Use of Hallway Beds, Radiology Studies, and Patients in Pain on Arrival to the Emergency Department Are Associated With Patient Experience - 18/01/25

Doi : 10.1016/j.annemergmed.2024.11.020

Diane Kuhn, MD, PhD ^a,^b,^⁎ , Peter S. Pang, MD ^a,^b, Olena Mazurenko, MD, PhD ^b,^c, Nancy K. Glober, MD ^a, Thomas A. Lardaro, MD, MPH ^d, Xiaochun Li, PhD ^e, Christopher A. Harle, PhD ^c,^f, Paul I. Musey, MD, MSc ^a,^b
^a Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
^b Center for Health Services Research, The William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, IN
^c Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN
^d Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
^e Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
^f Chief Information Officer, Regenstrief Institute, Indianapolis, IN

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 18 January 2025

Abstract

Study objective

Patient experience is an essential measure of patient-centered emergency care. However, emergency department (ED) patient experience scores may be influenced by patient demographics as well as clinical and operational characteristics unrelated to actual patient-centeredness of care. This study aimed to determine whether there are characteristics associated with patient experience scores that have not yet been proposed for risk adjustment by the Centers for Medicare and Medicaid Services (CMS).

Methods

This is a cross-sectional study of patient visits for 13 EDs across a regional health system from January 1, 2022, to December 31, 2023. We used a multivariable mixed-effects regression with physician-site random effects to examine the relationship between patient, clinical, and operational characteristics and ED patient experience scores. The dependent variable was a patient’s likelihood to recommend rating (0-10 scale), treated as a continuous variable. The independent variables included patient (age, race, gender, ethnicity, interpreter need, and payer type), clinical (radiology and laboratory studies, opioid administration, patient acuity, and initial pain score), and operational characteristics (door-to-doc times, hallway bed placement, and National Emergency Department Overcrowding Scale [NEDOCS] level).

Results

A total of 58,622 unique patient visits were included in the analysis. The patient experience survey response rate was 7.1% of discharged ED patients during the study period. Black or African American patients, those with Medicaid insurance, and adults aged younger than 40 years were underrepresented relative to the expected proportions based on population data. Several clinical and operational characteristics were significantly associated with experience ratings, including hallway bed placement (-0.38 [95% confidence interval, -0.53 to -0.23]), receiving radiology studies (0.27 [0.20 to 0.35]), initial pain scores (-0.08 [-0.09 to -0.06]), and NEDOCS level.

Conclusion

We found several clinical and operational characteristics associated with patient experience scores, which CMS does not currently use for risk adjustment. Our findings raise concerns that there are elements of care associated with patients' overall experience ratings which have an unclear relationship with patient-centered constructs such as communication and coordination of care.

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Keywords : ED Performance, Patient Satisfaction, Crowding, Pain Control, ED CAHPS

Plan

Introduction

Background

Importance

Goal of This Investigation

Materials and Methods

Study Design and Setting

Selection of Participants

Measurements

Analysis

Results

Characteristics of the Survey Participants

Main Results

Limitations

Discussion

	Supervising editor: Stephen Schenkel, MD, MPP. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: DK conceptualized and designed the study, obtained the data and conducted the statistical analysis. XL planned the statistical approach and reviewed the manuscript. PP, OM, NG, TL, CH, and PM were responsible for conceptualization of the study and the writing and editing of the manuscript. DK takes responsibility for the manuscript as a whole.
	Data sharing statement: The dataset associated with this study will not be retained after publication, in accordance with our regulatory exemption. Analytic code can be provided upon reasonable request from the corresponding author by emailing dkuhn1@iuhealth.org.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors of the paper report no such relationships. This work was made possible by an award from the Ralph W. and Grace M. Showalter Research Trust and the Indiana University School of Medicine.
	The content is solely the responsibility of the authors and does not necessarily represent the official views of the Showalter Research Trust or the Indiana University School of Medicine.
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