Abstract
Background
Patient-physician interactions in the emergency department (ED) are unique in that
prior relationships may not exist; interactions are brief, and the environment is
hectic.
Objectives
The research hypotheses were that patient satisfaction scores on a commonly used national
satisfaction survey are associated with patient complaints and risk management file
openings or lawsuits (risk management episodes).
Methods
Administrative databases from an emergency physician management group that staffs
34 EDs in 8 states were merged with patient satisfaction data. Dates of inclusion
were January 2002-April 2006. Estimates of physician contribution to satisfaction
utilized a multi-level mixed-effects linear regression with a random-effect for practice
site and physician, and fixed-effect adjustments for patient factors, time pressures,
acuity mix, and physician productivity. Adjusted satisfaction scores were used to
explore the relationship with complaints and risk management episodes.
Main outcome measure
Association of patient satisfaction scores with risk of complaint and risk management
episodes.
Results
There were 3947 physician-quarters of practice data analyzed, representing 2,462,617
patient visits. There were 375 complaints and 61 risk management episodes. Those in
the lowest quartile of satisfaction were nearly twice as likely to have a complaint
(adjusted odds ratio 1.84; 95% confidence interval [CI] 1.29–2.63) as those in the
highest quartile. Satisfaction was not directly related to risk management episodes.
Complaints were more strongly associated with risk management episodes than other
variables: those receiving ≥ 2 complaints in a quarter were 4.13 (95% CI 1.12–15.2)
times more likely to have a risk management episode.
Conclusions
Patient satisfaction scores are not associated with increased risk management episodes
but are closely related to receiving complaints. Receiving complaints is a strong
marker for increased risk management episodes and should prompt early corrective action.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Investigations of complaints and quality of health care.J Law Med. 2005; 12: 366-372
- Medical malpractice law in the United States.The Henry J Kaiser Foundation, Menlo Park, CA2005
- Sued and nonsued physicians’ self-reported reactions to malpractice litigation.Am J Psychiatry. 1985; 142: 437-440
- The psychological impact of complaints and negligence suits on doctors.Australas Psychiatry. 2004; 12 (discussion 282): 278-281
- Defensive medicine among high-risk specialist physicians in a volatile malpractice environment.JAMA. 2005; 293: 2609-2617
- Epidemiology of medical complaints in Mexico: identifying a general profile.Int J Qual Health Care. 2006; 18: 220-223
- Physician communication skills and malpractice claims. A complex relationship.West J Med. 1989; 150: 356-360
- Quality improvement in primary care and the importance of patient perceptions.J Ambul Care Manage. 2001; 24: 30-46
- The relationship between malpractice claims history and subsequent obstetric care.JAMA. 1994; 272: 1588-1591
- Patient complaints and malpractice risk.JAMA. 2002; 287: 2951-2957
- Doctor-patient communication and medical malpractice: implications for pediatricians.Pediatr Ann. 1997; 26: 186-193
- Why do people sue doctors? A study of patients and relatives taking legal action.Lancet. 1994; 343: 1609-1613
- Predicting risk for medical malpractice claims using quality-of-care characteristics.West J Med. 1992; 157: 433-439
- Obstetricians’ prior malpractice experience and patients’ satisfaction with care.JAMA. 1994; 272: 1583-1587
- Patient complaints and malpractice risk in a regional healthcare center.South Med J. 2007; 100: 791-796
- In context: physician-patient communication and managed care.J Med Pract Manage. 1999; 14: 226-230
- Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.JAMA. 1997; 277: 553-559
- Medical practices’ sensitivity to patients’ needs. Opportunities and practices for improvement.J Ambul Care Manage. 2003; 26: 110-123
- They may excel, but they’re the worst hospitals for patient satisfaction.US News World Rep. 2009; (Available at: http://health.usnews.com/health-news/best-hospitals/articles/2009/10/20/they-may-excel-but-theyre-the-worst-hospitals-for-patient-satisfaction.html. Accessed October 20, 2009.)
American Board of Emergency Medicine. Required steps for communication/professionalism feedback; 2009. Available at: https://www.abem.org/public/portal/alias__Rainbow/lang__en-US/tabID__3794/DesktopDefault.aspx. Accessed March 10, 2010.
- The best malpractice insurance of them all: consumer satisfaction.Health Mark Q. 1983; 1: 83-92
- The relation of patient satisfaction with complaints against physicians and malpractice lawsuits.Am J Med. 2005; 118: 1126-1133
- Hospital characteristics associated with adverse events and substandard care.JAMA. 1991; 265: 3265-3269
- Adverse events, negligence in hospitalized patients: results from the Harvard Medical Practice Study.Perspect Healthc Risk Manage. 1991; 11: 2-8
- Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I.N Engl J Med. 1991; 324: 370-376
- Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III.N Engl J Med. 1991; 325: 245-251
- Keys to patient satisfaction in the emergency department: results of a multiple facility study.Hosp Health Serv Adm. 1996; 41: 515-532
- Patient satisfaction with the outpatient experience. How does your organization measure up?.Healthc Exec. 2003; 18: 94-95
- Patient satisfaction: where does it fit in the quality picture?.Trustee. 1992; 45 (21): 8-10
- The mailout questionnaire as the practical method of choice in patient satisfaction monitoring.J Health Care Mark. 1989; 9: 67-68
- An evaluation of the impact of nonresponse bias on patient satisfaction surveys.Med Care. 1997; 35: 646-652
- Initiation of medical malpractice suits: a conceptualization and test.Med Care. 1994; 32: 813-831
- Relationship between complaints and quality of care in New Zealand: a descriptive analysis of complainants and non-complainants following adverse events.Qual Saf Health Care. 2006; 15: 17-22
Article info
Publication history
Published online: January 10, 2011
Accepted:
October 31,
2010
Received in revised form:
August 26,
2010
Received:
December 14,
2009
Footnotes
Currently, Dr. Tamayo-Sarver works at California Emergency Physicians, Emeryville, California.
Reprints are not available.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
