Should We Be Surprised?

Added on Apr 16, 2014

The authors of a recent study showing no association between the receipt of painkillers in the emergency department (ED) and patient experience scores were surprised by the results. 

"The lack of connection between painkillers and patient satisfaction is frankly the opposite of what we expected to find," said lead researcher Tayler Schwartz of Alpert Medical School at Brown University in Providence, R.I., in a news release

For the study, which was published online ahead of print in the Annals of Emergency Medicine, Schwartz and her colleagues analyzed more than 4,700 Press Ganey patient satisfaction surveys from two academic, urban emergency departments collected over a two-year period. They showed that the mean overall patient satisfaction scores for the 48.5% of patients receiving analgesic medications and the 29.6% of patients receiving opioid analgesics were lower than the scores for those patients who did not receive any form of painkiller. This led to their conclusion that factors other than painkillers may be more important to patient satisfaction. 

The findings are important, especially because they refute the argument that tying pay incentives to patient experience measures will encourage overtreatment of pain to inflate satisfaction scores. But are they really surprising? 

Certainly, most patients seeking emergency care are experiencing some sort of pain or discomfort, and, of course, they want relief. But that is just a piece of what they want. They also want to be acknowledged, listened to, comforted and educated. They want their anxiety eased and their fears assuaged. And they want reassurance through their caregivers’ words and actions that they matter as individuals—that even though their illness or injury is why they are there, it is not who they are. 

In many ways, the findings validate what Drs. Press and Ganey understood more than a quarter century ago when they founded Press Ganey and what continues to guide the company today: the patient experience is multi-dimensional. Not only is it influenced by the quality and perception of every interaction that the patient has with the health care system, but also by individual patient attributes, such as pain, disability, diagnosis, culture, demographics, fear, anxiety and comorbidities, among others. 

“What this study confirms is that medicine is complicated, and patients' overall experience reflects many factors, including the extent to which their pain is acknowledged and treated,” said Dr. Thomas H. Lee, Press Ganey Chief Medical Officer. “Pain is only one of the many issues that are important to patients, which is reflected in this study by the fact that the use of pain medications was not correlated with overall satisfaction.” 

Patient satisfaction scores are not a surrogate for patient happiness or pain relief or operational efficiency. Rather, they represent a uniquely individual, multidimensional construct that comprises all of these domains and many others. 

The study findings reject the conventional wisdom that giving more pain medication will improve satisfaction, and, by extension, the notion that including patient experience measures in national standards and reimbursement algorithms will lead to over-prescription of pain medication. 

"Our research shows that emergency physicians can administer painkillers, including opiates, based on clinical and patient factors without concern for the effect on patient satisfaction scores,” the authors wrote. 

That is to say, ED doctors can do what they are trained to do: deliver safe, effective, evidence-based patient care.