ED Patient Satisfacion Scores - Out of Balance

A few months ago I ran a post titled Top Ten ways to improve your Patient Satisfaction Scores where I listed some of the disturbing methods being undertaken to improve patient satisfaction scores in Emergency Departments. Is anyone else bothered by the constant drum beat from administration that seems to have a single minded focus on satisfaction scores to the exclusion of almost everything else? I have seen Managers in tears when the monthly report cards come out and their scores for their departments have not risen or perhaps even dipped a point or two. Many Managers who until recently were at the top of their careers suddenly are pushed out over the issue. Why is this so important now? Easy, it’s being tied to reimbursement, CEO bonuses, and it’s now listed on the web which gets featured in many community newspapers. In the typical 2-4 Hospital town it can become a major competitive advantage or disadvantage. That would be fine if the scores reflected the critical mission of an Emergency Department. I do not believe they do.

Now before everyone gets their panties in a bunch I am not advocating against a satisfied patient. That would be like being against mom and apple pie. What I am advocating for is balance. The surveys focus seems to lack balance and does not recognize that Emergency Departments primary focus should be emergencies. Lets look at the survey and who it targets, and more importantly, who gets excluded. The National Quality Measures Clearinghouse forms the basis of the Press Ganey or other organizations who produce patient satisfaction surveys sent to ED Patients. Here is a survey section on ED satisfaction and who gets excluded is described below.

“Patients with an emergency department (ED) visit during the reporting period who answered at least one question in the "Overall Assessment" section of the Emergency Department Survey. Deceased patients, patients admitted to hospital through the ED, patients who leave the ED against medical advice, patients who leave the ED without being seen, and patients transferred to another hospital/institution are not eligible”

So the Critical Care patient who you and half the department bust your ass to stabilize, admit, or transfer does not get surveyed, at least for their ED stay. Some hospital surveys do include these patients for their own purposes but they are excluded from the reported scores used for like hospital comparison of Emergency Department questions. In fact, putting a lot of resources into your critical patient can detract from and increase waits for the non-critical patient, the ones who get surveyed, many of which don’t need to be there. We all know that wait times are highly correlated to patient satisfaction. That is why Hospitals have changed their focus and are catering to the lower acuity patients with programs such as expanded Fast Tracks, Provider is Triage, Triage Bypass, liberal prescription practices, and other sometimes short sighted practices that sacrifice solid principles and safety for expediency. Critical care and educating staff to do well at it in many ED's has assumed a lower priority.

I have a suggestion. The survey should be weighted based on the patients acuity. Critical patients surveys would be weighted heavily and patients with clinic conditions should receive much less weight. So if I get high rating from one acute MI that should mean as much as 5 clinic patients. If that were to happen you would see administration put much more emphasis into expanded training and education with a focus on critical thinking and skills rather than over serving a patient population who want boutique treatment with no waiting.