Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: For emergency department (ED) patients, delays in care are associated withdecreased satisfaction. Our department focused on implementing a front-end vertical patient flowmodel aimed to decrease delays in care, especially care initiation. The physical space for this newmodel was termed the Flexible Care Area (FCA). The purpose of this study was to quantify theimpact of this intervention on patient satisfaction.

Methods: We conducted a retrospective study of patients discharged from our academic ED over aone-year period (7/1/2013-6/30/2014). Of the 34,083 patients discharged during that period, 14,075were sent a Press-Ganey survey and 2,358 (16.8%) returned the survey. We subsequently comparedthese survey responses with clinical information available through our electronic health record(EHR). Responses from the Press-Ganey surveys were dichotomized as being “Very Good” (VG, thehighest rating) or “Other” (for all other ratings). Data abstracted from the EHR included demographicinformation (age, gender) and operational information (e.g. – emergency severity index, length of stay,whether care was delivered entirely in the FCA, utilization of labs or radiology testing, or administrationof opioid pain medications). We used Fisher’s exact test to calculate statistical differences inproportions, while the Mantel-Haenszel method was used to report odds ratios.

Results: Of the returned surveys, 62% rated overall care for the visit as VG. However, fewerpatients reported their care as VG if they were seen in FCA (53.4% versus 63.2%, p=0.027). Patientsseen in FCA were less likely to have advanced imaging performed (12% versus 23.8%, p=0.001) orlabs drawn (24.8% vs. 59.1%, p=0.001). Length of stay (FCA mean 159 ±103.5 minutes versus non-FCA 223 ±117 minutes) and acuity were lower for FCA patients than non-FCA patients (p=0.001).There was no statistically significant difference between patient-reported ratings of physicians ornurses when comparing patients seen in FCA vs. those not seen in FCA.

Conclusion: Patients seen through the FCA reported a lower overall rating of care comparedto patients not seen in the FCA. This occurred despite a shorter overall length of stay for thesepatients, suggesting that other factors have a meaningful impact on patient satisfaction.