Association of patient, operational, and care factors with emergency department satisfaction in dental pain, back pain, and headache patients [abstract]
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Study Objectives: Due to the limited treatment options available to emergency physicians to treat certain chief complaints, providers anecdotally report the perception that these patients may rate satisfaction with their care lower. This will be important as health care reform incorporates patient satisfaction into reimbursement models. This study aimed to determine which factors appear to influence patient satisfaction scores for three different chief complaints with treatment options that are limited to symptomatic care (dental pain, low back pain, and headache). Methods: This is a retrospective observational study of patient satisfaction data from patients seen at a single, urban, community-based Level 1 Adult and Pediatric Trauma Center with an emergency medicine residency program. As part of a performance improvement initiative, a 3 rd party vendor specializing in emergency medicine patient satisfaction assessment made up to 3 telephone attempts to contact each English or Spanish-speaking patient discharged from the emergency department (ED) between September 1, 2011, and March 31 st , 2012. Patients were administered a standardized survey assessing satisfaction with their overall ED experience. Multivariate ordinal logistic regression with forward selection was used to determine the impact of patient (sex, age group, primary language, race/ethnicity, insurance status, multiple visits within the study period), operational (day of week, time of day, treatment pod, wait time), and care (Emergency Severity Index score, number of lab tests, number of imaging tests, number of prescriptions written, number of prescriptions filled, self-assessed change in medical condition) variables on a five-level patient satisfaction score (5 = Best; 1 = Worst). Results: During the study period, 5,479 patients were discharged from our emergency department with a chief complaint of dental pain (37.1%), headache (28.5%), or back pain (44.4%), and 49.6% were reached by the survey vendor. Overall patient satisfaction was distributed as follows: 5 = 60.3%; 4 = 23.4%; 3 = 9.5%; 2 = 3.4%; 1 = 3.5%. The odds of lower satisfaction for all conditions was associated with a longer wait time to be roomed and longer time from rooming to final disposition (OR = 0.63; 95% CI 0.56-0.69; OR = 0.83; 95% CI 0.77-0.89, respectively) and patient self-assessed condition remaining the same or worsening after discharge (OR = 0.60; 95% CI 0.49-0.73; OR = 0.37; 95% CI = 0.27-0.51, respectively). Patients aged 0-7 years old had higher odds of having lower satisfaction than those > 18 years old (OR=0.37; 95% CI 0.14-0.99). The odds of higher patient satisfaction were present for patients who received more imaging (OR =1.23; 1.11-1.37). Conclusions: In this urban community emergency department, patient satisfaction for conditions with limited emergency department treatment options does not appear to be linked to patient care interventions, with the exception of the number of imaging tests patients receive. Focusing on operational factors, such as reducing wait times, may result in higher satisfaction in this subset of patients. Addressing expectations about the likelihood of their condition improving in a short amount of time may also assist in improving patient satisfaction.