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Tom Scaletta

Health Care

Quality Improvement in the Emergency Department

Timely, objective, patient-specific comments and data can help physicians enhance patient satisfaction

Published: Tuesday, February 21, 2017 - 12:02

Quality improvement initiatives are a mainstay for hospital care teams. They can also offer a fresh approach for raising patient satisfaction scores. To achieve maximum effectiveness, however, they require timely patient feedback.

Nowhere is this truer, perhaps, than in the high-volume/short-visit emergency department (ED), where physicians seldom get much insight into how their patients feel about the overall care experience. When physicians do receive patient ratings and comments, that information is often suboptimal:
• Complaint management systems typically report only isolated cases of extreme dissatisfaction.
• Satisfaction surveys such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, provide information from a very small sample, and those data arrive many weeks or even months later—too far removed from the clinical encounter to drive useful change.

As strengthening the patient experience grows in importance for healthcare organizations, a new opportunity exists for automated patient follow-up tools to give patients a voice that both providers and health systems can hear. Automated response solutions and shift reports can help hospitals not only monitor and evaluate patients’ medical status after discharge, but also gather visibility into the perceived ED experience in nearly real time.

Five benefits of immediate response

This emerging feedback loop can assist providers across the continuum of care, but it is especially useful in emergency departments focused on care quality and patient satisfaction. It replaces the significant timing gap inherent in traditional patient satisfaction measurement surveys with a two-day maximum turnaround.

Automated response tools allow providers to check on the health status of patients 24 hours following an ED visit. Patients can report how they are feeling—better or worse—to ensure appropriate clinical follow-up. In addition, patients can offer clear remarks to providers about their perceived treatment as individuals during the visit.

The automated response tool that we employ has a unique feature for communicating directly to providers. Forty-eight hours after a provider completes a shift, he receives a brief, personalized summary report of the post-discharge survey feedback conveyed by the specific patients that provider treated. These shift reports are sent automatically by the system only to the applicable provider—a potentially less judgmental mechanism than a report forwarded on by the ED director.

Combined, these factors deliver the following advantages for patient experience managers, providers, and patients:

Improves recall of a specific encounter. An ED physician might easily see hundreds of patients in the weeks or months it takes to compile data from traditional feedback mechanisms. Consequently, the likelihood of remembering a specific patient encounter is fairly remote. On the other hand, automated solutions can deliver targeted responses in one to two days, while an encounter is still fresh in the physician’s mind. That allows physicians to clearly recall the specifics of a patient’s encounter in time to identify and address any patient experience issues.

Encourages self-coaching. A physician supplied with timely observations can more accurately reflect on what works well—and what doesn’t—during patient encounters. For example, a physician reviewing her shift report might acknowledge that she tends to describe treatment options too quickly for her patients to comprehend. Alternatively, the physician might be able to refute the complaints of a narcotics-seeker, or appreciate the high praise of a grateful patient. By viewing actual patient commentary a day or two after the visit, physicians have the opportunity to proactively fix any issues before management intervention becomes necessary. Whether feedback is positive or negative, the power behind any improvement effort rests with the physician.

Reaffirms effective behaviors. Most physicians welcome automated shift reports as a sort of barometer or report card. In addition to patient comments, the reports can relay other information such as demographics, patient volumes, clinical categories, admissions, utilization, and turnaround times. This gives ED directors and patient experience managers a well-rounded snapshot of provider workflows and behavior. For physicians who work especially intense shifts, the feedback can be both enlightening and reaffirming. Providers who are working hard to deepen their patient relationships can see fairly quickly whether their efforts are paying off—or whether they need to try different techniques.

Provides objective data. An automated response solution that gives providers timely, unvarnished patient insight can also help ED directors and quality managers remove the potential for ambiguity or “personal opinion.” Physicians skeptical of a manager’s negative performance review, for instance, might be more inclined to accept objective data that come straight from patients immediately after their encounters. Much like a basketball player’s post-game stats, shift reports can offer providers an unbiased view of what they do well and where they need to focus improvement efforts.

Builds collegial brainstorming. Physicians quite often seek out the advice of higher-performing colleagues if they realize they are struggling to provide certain aspects of a positive patient experience. One physician might share effective communication techniques, for example, or recommend specific language to explain a complex concept to patients. In turn, that physician might ask fellow providers for help connecting with patients through better listening skills. As providers come to better understand their individual strengths and weaknesses, they can collectively fulfill the adage, “All boats rise with the tide.”

Through timely, objective, patient-specific comments and data, automated patient response systems can help physicians enhance patient satisfaction. Such technology gives hospitals a new way to stay connected with patients, build rapport, and foster truly continuous quality improvement in the ED.


About The Author

Tom Scaletta’s picture

Tom Scaletta


Tom Scaletta, MD, completed an undergraduate degree in math and computer science, and worked as an applications programmer for an actuarial firm before beginning medical school at the University of Illinois. He completed his residency in emergency medicine at Northwestern Memorial Hospital and is currently the emergency department chair and patient experience medical director at Edward-Elmhurst Health in Naperville, Illinois.



Contact Info

Please share your thoughts on this QI effort. I can be reached at Tom.Scaletta@eeheath.org.

Speed is the Healing App!

Faster feedback sounds like a great idea. 

Now if we could just get ED Length of Stay down from four hours.

In 2004, Baldridge award winning RJW Hospital discharged patients in 38 minutes and admitted patients in 90. They had a 15-30 guarantee: see a nurse in 15 minutes and a doctor in 20 or your visit is free. 

That's the healing power of Lean Six Sigma for Hospitals.