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Is Bedside Manner Relevant to the ER?

by Rick Blizzard, D.B.A.
Health and Healthcare Editor

What drives patient satisfaction in the emergency department? A typical guess might be speed and efficiency of service -- and an analysis of emergency department satisfaction ratings in Gallup's healthcare database confirms that that's a good answer. The specific questions in Gallup's database that are most highly correlated with overall patient satisfaction include:

  • confidence you can get help at any time
  • speed of service
  • emergency department efficiency
  • sense of urgency shown by staff

But the emphasis on speed in the emergency department (ED) environment shouldn't preclude consideration of the quality of interactions between patients and caregivers -- the nurses and doctors, most importantly. Speed is not adequate if it leads to an unsatisfactory treatment outcome, and the ultimate outcome depends on the quality of the staff.

Gallup measures patient satisfaction with the human side of the ED with two items:

  • satisfaction with overall nursing care
  • satisfaction with the quality of emergency department physicians

Patient Perceptions of Emergency Department Doctors and Nurses

Emergency staff members are a key factor in patient satisfaction, and patients tend to evaluate them very positively. Gallup's 2002 healthcare database indicates that based on a scale of 1 to 4, ED doctors receive a mean satisfaction rating of 3.35, and overall nursing care receives a mean rating of 3.39. Satisfaction with ED doctors and satisfaction with nursing care are rated relatively highly compared to other specific questions relating to ED satisfaction, and both ratings exceed the mean overall ED satisfaction rating (3.29).

Potential for Improvement

So despite often inadequate (sometimes antiquated) facilities, overcrowding, and nursing shortages, most ED caregivers seem to be successfully meeting the needs and expectations of patients. How can satisfaction levels with ED doctors and nurses be raised even higher?

One key is to recognize that success among the ED staff depends on performance as an integrated team. The doctor-nurse team is particularly important. Several years ago, I conducted an analysis of ED satisfaction scores that compared full-time ED physicians with locum tenens ED physicians (who were working only temporarily in the ED). Not surprisingly, patients gave higher ratings to full-time ED physicians than to the temporary ED physicians. But more surprisingly, patients who saw full-time physicians also gave higher scores for nursing care than patients who saw locum tenens physicians did.

The explanation behind the nursing scores is simple: Locum tenens physicians are not only less familiar with the ED's systems and processes, they are also less likely to have a smooth working relationship with the nursing staff. They have not yet built an effective team. Hospitals looking to improve their ED performance need to concentrate on strengthening relationships between doctors and nurses.

Bottom Line

ED nurses recognize the importance of an integrated team, and they look to physicians for leadership. When reviewing patient satisfaction results, nurses often ask, "Have the physicians seen these data?" The mere raising of this question indicates a barrier to team development that may weaken the tendency to take responsibility for patient satisfaction among both groups. Satisfaction results have traditionally been presented to two separate groups -- ED medical staff and ED nursing staff. If performing as a team is integral to successful ED performance, shouldn't all the team members work on improving their performance together?


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