Members of the ACEP Emergency Medicine Practice Committee (EMPC) (2010-2012) offer, in this article, information on patient satisfaction surveys including methodologies utilized, limitations of these methodologies, and thoughts on utilization of survey data for emergency physicians when working with hospital leaders on appropriate interpretation of scores and creation of environments conducive to quality care and patient satisfaction.

In service industries, including health care, satisfaction surveying is a common practice. Recently, the Centers for Medicare and Medicaid Services have embraced value-based purchasing as a methodology for apportioning entitlement health care resources, and identified patient satisfaction as a key marker of value. While Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is based on the inpatient experience, hospital administrators have come to accept the ED as the “front door to the hospital” and expect their emergency medicine physician groups and ED staff to take the issue of patient satisfaction seriously. And yet the ED environment has unique challenges encountered when striving for patient satisfaction targets, including:

• The need to interact with patients without the benefit of an established physician-patient relationship.
• The need to inspire confidence and communicate concern for the patient and family in a short period of time.
• Long waits without the ability to monitor incoming patient flow.
• A wide range of presenting complaints complicated by diverse health status and demographics (Ann. Emerg. Med. 2000;35:426-34).
• Boarding of patients awaiting an inpatient bed that profoundly affects both the physical space and the personnel resources available for the ED patients who eventually are treated and discharged home.

ACEP’s Satisfaction Survey Policy

ACEP and the EMPC have worked for the past 2 years to educate members about patient satisfaction surveys and share concerns about measuring satisfaction in the emergency department with survey organizations. A Patient Satisfaction Point/Counterpoint session at Scientific Assembly will look at the validity of surveys and how emergency physicians can use these surveys to improve their practices. Dr. James G. Adams and Dr. Gillian Schmitz lead the discussion at 3 p.m. on Tuesday, Oct. 9. ACEP’s policy statement on patient satisfaction, released in 2010, is as follows:

The American College of Emergency Physicians (ACEP) recognizes that patient satisfaction surveys that are methodologically and statistically sound can be a valid measure of the patient’s perception of health care value and that patient outcome can be related to perceived patient satisfaction. Patient satisfaction survey tools should be:

• Standardized and validated for the average education level of those being surveyed.
• Administered and tabulated as close to the date of service as possible.
• A measure of the specific components of service received in the emergency department with discrete data points.
• Based on a statistically valid sample size free from selection bias.
• Transparent in the administration and analysis methodologies.
• Explicit in intended purpose and use.

Due to the difficulty in segregating whether patient satisfaction scores are a result of physician performance or due to demands and restrictions of the current health care system or other factors out of the control of the physician, patient satisfaction methods that have not been validated should not be used for purposes such as credentialing, contract renewal, and incentive bonus programs.