The Impact of an Emergency Department Front-End Redesign on Patient-Reported Satisfaction Survey Results

Abstract

IntroductionFor emergency department (ED) patients, delays in care are associated with decreased satisfaction. Our department focused on implementing a front-end vertical patient flow model aimed to decrease delays in care, especially care initiation. The physical space for this new model was termed the Flexible Care Area (FCA). The purpose of this study was to quantify the impact of this intervention on patient satisfaction.MethodsWe conducted a retrospective study of patients discharged from our academic ED over a one-year period (7/1/2013–6/30/2014). Of the 34,083 patients discharged during that period, 14,075 were sent a Press-Ganey survey and 2,358 (16.8%) returned the survey. We subsequently compared these survey responses with clinical information available through our electronic health record (EHR). Responses from the Press-Ganey surveys were dichotomized as being “Very Good” (VG, the highest rating) or “Other” (for all other ratings). Data abstracted from the EHR included demographic information (age, gender) and operational information (e.g. – emergency severity index, length of stay, whether care was delivered entirely in the FCA, utilization of labs or radiology testing, or administration of opioid pain medications). We used Fisher’s exact test to calculate statistical differences in proportions, while the Mantel-Haenszel method was used to report odds ratios.ResultsOf the returned surveys, 62% rated overall care for the visit as VG. However, fewer patients reported their care as VG if they were seen in FCA (53.4% versus 63.2%, p=0.027). Patients seen in FCA were less likely to have advanced imaging performed (12% versus 23.8%, p=0.001) or labs drawn (24.8% vs. 59.1%, p=0.001). Length of stay (FCA mean 159 ±103.5 minutes versus non-FCA 223 ±117 minutes) and acuity were lower for FCA patients than non-FCA patients (p=0.001). There was no statistically significant difference between patient-reported ratings of physicians or nurses when comparing patients seen in FCA vs. those not seen in FCA.ConclusionPatients seen through the FCA reported a lower overall rating of care compared to patients not seen in the FCA. This occurred despite a shorter overall length of stay for these patients, suggesting that other factors have a meaningful impact on patient satisfaction.

The Impact of the Healthcare Environment on Patient Experience in the Emergency Department: A Systematic Review to Understand the Implications for Patient-Centered Design

“…They concluded that reorganizing process flow and providing rapid assessment services was more effective for improving patient experience than facility expansions and renovations. In a similar intervention, Repplinger et al (2017) implemented a front-end Flexible Care Area (FCA) in an ED to decrease delays in care. In their study, patients receiving care at the FCA reported lower satisfaction levels despite a shorter length of stay, compared to those not seen at the FCA—suggesting that the effect of wait times on patient experience may be moderated by other factors.…”

The Buffering Effect of Humanity of Care in the Relationship between Patient Satisfaction and Waiting Time: A Cross-sectional Study in an Emergency Department

“…Humanity of care was measured with a 9-item scale. The items were adapted from the works by Murante et al [23], Bleustein et al [13], and Repplinger et al [26], and the scale aimed to assess the patients' perceptions of staff regarding courtesy, willingness displayed to meet the needs of the patient, confidence inspired, and the acceptance of the needs for humanization and personalization of care (see Table 1).…”