Emergency Department Crowding is Associated with Reduced Satisfaction Scores in Patients Discharged from the Emergency Department

Abstract

IntroductionEmergency department (ED) crowding has been shown to negatively impact patient outcomes. Few studies have addressed the effect of ED crowding on patient satisfaction. Our objective was to evaluate the impact of ED crowding on patient satisfaction in patients discharged from the ED.Methods:We measured patient satisfaction using Press-Ganey surveys returned by patients that visited our ED between August 1, 2007 and March 31, 2008. We recorded all mean satisfaction scores and obtained mean ED occupancy rate, mean emergency department work index (EDWIN) score and hospital diversion status over each 8-hour shift from data archived in our electronic tracking board. Univariate and multivariate logistic regression analysis was calculated to determine the effect of ED crowding and hospital diversion status on the odds of achieving a mean satisfaction score ≥ 85, which was the patient satisfaction goal set forth by our ED administration.Results:A total of 1591 surveys were returned over the study period. Mean satisfaction score was 77.6 (standard deviation [SD] ±16) and mean occupancy rate was 1.23 (SD ± 0.31). The likelihood of failure to meet patient satisfaction goals was associated with an increase in average ED occupancy rate (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.17 to 0.59, P < 0.001) and an increase in EDWIN score (OR 0.05, 95% CI 0.004 to 0.55, P = 0.015). Hospital diversion resulted in lower mean satisfaction scores, but this was not statistically significant (OR 0.62, 95% CI 0.36 to 1.05). In multivariable analysis controlling for hospital diversion status and time of shift, ED occupancy rate remained a significant predictor of failure to meet patient satisfaction goals (OR 0.34, 95% CI 0.18 to 0.66, P = 0.001).Conclusion:Increased crowding, as measured by ED occupancy rate and EDWIN score, was significantly associated with reduced patient satisfaction. Although causative attribution was limited, our study suggested yet another negative impact resulting from ED crowding.

Variations in Crowding and Ambulance Diversion in Nine Emergency Departments

“…ED beds were defined as any bed consistently used for treatment, which may have included hallway and fast track beds (if available) at each respective site. The ED workload rate was based on the concept of an occupancy rate, which has been well described in the literature 18 and has been found to be a valid measure of ED crowding 19,20 . However, occupancy rate is an hourly variable, and given the limitation of daily data, a different metric was needed.…”

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

“…Previous studies using ED occupancy rate only measured occupancy at ED presentation. [20][21][22] To evaluate if other times during an ED cardiac arrest were associated with crowding levels, we measured ED occupancy rates of both IHCA and OHCA cases at presentation, at time of arrest, at time of maximum occupancy, and the average during ED stay. We then calculated the accumulated ED stay time of all patients.…”

Emergency Department Rapid Medical Assessment: Overall Effect and Mechanistic Considerations

“…Poor ED throughput has been associated with increased 28-day mortality from pneumonia, delays to percutaneous coronary intervention in patients with acute myocardial infarction, adverse cardiovascular outcomes in patients with chest pain, increased medication errors, and increased mortality (1)(2)(3)(4)(5). Poor ED throughput and the waits associated with it are a source of general patient dissatisfaction, and patients with longer waiting room times believe that they receive inferior care (6)(7)(8). For these and other reasons, the Committee on Medicare and Medicaid Services has added several ED throughput metrics to its list of publicly reported measures aimed at evaluating quality of care.…”