What Are We Measuring? Evaluating Physician-Specific Satisfaction Scores Between Emergency Departments

Abstract

Introduction Most emergency departments (ED) use patient experience surveys (i.e., Press Ganey) that include specific physician assessment fields. Our ED group currently staffs two EDs – one at a large, tertiary-care hospital, and the other at a small, affiliated, community site. Both are staffed by the same physicians. The goals of this study were to determine whether Press Ganey ED satisfaction scores for emergency physicians working at two different sites were consistent between sites, and to identify factors contributing to any variation. Methods We conducted a retrospective study of patients seen at either ED between September 2015 and March 2016 who returned a Press Ganey satisfaction survey. We compiled a database linking the patient visit with his or her responses on a 1–5 scale to questions that included “overall rating of emergency room care” and five physician-specific questions. Operational metrics including time to room, time to physician, overall length of stay, labs received, prescriptions received, demographic data, and the attending physician were also linked. We averaged scores for physicians staffing both EDs and compared them between sites using t-tests. Multiple logistic regression was used to determine the impact of visit-specific metrics on survey scores. Results A total of 1,012 ED patients met the inclusion criteria (site 1=457; site 2=555). The overall rating-of-care metric was significantly lower at the tertiary-care hospital ED compared to our lower volume ED (4.30 vs 4.65). The same trend was observed when the five doctor-specific metrics were summed (22.06 vs 23.32). Factors that correlated with higher scores included arrival-to-first-attending time (p=0.013) and arrival-to-ED-departure time (p=0.038), both of which were longer at the tertiary-care hospital ED. Conclusion Press Ganey satisfaction scores for the same group of emergency physicians varied significantly between sites. This suggests that these scores are more dependent on site-specific factors, such as wait times, than a true representation of the quality of care provided by the physician.

Increasing consultant-level staffing as a proportion of overall physician coverage improves emergency department length of stay targets

“…Streamlining care and minimizing LOS has overt benefits, such as optimizing use of ED beds; reduced LOS also has the potential to reap other (perhaps less intuitive) benefits: medical care quality, patient satisfaction, and LWBS rates [1,16]. A 2019 report focusing on factors driving ED patient satisfaction found that LOS and its tMD component were two of the most critical determinants, with both being more important than EP-related characteristics [7]. As exhibited by the models reported in this study, there are multiple factors that influence LOS broadly classified as consultant staffing, calendar and time-ofday factors, and operations factors.…”

“…These findings were consistent regardless of whether a shift's median LOS was assessed as a dichotomous outcome ("met the LOS goal") or as a continuous variable. Within the usual ranges of per-shift staffing at the study site for Consultants [1][2][3][4][5][6][7][8][9][10][11][12] and total EPs (10-35), each additional Consultant was associated with a 5.4-min reduction in shift median LOS and a 27% increase in odds of that shift's LOS being four hours or less.…”

“…The LOS is important because of its obvious relationship to efficiency and overcrowding, and also being linked to care quality and patient satisfaction [1][2][3]. Worldwide, LOS is perceived as important by both staff and patients [4][5][6][7]. In many EDs, the overall LOS target is four hours [2,8].…”

Minimal Differences in Responses but Big Differences in Rankings: Press Ganey Versus Professional Research Consultants

“…Despite importance of patient satisfaction data, there is variance as a function of site‐dependent factors and small sample sizes. This results in varied reported satisfaction data for the same provider, 2 and although often suggested as a measurement of quality of care, does not measure impact on health state 1 …”

Evaluating opportunities for improved orthopedics outpatient satisfaction: an analysis of Press Ganey® Outpatient Medical Practice Survey responses

“…A plethora of evidence in the literature has described factors that affect patient satisfaction that are unlikely to be representative of the value of care delivered. Examples of these include patient age [6][7][8], education level [9,10], race [9,[11][12][13][14] and sex [8,[13][14][15], provider race [12,[16][17][18] and sex [19,20], distance traveled to appointment [6,21], setting/location of the appointment [9,13,22,23], patient psychological status [24], and time between appointment and completion of survey [25].…”