Abstract
Background
Patient satisfaction is a common parameter tracked by health care systems, and likely
influences patient provider choice and may impact insurer payment. Achieving high
satisfaction in an academic emergency department (ED) can be a daunting task due to
variable volumes, acuity, and overcrowding.
Objective
The objective of this study was to assess the impact of a postdischarge telephone
call by a staff member after discharge from the ED on patient satisfaction.
Methods
This was a prospective cohort study conducted in the two University of California
San Diego Health System EDs. Press Ganey patient satisfaction surveys are mailed to
a random sample of 50% of all discharged patients. In August 2010 a program of MD
and RN telephone call back 1 to 5 days after the ED visit was initiated. In conjunction
with this program, a custom question was added to the standard survey, “Called back
after discharge, Yes/No?” All surveys returned between September 22, 2010 and December
7, 2010 were reviewed, and those that chose to self-identify were selected to allow
for ED chart review. The key outcome variable “likelihood to recommend score” was
dichotomized into the highest category, 5 (very good) and remaining levels, 1–4 (very
poor, poor, fair, good). ED records were abstracted for data on waiting time (WT),
length of stay (LOS), and triage class (TC). These variables were selected because
they have been shown to impact patient satisfaction in prior studies. Likelihood to
recommend ratings for those reporting “Yes” to call back were compared to those reporting
“No” to call back. Summary statistics were generated for patient characteristics in
the “Yes” and “No” groups. Ninety-five percent confidence intervals (CIs) for all
counts and proportions were calculated with the “exact” method. A logistic regression
model was constructed assessing odds ratio (OR) for likelihood-to-recommend score
5 while controlling for the variables of WT, LOS, and TC.
Results
In the study period, about 5000 surveys were mailed, 507 were returned, and 368 self-identified.
Of those that self-identified, 136 patients answered “Yes” to the callback question
and 232 answered “No.” The mean age for those indicating “Yes” was 55.8 years (CI
52.9–58.7), and for those indicating “No,” 50.7 years (CI 47.9–53.5). Gender and triage
code were similar between the two groups. Among those answering “Yes,” 89.0% (CI 82.5–93.7)
provided a “5” rating for “likelihood to recommend,” compared to 55.6% (CI 49.0–62.1)
who replied “No” for call back. The logistic regression model generated an OR of 6.35
(CI 3.4–11.7) for providing a level 5 rating for “likelihood to recommend” for patients
reporting “Yes” for call back after controlling for WT, LOS, and TC.
Conclusion
In the study institution, patients that are called back are much more likely to have
a favorable impression of the visit as assessed by likelihood to recommend regardless
of WT, LOS, or TC. These data support “call back” as an effective strategy to improve
ED patient satisfaction.
Keywords
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Article info
Publication history
Published online: January 31, 2014
Accepted:
November 16,
2013
Received in revised form:
October 31,
2013
Received:
August 9,
2013
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
