This poster was presented during the ACOEP poster competition at the AOA convention in San Diego on October 1, 2007
Abstract
Patient satisfaction is an important aspect of much of today’s modern medicine. This study investigated patient satisfaction within an inner city hospital’s emergency department. It utilized a cross sectional study to determine the patients’ current satisfaction with the emergency department waiting room. It also inspected the willingness of the patient to recommend the emergency department to others within the community. This data was analyzed against the patients’ suggested improvement to the waiting room. The outcome of the project yielded a suggested improvement that would theoretically increase patient satisfaction and increase the efficiency of the overall emergency department. The data shows that twenty nine percent of subjects would not recommend the hospital to others. The statistical analysis also showed that the majority of this subset of subjects suggested that there should be more reading material available and more televisions in the waiting area.
Introduction
Patient satisfaction has been a increasingly important issue in many Emergency Departments. 1 2 3 4 5 6 Increasing patient satisfaction in an emergency department can increase the utilization of that emergency department significantly. 2 3 Improving the perception of a patients feelings towards an emergency department can have an direct effect on increasing revenue for that hospital. 6
It has been shown that if a patient is satisfied in an emergency department they will be more likely to recommend that hospital to others. 6 The significance of one patient admission that is either gained or lost per day can make the difference of $3.65 million in annual gross revenue according to Karpiel. 6 Therefore, the significance of only affecting merely one patient’s satisfaction can prove to be overwhelmingly profitable.
Most of the past studies included variables that are not constant through time such as physician and nursing attitude. 1 2 3 This study was more focused on the ability of certain factors within the emergency department waiting room to decrease patient anxiety and tension. This project attempted to suggest some improvement to increase patient satisfaction which was also absent from past research. 1 2 3 4 This is duly important because once a dissatisfaction is identified, patient feedback is important to ensure that a planned improvement would increase patient satisfaction.
Past research has also shown that it is not actual wait time in an emergency waiting room that is predictive of patient satisfaction, but perceived wait time. 3 Thus, this study attempted to find factors other then actual wait time that can be improved to decrease perceived wait time and increase patient appreciation. Some of the factors that were examined were security, cleanliness of the waiting room, reading material, number of televisions, and television content. The overall outcome of the study is to enact some changes to the emergency department waiting room and to increase the utilization and effectiveness of the emergency department.
Methods
Participant Selection: All patients visiting the emergency department waiting room were eligible to participate with the exception of patients that were suicidal/ homicidal, non cognitive (due to dementia or psychosis) and patients that were impaired due to intoxication or substance abuse. Patients were recruited after being admitted to the emergency department.
Data Collection: Patients of the emergency department were asked to fill out a survey. The survey used a five point Likert scale: 1 = very poor, 2 = poor, 3 = average, 4 = good, and 5 = excellent. The patients used this scale to rate certain aspects of the emergency department waiting room. They then were asked to mark to what degree they would recommend the emergency department to others: Not recommend, recommend, or highly recommend. The final question was aimed to identify the patients’ view on the most useful improvement from a list of possibilities to increase their satisfaction.
Statistical Analysis: Data was evaluated by calculating frequencies of each of the recommended changes to the waiting area. These frequencies were also cross tabulated with sex, race and time of day. Subjects who did not recommend the hospital to others were analyzed to determine the frequencies of the changes they recommend.
Results
CATEGORY | NUMBER OF CORRESPONDENTS (PERCENTAGE OF CORRESPONDENTS) |
---|---|
Sex | |
Women | 174 (59) |
Men | 123 (41) |
Age | |
25 and under | 84 (28) |
26-45 | 148 (50) |
46-65 | 52 (18) |
66 and over | 13 (4) |
Ethnicity | |
Hispanic/Latino | 134 (45) |
Black/African American | 113 (38) |
White/Caucasian | 35 (12) |
Asian | 10 (3) |
South Asian | 2 (1) |
Other | 3 (1) |
Primary Language | |
English | 210 (71) |
Spanish | 71 (24) |
French | 8 (3) |
Chinese | 3 (1) |
Italian | 2 (1) |
Other | 3 (1) |
Time of day Survey Completed | |
4:00 AM to 12:00 PM | 81 (27) |
12:00 PM to 8:00 PM | 121 (41) |
8:00 PM to 4:00 AM | 95 (32) |
Table 1: Shows general demographics of the subjects that participated in study. Percentages do not always add up to 100 percent due to rounding.
SUBSETS OF SUBJECT POPULATION | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
RECOMMENDED CHANGES | MALE | FEMALE | 4:00 AM UNTIL 12 NOON | 12 NOON UNTIL 8:00 PM | 8:00 PM UNTIL 4:00 AM | WHITE | BLACK | HISPANIC | ASIAN | SOUTH ASIAN | OTHER RACE | TOTAL | |
Cleaner Waiting Room | 4.9 | 11.5 | 8.6 | 12.4 | 4.2 | 11.4 | 4.4 | 10.4 | 10 | 50 | 33.3 | 8.7 | |
Have Reading Material Available | 41.5 | 32.8 | 35.8 | 35.5 | 37.9 | 37.1 | 43.4 | 29.9 | 30 | 50 | 66.7 | 36 | |
Increased Security | 9.8 | 12.1 | 13.6 | 6.6 | 14.7 | 5.7 | 15 | 8.2 | 30 | 0 | 0 | 11 | |
Less Television | 0 | 0.6 | 0 | 0.8 | 0 | 0 | 0 | 7 | 0 | 0 | 0 | 0.3 | |
More Televisions | 19.5 | 16.1 | 22.2 | 10.7 | 22.1 | 34.3 | 13.3 | 18.7 | 0 | 0 | 0 | 17.3 | |
More Decorations | 0 | 0.6 | 0 | 0 | 1.1 | 0 | 0.9 | 0 | 0 | 0 | 0 | 0.3 | |
Showing a Movie While Waiting | 6.5 | 5.2 | 6.2 | 6.6 | 4.2 | 2.9 | 3.5 | 9 | 0 | 0 | 0 | 5.7 | |
Staff Able to Communicate in Different Languages | 7.3 | 8 | 4.9 | 8.3 | 9.5 | 0 | 4.4 | 12.7 | 10 | 0 | 0 | 7.7 | |
None of the Above | 10.6 | 13.2 | 8.6 | 19 | 6.3 | 8.6 | 15 | 10.4 | 20 | 0 | 0 | 12 |
Table 2: Shows the percent of subjects in each subset and in total population that recommend each of the recommended changes.
