Article

ED operational factors associated with patient satisfaction

Correspondence / American Journal of Emergency Medicine 33 (2015) 108122 111

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  • ED operational factors associated with patient satisfaction?,??

    To the Editor,

    High patient satisfaction scores are associated with improved patient outcomes [1,2]. As such, patient satisfaction scores have become critical quality benchmarks for hospitals, are publically reported, and are often tied to financial incentives [3-6].

    The emergency department (ED) is currently exempt from direct financial penalties in regard to patient satisfaction, although ED care affects inpatient satisfaction scores [7]. Whether Financial payments will be tied to ED patient satisfaction in the future is unknown, but will likely occur given the link between ED care and inpatient satisfaction.

    Previous research demonstrates operational factors associated with

    to-doctor time). A regression analysis determined the best model for predicting very good PG scores. Backward selection, using the locked variables of sex and age, and a removal P value of .10, was performed to determine which variables of volume, time of day, door-to-doctor time, length of stay, and average daily wait time to include in the model.

    A total of 26 981 surveys were mailed between January 2009 and July 2010. Six percent were undeliverable, whereas 2271 surveys were com- pleted and returned (response rate of 13%). A total of 1799 discharged ED patients rated their experience as very good (>=80). Baseline charac- teristics, as well as differences between patients who reported very good vs others, are listed in Table 1.

    Multivariable analysis using threshold times (Table 2, demonstrated a door-to-doctor time less than 1 hour (Relative risk , 1.36; SE, 0.05; P b .001) and a length of stay less than 4 hours (RR, 1.12; SE, 0.04; P b .001) were more likely to give very good PG scores. Although no signs of multicollinearity were present, 2 other models (Table 2: models 2 and 3) were reviewed to determine if door-to-doctor times and length of stay continued to be significant predictors on their own. In model 2 (Table 2), those with a door-to-doctor time less than 1 hour were 1.40 times more likely to give a very good score than those with a door-to- doctor time exceeding 1 hour (P b .001). In model 3 (Table 2), those with a length of stay less than 4 hours were 1.21 times more likely to give a very good score than those with a length of stay exceeding 4 hours (P b .001).

    When door-to-doctor and length of stay were analyzed continuously or broken up into 30-minute blocks (Tables 3 and 4), both scenarios

    Table 1

    Bivariate analysis for very good PG scores (PG >= 80)

    Characteristic PG scores

    patient satisfaction scores, such as the wait time to see a physician, patients’ perceivED wait time, treatment time, and length of stay greater than 6 hours in the ED [7-11]. However, these studies have been limited by small sample sizes, missing data, use of nonvalidated surveys, cross- sectional study populations, or a focus on admitted patients.

    Age (y), mean (SD)

    49.3 (18.8)

    45.5 (17.7)

    51.3 (19.0)

    b.001

    Female (%)

    63.6

    66.6

    62.0

    .02

    Acuity (%)

    Resuscitation

    0.1

    0.0

    0.1

    .77

    Emergent

    24.3

    21.6

    25.8

    Urgent

    43.7

    48.4

    41.3

    Semiurgent

    29.8

    28.6

    30.3

    Nonurgent

    2.1

    1.5

    2.5

    Door-to-doctor (min),

    59.7 (55.0)

    79.8 (65.8)

    49.6 (45.4)

    b.001

    mean (SD)

    Door-to-doctor

    2.5 (1.8)

    3.2 (2.2)

    2.2 (1.5)

    b.001

    (no. of 30-min blocks),

    mean (SD)

    Door-to-doctor (%)

    0-60 min

    65.0

    50.3

    72.5

    b.001

    N 60 min

    35.0

    49.7

    27.5

    We conducted an exploratory analysis to determine operational factors and clinical characteristics associated with patient satisfaction scores over an 18-month period involving more than 2000 ED patients. We hypothesized that longer ED length of stay, door-to-doctor time, and prolonged wait time would be associated with lower patient satis- faction scores among discharged ED patients.

    This institutional review board-approved pilot study was con- ducted at an urban, academic ED with more than 85 000 annual visits. Per institutional protocol, 30% of discharged patients are ran- domly selected to receive the Press Ganey (PG) patient Satisfaction survey, a psychometrically valid instrument, widely used to bench-

    Total

    (n = 2721)

    Less than very good (n = 922)

    Very good P

    or higher (n = 1799)

    mark comparable institutions nationwide [12,13].

    Press Ganey item questions are scored on a 5-point Likert scale

    Length of stay (min), mean (SD)

    244.3 (180.6)

    268.8 (185.4)

    231.7 (176.7)

    b.001

    (1 = very poor, 5 = very good). Data from the individual survey sections

    Length of stay

    8.6 (6.0)

    9.4 (6.2)

    8.2 (5.9)

    b.001

    are aggregated and summarized on a 0-100 scale. The primary outcome of interest was the PG overall score (range, 0-100), dichotomized into very good scores (>=80) vs remaining scores (0-79). Only the “very good” designation was chosen, as these scores reflect top decile performance

    (no. of 30-min blocks),

    mean (SD)

    Length of stay (%) b.001

    0-240 min 60.9 52.8 65.2

    N 240 min 39.1 47.2 34.9

    compared with similar institutions [14].

    ?2 Test and Wilcoxon rank sum test were used to evaluate for an association between very good PG scores (PG >= 80) and indepen- dent demographic and Operational variables of interest (ie, patient

    Mean wait time (min), mean (SD)

    Mean wait time

    (no. of 30-min blocks), mean (SD)

    41.5 (17.6) 44.3 (18.6) 40.0 (16.8) b.001

    1.8 (0.7) 2.0 (0.7) 1.8 (0.6) b.001

    demographics, ED volume, length of stay, triage acuity, and door-

    ? Conflict of interests: None.

