A patient education intervention does not improve satisfaction with emergency care

doi:10.1016/j.annemergmed.2004.02.002

Annals of Emergency Medicine

Volume 44, Issue 4, October 2004, Pages 378-383

https://doi.org/10.1016/j.annemergmed.2004.02.002 Get rights and content

Abstract

Study objective

We determine whether a patient education intervention based on a previously validated model increases satisfaction with emergency department (ED) care.

Methods

A single-page patient education form was distributed on alternating 2-week time blocks for 8 weeks at the triage desk of a single academic ED. Alert, discharged patients were administered an exit interview assessing satisfaction on a 5-point ordinal scale. Secondary outcomes included patient satisfaction measured on a bivariate scale, willingness to return, and process of care indicators previously demonstrated to be associated with satisfaction. Exclusion criteria included air or ground transport to the ED, inability to speak English or Spanish, and refusal to participate. Differences in patient satisfaction and other outcomes were adjusted for predefined covariates, including age, sex, triage severity, race, language, location in ED, total ED length of stay, and time to room, using multivariable logistic regression.

Results

Of 1,934 patients discharged during study periods, 1,233 (64%) were approached and 860 (44%) were enrolled. There were no important covariate differences between the control and intervention groups. There was no important correlation between intervention and patient satisfaction on univariate (odds ratio [OR] 0.840; 95% confidence interval [CI] 0.650 to 1.086) and multivariate analysis (OR 0.874; 95% CI 0.672 to 1.136). There were no important correlations between the intervention and secondary outcomes on multivariate analysis.

Conclusion

A triage-based, patient education intervention did not significantly improve patient satisfaction or performance on predictors of satisfaction at the study site.

Introduction

The measurement of patient satisfaction has become increasingly prevalent among health providers and purchasers.¹ Patient satisfaction describes the subjective experience of patients with health care, and it reflects one aspect of health care quality. Furthermore, patient satisfaction is tightly linked to other outcomes, including malpractice litigation,² willingness to return,³ and medical compliance.⁴

A predictive model of patient satisfaction in the emergency department (ED) has been recently derived and validated in 2 multicenter surveys.5., 6. Six process measures associated with low satisfaction included help not received when needed, poor explanation of causes of problem, not told about wait time, not told when to resume normal activity, poor explanation of test results, and not told when to return to the ED. Patients perceived that EDs had performed poorly on these metrics in 11% to 41% of visits.5., 6.

A patient education approach has the potential to be a low-cost, effective means of improving performance on identified process measures, as well as overall satisfaction. Two studies suggest that providing information about ED care is correlated with higher satisfaction, although they were limited by small sample size and failure to control for potential confounding variables.7., 8.

We conducted a quasi-experimental, single-center study to assess the effects of a patient education intervention on ED patient satisfaction. Multivariate analyses controlled for the confounding effects of predefined covariates. The intervention form focused on the 6 validated predictors of satisfaction identified by previous research.5., 6.

Section snippets

Theoretical model of the problem

We postulated that an intervention form would prompt patients to better advocate for their own care and improve overall satisfaction.

Study design

We conducted a quasi-experimental trial. On alternating 2-week blocks, a patient education form was distributed to all patients presenting to the waiting room triage desk. There was a washout period of 1 day between blocks. The study was designed to run for 8 weeks; however, we truncated the last week of a control period because of a shortage in research

Results

During the study period, 1,934 patients were discharged, 1,233 (64% discharged) were approached by research assistants, and 879 (71% approached) were enrolled. All approached but not enrolled patients met exclusion criteria. For control periods, 807 were discharged, 565 (70% discharged) were approached by research assistants, and 420 (74% approached) were enrolled. For intervention periods, 1,127 were discharged, 668 (60% discharged) were approached by research assistants, and 459 (69%

Limitations

There were several limitations to this study. First, this was not a randomized study, and confounders may have limited our ability to provide unbiased estimates of differences between the intervention and control groups. However, we found no important associations between outcomes and the intervention on univariate analysis, and we controlled for multiple, predefined confounders in multivariate analyses, with no change in our overall findings. Second, there was a differential recruitment and

Discussion

We conducted a quasi-experimental trial to assess the effectiveness of a simple, targeted intervention triage form on patient satisfaction. We designed an education form according to a previously validated model of ED patient satisfaction.5., 6. Patient satisfaction measured on a 5-point Likert scale was not appreciably improved with the intervention form. Our findings were robust and remained unchanged when satisfaction was analyzed as a binary variable. Secondary outcomes, such as willingness

Acknowledgements

We thank Ron Walls, MD, and Eric Nadel, MD (Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA) for their help in initiating and supporting this study.

References (13)

B.C. Sun et al.
Determinants of patient satisfaction and willingness to return with emergency care
Ann Emerg Med
(2000)
B.C. Sun et al.
Validating a model of patient satisfaction with emergency care
Ann Emerg Med
(2001)
S. Krishel et al.
Effect of emergency department information on patient satisfaction
Ann Emerg Med
(1993)
F. Gallefoss et al.
Patient satisfaction with healthcare in asthmatics and patients with COPD before and after patient education
Respir Med
(2000)
A.M. Epstein
Rolling down the runway: the challenges ahead for quality report cards
JAMA
(1998)
G.B. Hickson et al.
Obstetricians' prior malpractice experience and patients' satisfaction with care
JAMA
(1994)

There are more references available in the full text version of this article.

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^☆: Author contributions: BCS, JM, PR, and TS conceived the study and obtained research funding. BCS, MB, JM, and TS supervised the data collection. BCS performed data analysis and drafted the manuscript, and all authors contributed substantially to its revision. BCS takes responsibility for the paper as a whole.

^☆☆: This study was supported by an Emergency Medicine Foundation Resident Research Grant (Dr. Sun).

^★: Reprints not available from the authors.

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Health Policy and Clinical PracticeA patient education intervention does not improve satisfaction with emergency care☆,☆☆,★

Abstract

Study objective

Methods

Results

Conclusion

Introduction

Section snippets

Theoretical model of the problem

Study design

Results

Limitations

Discussion

Acknowledgements

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Respir Med

Rolling down the runway: the challenges ahead for quality report cards

JAMA

Obstetricians' prior malpractice experience and patients' satisfaction with care

JAMA

Health Policy and Clinical Practice
A patient education intervention does not improve satisfaction with emergency care☆,☆☆,★