Will Not Recommend | 87 (29) |
Recommend | 160 (54) |
Strongly Recommend | 50 (17) |
Frequency (Percent of total population)
Table 3: Shows the frequency of the subjects willingness to recommend the hospital and shows the percent of total population
Discussion
Patient satisfaction in an emergency department is sometimes overlooked due to the high patient volume and high stress situations that the hospital staff frequently encounters. At the same time, patient satisfaction is an important means to increase patient compliance, decrease malpractice, and increase fiscal benefit of the hospital. 2 3 6 Unsatisfied patients tend to leave the emergency department before being seen by a physician. 5 11 This premature departure results in decreased patient care and decreased revenue for the hospital. Satisfied patients were also found to be easier to treat, more likely to be compliant with giving a detailed history and less likely to pursue lawsuits. 8 10
A common misconception regarding patient satisfaction in an emergency department is that it is directly correlated to actual wait time. Previous studies showed that it is perceived wait time and not actual wait time that correlates to patient satisfaction. 8 Therefore, it is important to provide effective diversions so that the patients do not feel that they are waiting that long. Some effective distractions that have been proven in previous studies are televisions, magazines and videos. 8 The results of this study concurs with these finding (graph 1). The two most popular recommended changes among all subjects were to have reading material available and to have more televisions in the waiting area.
Of these subjects that would not recommend the hospital, they suggested that there be more reading material and more televisions (graph 1). Overall, the majority of the patients surveyed also had the same recommendations for the waiting area (table 2).
An important additional finding of this study was that twenty nine percent of subjects would not recommend the hospital (table 3). This approximates to 29,000 patients that would not recommend St Barnabas hospital over a one year period. This large number of dissatisfied patients can be economically devastating for the hospital. As Karpiel showed in his study in 2000, only one patient a day can have a significant impact on the fiscal operation of a hospital. As stated previously, one additional patient admission per day can increase the annual gross revenue by 3.65 million dollars. 6 This added monetary benefit to the hospital is more than ever important as shown by a study conducted by Touche Ross & Company. The study, as reported by the New York Times, surveyed 1,419 hospitals and found that 48 percent said their hospitals were in risk of going bankrupt. 7
Hospitals in inner city communities, like St. Barnabas Hospital, are essential in providing the primary medical care the neighboring population. Therefore, closing one hospital in the inner city can be devastating in the population’ ability in receiving quality healthcare. For that reason, it is vital to increase the satisfaction in the 29% that were not happy with their visit to the emergency department. Graph 1 shows this subset of subjects would like to see more televisions and reading material available. This finding is the most useful and constructive in increasing the utilization of the emergency department.
Patient satisfaction studies have become very numerous in the last 15 years. This study effectively showed that twenty nine percent of patients visiting this inner city hospital are not content with their service. Adding something as relatively inexpensive as a television can provide a great deal of benefit for the hospital. The hospital can also implement the distribution of pamphlets in the waiting room that can educate the community on ways to prevent and treat conditions that are prevalent in an inner city community such as diabetes, obesity, sexually transmitted diseases and hypertension. This could provide the added benefit of potentially decreasing the incidence of destructive ailments needlessly affecting the community.
This study was able to show pit falls within an inner city waiting room and how to correct these problems. A follow up study should be performed following the study to assess the effectiveness of adding more diversion to wait time in the waiting area. This would provide further evidence that simple improvements can go a long way in facilitating the delivery of modern medicine.
References
-
Bursch B, Beezy J, Shaw R. Emergency department satisfaction: what matters most? Ann Emerg Med. 1993; 22:586-91.
-
Boudreaux ED, Mandry CV, Wood K. Patient satisfaction data as a quality indicator: A tale of two emergency departments. Acad Emerg Med. 2003; 10:261-268.
-
Thompson DA, Yarnold PR, Williams DR, Adams SL. Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann Emerg Med. 1996; 28:657-65
-
Trout A, Magnusson AR, Hedges JR. Patient satisfaction investigations and the emergency department: what does the literature say? Acad Emerg Med. 2000; 7:695-709.
-
Graff L, Stevens C, Spaite D, Foody J. Measuring and improving quality in emergency medicine. Acad Emerg Med. 2002; 9:1091-1107.
-
Karpiel MS. Benchmarking facilitates process improvement in the emergency department. Healthcare Financial Management. 2000; 54:54-9.
-
Freudenheim. Rising number of hospitals forced to close. New York Times. 9/13/07
-
Welch, S. Can’t get no satisfaction: What patients really want. Emergency Medicine News. Feb 2005
-
Stiles, WB, Putnam SM, Wolf MH, James SA. Interaction exchange structure and patient satisfaction with medical interviews. Med Care. 1979 17:667-81.
-
Sobel, DS. Rethinking medicine: Improving health outcomes with cost-effective psychosocial interventions. Psychosom Med. 1995:57:234-244.
-
Fernandes CMB, Price A, Christenson JM. Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician? J Emerg Med. 1997; 15:397–9.