    ?? Author contributions: M.G. and P.S.P. conceived the study. M.G. drafted the manuscript, with D.M., M.S., J.A., and P.P. contributing substantially to its structure, form, revisions, and final draft. P.P. takes responsibility for the manuscript as a whole.

    Mean wait time (%) b.001

    0-30 min

    29.5

    24.6

    32.1

    N 30 min

    Time of day (%)

    70.5

    75.4

    67.9

    .005

    7:00 AM-7:00 PM

    71.5

    68.1

    73.3

    7:00 PM-7:00 AM

    28.5

    31.9

    26.7

    Patient volume, mean (SD) 227.1 (20.4) 228.2 (19.3) 226.6 (20.9) .04

    112 Correspondence / American Journal of Emergency Medicine 33 (2015) 108122

    Table 2

    Log-link regression for very good PG scores (PG >= 80) with cut-point times

    Characteristic

    Model 1, RR (SE)

    Model 2, RR (SE)

    Model 3, RR (SE)

    Male

    1.05 (0.03)

    1.05 (0.03)

    1.06? (0.03)

    Age

    Door-to-doctor (<=60 min)

    1.01?? (0.00)

    1.36?? (0.05)

    1.00?? (0.00)

    1.40?? (0.05)

    1.01?? (0.00)

    Length of stay (<=240 min)

    1.12?? (0.04)

    1.21?? (0.04)

    Peter S. Pang, MD, MSc Department of Emergency Medicine Northwestern University Feinberg School of Medicine, Chicago, IL Department of Emergency Medicine

    The variables door-to-doctor and length of stay were described in terms of significant cut points. Backward selection preferred model 3, using a removal P value of .10 and male and age as locked variables.

    * P b .05.

    ?? P b .001.

    Table 3

    Log-link regression for very good PG scores (PG >= 80) with continuoUS times

    Characteristic

    Model 1, RR (SE)

    Model 2, RR (SE)

    Model 3, RR (SE)

    Male

    1.05 (0.03)

    1.05 (0.03)

    1.07? (0.03)

    Age

    Door-to-doctor Length of stay

    1.00?? (0.00)

    1.00?? (0.00)

    1.00 (0.00)

    1.00?? (0.00)

    1.00?? (0.00)

    1.01?? (0.00)

    1.00?? (0.00)

    The variables door-to-doctor and length of stay were described in terms of minutes. Backward selection preferred model 3, using a removal P value of .10 and male and age as locked variables.

    * P b .05.

    ?? P b .001.

    Table 4

    Log-link regression for very good PG scores (PG >= 80) with 30-min block times

    Characteristic

    Model 1, RR (SE)

    Model 2, RR (SE)

    Model 3, RR (SE)

    Male

    1.05 (0.03)

    1.05? (0.03)

    1.07 (0.03)

    Age

    Door-to-doctor Length of stay

    1.00?? (0.00)

    0.89?? (0.01)

    1.00 (0.00)

    1.00?? (0.00)

    0.89?? (0.01)

    1.01?? (0.00)

    0.99?? (0.00)

    The variables door-to-doctor and length of stay were described in terms of 30-minute blocks. Backward selection preferred model 3, using a removal P value of .10 and male and age as locked variables.

    * P b .05.

    ?? P b .001.

    demonstrated that door-to-doctor and length of stay still appeared to be significant factors when examined separately in models 2 and 3. How- ever, when both were included in the same model (model 1), door-to- doctor seemed to matter, whereas length of stay dropped to insignificance, with no signs of multicollinearity present.

    Overall, we found that a lower door-to-doctor time and overall length-of-stay were significantly associated with the highest PG patient satisfaction scores. A door-to-doctor time less than 1 hour and a length of stay less than 4 hours were found to be ideal operational metric goals to target in order to improve patient satisfaction. Both door-to- doctor time and length of stay are important; however, door-to-doctor time may have a slightly greater influence on patient satisfaction, suggest- ing that door-to-doctor may mediate the effects of length of stay. Ensuring efficient operations are critical to high ED patient satisfaction scores.

    Molly Goloback, MD

    Department of Emergency Medicine Colorado Permanente medical group, Denver, CO

    Danielle M. McCarthy, MD, MS Michael Schmidt, MD James G. Adams, MD

    Department of Emergency Medicine Northwestern University Feinberg School of Medicine, Chicago, IL

    Indiana University School of Medicine, Indianapolis, IN

    Corresponding author. Department of Emergency Medicine

    Indiana University School of Medicine 702 Eskenazi Ave, FOB, 3rd Floor, Indianapolis, IN 46202

    Tel.: +1 312 515 4025

    E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2014.09.051

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      A field survey of spinal cord injury in bodyboarders?,??

      To the Editor,

      During the summer, a large number of tourists visit Izu Peninsula, and our hospital is the only hospital capable of treating patients with acute- phase spinal cord injuries on Izu Peninsula. Among the various marine sports, bodyboarding was the leading cause of spinal cord injury in sub- jects transported by the physician-staffed emergency helicopters in Izu peninsula [1]. Hence, we investigated the number of players of surfing, bodyboarding and obtained information using a questionnaire in a field. From July 26, 2014 to August 5, 2014, we asked bodyboarders at the beaches and our hospital on Izu Peninsula to complete a questionnaire. The items on the questionnaire were as follows: sex, age, hometown, years of experience, owner of the bodyboard, past history of head injury, past history of dysesthesia of the extremities, background of the event if

      ? Source(s) of support; none.

      ?? The name of organization presented; none.

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