Administration of Emergency Medicine| Volume 46, ISSUE 4, P560-566, April 2014

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The Impact of Patient Telephone Call after Discharge on Likelihood to Recommend in an Academic Emergency Department



      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.


      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.


      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.


      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.


      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.


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      1. Centers for Medicare & Medicaid Services. Clinical quality measures (CQMs). Available at: Accessed November 28, 2012.

      2. Medicare. Hospital compare: quality of care. Available at: Accessed October 26, 2011.

      3. U.S. Department of Health & Human Services. Hospital value-based purchasing: measuring explanations. Available at: basedpurchasing04292011b.html. Accessed October 26, 2011.

      4. Adamy J. U.S. ties hospital payments to making patients happy. The Wall Street Journal, October 14, 2012. Available at: Accessed November 26, 2012.

        • Soremekun O.A.
        • Takayesu J.K.
        • Bohan S.J.
        Framework for analyzing wait times and other factors that impact patient satisfaction in the emergency department.
        J Emerg Med. 2011; 41: 686-692
        • Soleimanpour H.
        • Gholipouri C.
        • Salarilak S.
        • et al.
        Emergency department patient satisfaction survey in Imam Reza Hospital, Tabriz, Iran.
        Int J Emerg Med. 2011; 4: 2
        • Toma G.
        • Triner W.
        • McNutt L.A.
        Patient satisfaction as a function of emergency department previsit expectations.
        Ann Emerg Med. 2009; 54 (e6): 360-367
        • Walrath J.M.
        • Tomallo-Bowman R.
        • Maguire J.M.
        Emergency department: improving patient satisfaction.
        Nurs Econ. 2004; 22 (55): 71-74
      5. Robert Wood Johnson Foundation. Improving patient satisfaction in the emergency department (ED) with a call back clerk; January 4, 2008. Available at: Accessed November 28, 2012.

        • Trout A.
        • Magnusson A.R.
        • Hedges J.R.
        Patient satisfaction investigations and the emergency department: what does the literature say?.
        Acad Emerg Med. 2000; 7: 695-709
        • Boudreaux E.D.
        • Friedman J.
        • Chansky M.E.
        • Baumann B.M.
        Emergency department patient satisfaction: examining the role of acuity.
        Acad Emerg Med. 2004; 11: 162-168
      6. Román C, Setia N. Discharge phone calls nearly double patient satisfaction. Hardwired Results Ezine, Issue 9; StuderGroup; 2008. Available at: Accessed November 28, 2012.

      7. Baker S. Hardwiring flow in the emergency department. Hardwired Results Ezine; StuderGroup; 2010. Available at: 12/Issue12_article1.html. Accessed November 2012.

        • Guss D.A.
        • Leland H.
        • Castillo E.M.
        The impact of post-discharge patient call back on patient satisfaction in two academic emergency departments.
        J Emerg Med. 2013; 44: 236-241
        • Taylor C.
        • Benger J.R.
        Patient satisfaction in emergency medicine.
        Emerg Med J. 2004; 21: 528-532
        • Hedges J.R.
        • Trout A.
        • Magnusson A.R.
        Satisfied Patients Exiting the Emergency Department (SPEED) study.
        Acad Emerg Med. 2002; 9: 15-21
        • Boudreaux E.D.
        • O'Hea E.L.
        Patient satisfaction in the Emergency Department: a review of the literature and implications for practice.
        J Emerg Med. 2004; 26: 13-26
        • Bursch B.
        • Beezy J.
        • Shaw R.
        Emergency department satisfaction: what matters most?.
        Ann Emerg Med. 1993; 22: 586-591
        • Thompson D.A.
        • Yarnold P.R.
        • Williams D.R.
        • Adams S.L.
        Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department.
        Ann Emerg Med. 1996; 28: 657-665
        • McMillan J.R.
        • Younger M.S.
        • DeWine L.C.
        Satisfaction with hospital emergency department as a function of patient triage.
        Health Care Manage Rev. 1986; 11: 21-27
        • Booth A.J.
        • Harrison C.J.
        • Gardener G.J.
        • Gray A.J.
        Waiting times and patient satisfaction in the accident and emergency department.
        Arch Emerg Med. 1992; 9: 162-168
        • Reichheld F.F.
        The one number you need to grow.
        Harv Bus Rev. 2003; 81 (124): 46-54
        • Kessler D.P.
        • Mylod D.
        Does patient satisfaction affect patient loyalty?.
        Int J Health Care Qual Assur. 2011; 24: 266-273
        • Shesser R.
        • Smith M.
        • Adams S.
        • Walls R.
        • Paxton M.
        The effectiveness of an organized emergency department follow-up system.
        Ann Emerg Med. 1986; 15: 911-915
        • Dudas V.
        • Bookwalter T.
        • Kerr K.M.
        • Pantilat S.Z.
        The impact of follow-up telephone calls to patients after hospitalization.
        Am J Med. 2001; 111: 26S-30S
        • Pankaj B.
        • Vinson D.R.
        Physician e-mail and telephone contact after emergency department visit improves patient satisfaction: a crossover trial.
        Ann Emerg Med. 2013; 61: 631-637
        • Kim S.S.
        • Kaplowitz S.
        • Johnston M.V.
        The effects of physician empathy on patient satisfaction and compliance.
        Eval Health Prof. 2004; 27: 237-251
        • Jones J.
        • Clark W.
        • Bradford J.
        • Dougherty J.
        Efficacy of a telephone follow-up system in the emergency department.
        J Emerg Med. 1988; 6: 249-254
        • Rakel D.P.
        • Hoeft T.J.
        • Barrett B.P.
        • Chewning B.A.
        • Craig B.M.
        • Niu M.
        Practitioner empathy and the duration of the common cold.
        Fam Med. 2009; 41: 494-501
        • Hojat M.
        • Louis D.Z.
        • Markham F.W.
        • Wender R.
        • Rabinowitz C.
        • Gonnella J.S.
        Physicians' empathy and clinical outcomes for diabetic patients.
        Acad Med. 2011; 86: 359-364