Understanding Patient Perspectives

By better understanding the patient perspective, hospital administrators can make positive changes to improve their service. As a consulting company, Press Ganey regularly helps hospitals improve their facilities and service and has compiled a few top-line solutions to help administrators improve their emergency department and their patients’ satisfaction.

» Hospital Administrator Tip Sheet (PDF)

Key insights from the Institute of Medicine (IOM) Report

The June 2006 IOM report, Hospital-Based Emergency Care: At the Breaking Point, underscores the importance of the critical challenges faced by emergency departments in the United States, including overcrowding, ambulance diversions and inefficient patient flow and hospital operations. According to the report:

• "Hospital chief executive officers should adopt enterprise-wide operations management and related strategies to improve the quality and efficiency of emergency care."
• "By smoothing the inherent peaks and valleys in patient flow, and eliminating the artificial variabilities that unnecessarily impair patient flow, hospitals can improve patient safety and quality while simultaneously reducing hospital waste and cost."
  

Key insights from the 2009 Press Ganey Pulse Report

• Communication is key. Patients who reported that they received “good” or “very good” information about delays reported nearly the same overall satisfaction regardless if they spent more than four hours or less than one hour in the emergency department.
• Timing and staffing are key. Patients who arrive in the emergency department between 7:00 a.m. and 3:00 p.m. report higher satisfaction than those who arrive in the evening or overnight hours. Staffing patterns, patient volume and acuity of patient conditions may play a large part in these differences in satisfaction. By mid-afternoon, wait times may be on the rise as patient volumes have increased during the day. If a shift change is occurring during a particularly busy time, it may add to any actual or perceived disorganization or delays for patients.
• Areas for improvement. Patients report that emergency departments need improvement in the arrival process and in dealing with patients’ personal issues. Providing a comfortable, safe waiting area, informing patients about delays, helping to control their pain and communicating with patients frequently and respectfully throughout their visit are all critical components of improving these two aspects of care.
• Comfort is important. Whether a patient spent one hour or four hours in the emergency department, those who rated the waiting room as “very poor” in comfort had dramatically lower overall satisfaction with their visit than those who rated the comfort of the waiting room as “very good.” Hospitals can analyze their patients’ comments to find ways to improve the comfort level.
  

General facts from the Centers for Disease Control and Prevention (CDC)

• From 1996 through 2006, the annual number of ED visits increased from 90.3 million to 119.2 million visits (up by 32%). An average increase of about 2.9 million visits (3.2%) per year.
• As the number of visits to the ED has increased, the number of hospital EDs has decreased from 4,019 to 3,833, thus increasing the annual number of visits per ED.
• Diagnostic services, exclusive of medical screening and mental status exams, were provided at 77.4% of visits.
• Blood tests were ordered at 38.8% of visits.
• Imaging was ordered at 44.2% of visits.
• Procedures were performed at 47.6% of ED visits. Most frequent procedures were the administration of intravenous fluids (24.0%), wound care (10.0%), orthopedic care (5.9 %), nebulizer therapy (3.1%) and bladder catheterization (2.8%).
• Patients saw physicians at 90.2% of ED visits, physician assistants at 8.7% and nurse practitioners at 4.1% of visits.

2009 Press Ganey Summit Award Winners: Emergency Department

Summit Award winners have ranked in the 95^th percentile or above in the Press Ganey database for a minimum of three consecutive years.

Avera Sacred Heart Hospital – Yankton, SD
Avera St. Benedict Health Center – Parkston, SD
Avera Weskota Memorial Medical Center – Wessington Springs, SD
Custer Regional Hospital – Custer, SD
Floyd Valley Hospital – Le Mars, IA
Hegg Memorial Health Center – Rock Valley, IA
Henry Ford Wyandotte Hospital Center for Health Services – Brownstown Township, MI
John and Mary E. Kirby Hospital – Monticello, IL
Lodi Community Hospital – Medina County, OH
Middlesex Hospital-Marlborough Medical Center – Marlborough, CT
Monroe County Hospital – Albia, IA
Oconomowoc Memorial Hospital – Oconomowoc, WI
Paul Oliver Memorial Hospital – Frankfort, MI
Sioux Center Community Hospital and Health Center – Sioux Center, IA
Southwestern Vermont Medical Center – Bennington, VT
Spencer Hospital – Spencer, IA
St. John's Medical Center – Jackson, WY
St. Vincent Heart Center of Indiana – Indianapolis, IN
Summa Wadsworth-Rittman Hospital – Wadsworth, OH
Swedish Health Services – Issaquah/Lake Sammamish Emergency Department – Issaquah, WA
Wayne County Hospital – Corydon, IA
Wright Medical Center – Clarion, IA