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The ED: Doorway to Dissatisfaction?

by Rick Blizzard

According to the National Center for Health Statistics, there were 102,765,000 emergency department (ED) visits in the United States in 1999 (the most recent year for which statistics are available). This averages to 37.8 visits per 100 people. Considering the nursing shortages and outdated facilities in many hospitals, it is no wonder that patient satisfaction with the nation's EDs is declining relative to other healthcare services.

According to Dr. Susan Lambe, lead author of an article about California EDs in the April issue of Annals of Emergency Medicine, this is just the tip of the iceberg. In 1999, 30.5 million of U.S. ED visits were defined as urgent, meaning that the patients needed care within two hours. This represents a 36% increase since 1990.

As Dr. Brent Asplin, an emergency physician and member of the American College of Emergency Physicians task force on emergency room overcrowding, observed in a March 31 CNN article, "It's the sickest patients who are holding up the monitored beds … And when these beds are filled, ambulances must be diverted to other hospitals, sometimes delaying care for extremely ill patients."

How has increased emergency department dissatisfaction affected inpatient satisfaction for those admitted through the ED? To answer this question, Gallup examined more than 177,000 responses from its 2001 inpatient loyalty database for which the admission type was known. On a four-point scale in which "4" is high and "1" is low, inpatient satisfaction is significantly lower for admissions through the ED than for other types of admissions (3.45 compared to 3.52, respectively). In fact, inpatient satisfaction among those admitted through the ED is significantly lower for 20 out of 21 satisfaction indicators (the sole exception being satisfaction with food service). The largest gaps occur with respect to patients' satisfaction with educational and informational materials (3.27 compared to 3.41) and with the admitting process (3.29 compared to 3.41).

Key Points

The number of urgent care visits to the nation's emergency departments is increasing, and this trend is resulting in a decline in ED satisfaction. For many hospitals, the ED accounts for half or more of all inpatient admissions; therefore ED dissatisfaction is having a direct impact on inpatient satisfaction. The emergency department is increasingly becoming the door through which patient dissatisfaction is likely to enter.

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