a telephone survey 2 weeks after their ED visits. The primary outcomes between groups were compared using chi-square tests and relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Thirty-three percent of the intervention group and 32% of the control group followed-up as recommended (RR = 1.04, 95% CI = 0.81 to 1.33); 52% of the intervention group and 48% of the control group followed-up within 10 days of the recommended time (RR = 1.08, 95% CI = 0.91 to 1.29). The 334 patients (57%) successfully contacted via telephone demonstrated a high interest in receiving future e-mail reminders (75%), with the group that received e-mail reminders more likely to want one in the future than those who did not receive e-mail reminders (82.5% vs. 69.76%; p = 0.04). CONCLUSIONS: E-mail reminders sent after ED visits did not improve patients' adherence to the recommended timing of primary care follow-up contained in discharge instructions. Subjects in both the control and the intervention groups favorably viewed the concept of e-mail reminders, suggesting that the value of e-mail reminders after ED discharge may be in areas such as patient satisfaction that were not specifically targeted for measurement in this study.

Implementation of a novel communication tool and its effect on patient comprehension of care and satisfaction.

BACKGROUND: Emergency department (ED) communication has been demonstrated as requiring improvement and ED patients have repeatedly demonstrated poor comprehension of the care they receive. Through patient focus groups, the authors developed a novel tool designed to improve communication and patient comprehension. STUDY DESIGN: This is a prospective, randomised controlled clinical trial to test the efficacy of a novel, patient-centred communication tool. Patients in a small community hospital ED were randomised to receive the instrument, which was utilised by the entire ED care team and served as a checklist or guide to the patients' ED stay. At the end of the ED stay, patients completed a survey of their comprehension of the care and a communication assessment tool-team survey (a validated instrument to assess satisfaction with communication). Three blinded chart reviewers scored patients' comprehension of their ED care as concordant, partially concordant or discordant with charted care. The authors tested whether there was a difference in satisfaction using a two-sample t test and a difference in comprehension using ordinal logistic regression analysis. RESULTS: 146 patients were enrolled in the study with 72 randomised to receive the communication instrument. There was no significant difference between groups in comprehension (OR=0.65, 95% CI 0.34 to 1.23, p=0.18) or communication assessment tool-team scores (difference=0.2, 95% CI: -3.4 to 3.8, p=0.91). CONCLUSIONS: Using their novel communication tool, the authors were not able to show a statistically significant improvement in either comprehension or satisfaction, though a tendency towards improved comprehension was seen.