ACEP recommends that the topic of patient satisfaction measurement be incorporated into the Model of the Clinical Practice of Emergency Medicine.

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Survey Methodology

HCAHPS is a CMS-driven process initiated in 2006. It has been described as the first national public and standardized survey that measures the patient’s perception of health care. Prior satisfaction surveys were used internally by hospitals. In contrast, HCAHPS compares hospitals publicly in relation to the patient’s perception of care. It is now being extended to include home health care and physician practices. Currently, the HCAHPS methodology revolves around surveys sent to a sample of adult patients between 48 hours and 6 weeks after discharge. Hospitals may use a survey vendor to acquire data or perform their own survey. The surveys may be performed by telephone, mail, or interactive voice recognition and are offered in different languages. The minimum target is 300 returned surveys per facility per year. HCAHPS excludes:

• Patients under 18.
• Patients who died in the hospital.
• Patients discharged to hospice.
• Patients discharged with a primary psychiatric diagnosis.
• Prisoners.
• Patients with international addresses.
• “No contact” patients.

There are many private survey companies that measure patient satisfaction, including Press Ganey, Avatar, NRC Picker, Professional Research Consultants (PRC), and Healthstream, among others. While these agencies send surveys to individual patients, data are usually collated for the hospital as an entity, although the data may be targeted to individual practitioners.

Utilization of Survey Results

Obtain the best available data. Because survey companies charge per survey, most hospitals limit the number of patients to be contacted. This leads to one of the biggest concerns by ED practitioners – the small number of survey results in an inadequate tool. The key is in how the data are used. When setting out to collect data, determine the desired outcome. Align the amount of data received with its significance.

Understand the target audience. Understand what your organizational goals are and create target incentives for increasing levels of performance. Of potential interest to hospital administration is research relating ED patient perception and experience with their entire hospital experience (Acad. Emerg. Med. 2008;15:825-31). The ED physician group needs to understand the effects this has on the public perception of the hospital. Patient satisfaction is strongly associated with willingness to return (Ann. Emerg. Med. 2001;38:527-32).

Drive process improvement. Patient satisfaction data are perceptive, and in almost every case affected by the circumstances unique to that particular situation. We must be open to these perceptions, yet cognizant that they may have less capacity to understand the medical decision making behind the scenes. This is where the peer review process becomes so valuable. But don’t under-sell patient perceptions as a tool for driving proper change within our organizations. Our patients can be one of our most valuable resources in pointing out what is working, and what isn’t, within our EDs.