Factors associated with older patients’ satisfaction with care in an inner-city emergency department

doi:10.1067/mem.2001.114304

Annals of Emergency Medicine

Volume 38, Issue 2, August 2001, Pages 140-145

Presented in part at the Midwest Society of General Internal Medicine annual meeting, Chicago, IL, September 1997.

https://doi.org/10.1067/mem.2001.114304 Get rights and content

Abstract

Study Objectives: We sought to assess older patients’ satisfaction with care in the emergency department and to identify factors associated with global satisfaction with care. Methods: We performed a prospective cohort study of 778 patients 65 years of age and older presenting to an urban academic ED between 1995 and 1996, of whom 79% were black and 63% were female. A baseline survey at presentation to the ED asked for demographic information, medical history, and health-related quality of life information. A follow-up satisfaction survey asked patients to rate the care they received in the ED on a 5-point Likert scale (1=excellent, 5=poor). Overall satisfaction with care, dichotomized into responses of “excellent” versus all others, was the primary dependent variable in our bivariate analyses. Results: Of respondents, 40% rated their ED care as “excellent.” Variables significantly correlated with high satisfaction include having the perception of time spent in the ED as not “too long,” having the emergency physicians and nurses clearly answer patients’ questions, having a relationship of trust with an ED staff member, being told why tests were done, feeling involved in decisions about care as much as they wanted, having pain addressed fully, having a perception of greater health status, and having fewer comorbid conditions at the time of the ED visit. Results may be applicable only to urban academic EDs and may be limited by time elapsed between ED visits and follow-up surveys. Conclusion: To improve quality of care for older adults in the ED, physicians should be more attentive to older patients’ concerns and questions, recognize and aggressively treat pain, and reduce the patients’ perception of a long waiting time. [Nerney MP, Chin MH, Jin L, Karrison TG, Walter J, Mulliken R, Miller A, Hayley DC, Friedmann PD. Factors associated with older patients’ satisfaction with care in an inner-city emergency department. Ann Emerg Med. August 2001;38:140-145.]

Introduction

The population 65 years of age and older constitutes a growing 15% to 20% of total emergency department visitors. These patients can be difficult to care for in the ED because they often have multiple complex medical problems, poor social support, cognitive impairment, and limited financial resources.1, 2, 3, 4, 5 Older patients are more likely to have a greater length of stay in the ED, receive more tests, and be admitted to the hospital than younger patients, yet they are somewhat less likely to receive an accurate diagnosis.⁶ They are also more likely than younger patients to believe that the ED visit did not resolve their medical problems.¹ These unresolved issues contribute to ED revisit rates 50% greater than those for young patients by 3 weeks after the initial ED visit.³

Patient satisfaction surveys can identify problem areas in a patient’s encounter with the medical system. Older patients are particularly vulnerable, and low satisfaction may be indicative of remediable problems on both individual patient and management levels. Satisfaction ratings may help staff better care for patients by identifying problems and might assist managers in maximizing the efficiency and effectiveness of the ED through improved daily operations and consideration of patient preferences in allocation decisions.7, 8, 9 Higher satisfaction can also improve patient retention in increasingly competitive markets.¹⁰

We constructed our model on the basis of past work in patient satisfaction research.⁹ We hypothesized that older persons’ satisfaction with ED care is multifactorial, including both out-of-hospital variables, such as the patients’ demographic profile and health status, and ED factors, such as waiting times, staff communication and attentiveness, and discharge planning. This model is tested in a unique way that offers a relatively large sample and a broad range of measurements and concentrates on a population 65 years of age and older who are chiefly inner-city African Americans.

Section snippets

Materials and methods

We logged 1,807 patients 65 years and older who visited an inner-city university hospital ED between the hours of 8 AM and midnight from October 1995 and June 1996. Details of our study population have previously been described.¹¹ The study was approved by the institutional review board. Research assistants administered an ED questionnaire to consenting patients or proxies during their ED visit. In the event that the ED questionnaire could not be completed in the ED, research assistants

Results

ED questionnaires were completed by 983 (54%) of 1,807 patients or proxies eligible for the study. Reasons for nonparticipation included refusal (29%), cognitive impairment with no proxy available (16%), too ill (8%), being missed by the research assistants (34%), and miscellaneous reasons (13%). Seven hundred seventy-eight (79%) of the 983 patients who completed the questionnaire also completed the follow-up satisfaction survey. This group made up the final study population.

Of the 778

Discussion

Only 70% of inner-city ED patients rated the care they received as “excellent” or “very good.” Although this suggests that patients were generally satisfied, this is a relatively low figure compared with those of other clinical environments, where high ratings of 85% to 90% are typical.¹⁶ Factors beyond the control of ED staff may lower ratings here. For example, patients who are new to a physician or clinical setting rate their satisfaction with care lower than do continuing patients.⁹ Such

Acknowledgements

Author contributions: MPN, MHC, TGK, JW, RM, AM, DCH, and PDF conceived and designed the study. MPN, MHC, LJ, TGK, and PDF analyzed and interpreted the data. LJ and TGK provided statistical expertise. MPN drafted the article. All authors critically revised the article for important intellectual content. MHC and PDF obtained funding. MPN, MHC, and PDF take responsibility for the paper as a whole.

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^*: Mr. Nerney is currently a student at Chicago College of Osteopathic Medicine, Downers Grove, IL. Dr. Friedmann is currently with the Division of General Internal Medicine, Rhode Island Hospital, Brown University, Providence, RI.

^**: Author contributions are provided at the end of this article.

^*: Supported by grants from the Chicago Community Trust (12212) and the Retirement Research Foundation (95-122), National Institute on Aging Geriatric Academic Program Award 5K12-AG-00488 (Dr. Chin), and the Mentored Clinical Scientist Career Development Award 1K08DA00320 from the National Institute on Drug Abuse (Dr. Friedmann). Dr. Chin and Dr. Friedmann are Robert Wood Johnson Foundation Generalist Physician Faculty Scholars.

^**: Address for reprints: Marshall H. Chin, MD, MPH, University of Chicago, Section of General Internal Medicine, 5841 South Maryland Avenue, MC 2007, Chicago, IL

^*: 60637; 773-702-4769, fax 773-834-2238; E-mail [email protected].

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Original ContributionsFactors associated with older patients’ satisfaction with care in an inner-city emergency department*,**,*,**,*

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Soc Sci Med

Qual Rev Bull

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Am J Emerg Med.

Original Contributions
Factors associated with older patients’ satisfaction with care in an inner-city emergency department*,**,*,**,*