Patient satisfaction: Good medicine and good business

It goes without saying that emergency physicians want their patients to be satisfied.

After all, happy patients not only contribute to job satisfaction, they also tend to have better clinical outcomes and may present a lower professional liability risk.1 There's another reason, however, why patient satisfaction should be especially top-of-mind for emergency department (ED) physicians today.

Competition among ED groups is heating up in many markets. While patient satisfaction has traditionally had minimal impact on an ED group's relationship with hospitals, it's now becoming a critical yardstick. It's playing a growing role in many groups' ability to win—and keep—employment contracts, as well as impacting salaries. Satisfaction and consumerism are interrelated forces that physicians must contend with in marketplaces where people consider themselves "healthcare clients" rather than "patients."

Consequently, patient satisfaction must be at the forefront of ED physicians' activities. But it involves more than just monitoring the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (e.g. Press Ganey) scores based on small sample sizes and months-old data. One strategy that can actually help boost and maintain high satisfaction rates, as well as influence patient care in real time, is to employ a patient follow-up program to quickly identify, troubleshoot and correct potential care issues.

Discharge follow-up essential
Providers facing the dual pressures ensuring a positive patient experience and meeting productivity requirements can follow some simple time-conscious tips to improve the patient experience.

First, consider filling out discharge instructions at the bedside. This allows physicians to simultaneously complete charting while also reviewing test results and the care plan with patients and their families. Second, offer a missing piece of the ED patient-satisfaction puzzle by following up with patients post-discharge to assess—and document—their wellbeing long before they receive a Press Ganey survey.

Emergency physicians have distinct challenges when it comes to following up with patients after discharge. Not only are patient volumes typically greater than for office-based colleagues, but varied schedules and ED sizes make phone accessibility difficult.

This is why digital patient engagement can offer a satisfaction-boosting advantage. Based on a secure daily upload of all patients seen in the ED within 24 hours, a cloud-based system easily can be configured to deliver a three- to six-question survey to patients via text or email the day after discharge. The survey typically asks patients how they are feeling, whether they have any medication concerns, the level of concern expressed by the physician/nurse team and any other comments they have about the overall ED experience.

If patients reply that they feel worse, the response triggers a chain of events that starts with a pop-up message telling them to call their physician or return to the ED. At the same time, the tool emails the patient's information and comments to an ED charge nurse or ED case manager, who triages and elevates cases to physicians as appropriate. If necessary, patients can be called within minutes.

For those patients who are not active users of text or email, family members may respond on their behalf. Alternatively, they can be assisted through a call-back module that is activated when there is no response through text or email.

At a cost of about $1 per patient, the digital system at Elmhurst Hospital, for example, reaches around 20 percent of all patients who admit to the ED. While the vast majority of them report no concerns, roughly five percent of the 180 cases each day say they are feeling worse and eight percent describe an aftercare issue.

This valuable feedback collected so soon after discharge enables providers to engage those whose conditions may be deteriorating, as well as to identify and motivate patients who aren't compliant with—or don't understand—their discharge plans. For instance, one patient who failed to follow post-discharge care plans experienced worsening symptoms and eventually was diagnosed with diverticulitis and a perforated colon. This case, which presented prior to the implementation of the digital patient engagement system, likely would have had better outcomes had electronic patient follow-up been available to intervene.

Regardless of the outreach method or health status, this level of quick response reassures patients and helps them feel that their concerns are important to the provider and hospital. At Elmhurst, an investment of about 15 minutes total daily time by the charge nurse or case manager helps build satisfaction and loyalty. Physicians receive a measure of satisfaction as well, knowing that their patients are being monitored once they walk out the ED doors.

Communication builds satisfaction
Effective and empathetic communication is a key element when it comes to building trust and satisfaction between patients and providers. Opening avenues of communication quickly—while patients' health concerns are most pressing—is important. The patient who initially reports a misperception about care received in the ED, for example, might change his or her opinion if offered a prompt opportunity to voice concerns and have them addressed.

The same generally cannot be said if a patient's first chance to provide feedback on the ED experience comes when the Press Ganey survey arrives in the mailbox weeks later. Although HCAHPS scores commonly are used by hospitals to evaluate ED groups, the data they provide is usually too little and too late to actively improve patient care and patient perception. In comparison, digital patient engagement can help improve survey results by encouraging timely and proactive feedback from all patients. Some organizations, in fact, have reported an uptick in patient satisfaction scores after implementing digital follow-up. 2,3,

More importantly, this technology can help providers identify patients who require a rapid follow-up clinical intervention. Both factors can contribute to improved outcomes and help emergency medicine groups win the hospital employment contracts they deserve.

During a hectic shift in the ED, it's all too easy to let time pressures take precedence over establishing a rapport with patients. Yet mustering up the energy to keep patients happy—even after they've left the ED—really does pay off.

About the author:
Kathleen Stevison Schmelka, M.D., MPH, is an emergency physician with Elmhurst Emergency Medical Services in Elmhurst, Illinois.

1 Fullam F, Garman AN, Johnson TJ, Hedberg EC. The use of patient satisfaction surveys and alternative coding procedures to predict malpractice risk. Med Care. 2009;47(5):553-9.
2 Thew J. A Better Way to Elicit Patient Feedback. HealthLeaders Media. July 7, 2015. http://www.healthleadersmedia.com/nurse-leaders/better-way-elicit-patient-feedback., 2016 Accessed July 7, 2016.
3 Robert Wood Johnson Foundation. Post-Visit Patient Contact Improves Patient Satisfaction. Promis Pr Emerg Dep. 2013. http://www.rwjf.org/en/library/articles-and-news/2013/04/post-visit-patient-contact-improves-patient-satisfaction.html. Accessed July 7, 2016.

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