Efforts to improve the care experience for ED patients have the potential for wide-ranging benefits, including more effective continuity of care, reduced need for follow-up visits, and higher staff morale. Recent studies suggest that several types of interventions can be effective tools to enhance ED patient satisfaction. “In some analyses, telephone and email follow-up by healthcare providers has been shown to improve patient satisfaction rates,” says Pankaj B. Patel, MD. “The benefits of higher patient satisfaction range from better patient compliance with discharge instructions to higher staff morale. Contacting patients after they leave the ED may also improve transitions of care and help reduce unnecessary return visits to the ED.”
Given that emergency care is often rushed, it has been hypothesized that ED patients may have even more to gain from timely post-visit contact with healthcare providers, especially among the elderly. “The potential for improving follow-up communication with elderly ED patients is particularly important because of their rising population,” Dr. Patel says. “It behooves EDs to identify opportunities that can help improve continuity of care and opportunities to increase patient satisfaction. In turn, there is also an opportunity to enhance patient outcomes for the long term.”
In-Depth Analysis of Patient Satisfaction
The direct effect of post-visit patient contact by ED physicians has not been studied extensively. Dr. Patel and David R. Vinson, MD, published an article in Annals of Emergency Medicine detailing results of their study that examined the impact of post-visit email or phone contact on patient satisfaction. “Prior to our investigation, our study team was contacting patients by email or by telephone shortly after their ED visit,” explains Dr. Patel. “Anecdotally, this communication was greatly appreciated by patients, but we wanted to quantify and validate the effectiveness of our experience.”
For their analysis, Drs. Patel and Vinson had 42 of their emergency physician colleagues either email or phone their patients within 72 hours of being discharged from the ED for 1 month, with no follow-up contact on an alternate month. “ED patients who received post-visit phone calls or emails from their physicians were significantly more satisfied with their ED experience than those who were not contacted,” says Dr. Patel.
The average satisfaction score given by patients who received post-visit contact was 87.7%, compared with a 79.4% rate for those not receiving post-visit contact (Table). The patient satisfaction scores were similar for email and phone contact. Patient satisfaction scores for 39 of the 42 participating physicians during both the noncontact and contact months allowed for a graphic physician-specific comparison between the two study months (Figure).
“It behooves EDs to identify opportunities that can help improve continuity of care and opportunities to increase patient satisfaction.”
Dr. Patel’s research team also found that physicians preferred contacting patients via email over telephone because email took less time to complete (2.2 vs 3.6 minutes, respectively) and was easier to do in light of an ED physician’s erratic schedule. “Our findings indicated no significant differences in patient satisfaction between post-visit email and phone contact,” Dr. Patel adds. “Physicians may select either modality as the gains are similar with regard to patient satisfaction ratings, according to our study.”
Considering Patient-Communication Logistics
In order to implement an effective post-ED visit email and phone contact protocol, several logistical factors need to be considered. “Standardized email and telephone templates should be used,” says Dr. Patel. It is important to have measures in place for secure HIPAA compliant email contact and ensure the accuracy of the contact information being provided. The hospital’s medical-legal department should review the program. EDs should also consider developing institution-wide guidelines for post-visit ED contact so that all emergency physicians are on the same page.”
Seizing an Opportunity in Improve Satisfaction
Developing a post-visit contact system for ED patients provides an excellent opportunity to improve both patient and physician satisfaction, says Dr. Patel. “This type of program could be modified and expanded in ways so that other healthcare benefits can emerge. Having the treating emergency physician provide post-visit patient contact may be time consuming, but it can facilitate continuity of care and may improve clarity for patients after discharge because it occurs at a time and place apart from the stress of the busy ED. We should seize the opportunity and take just a few minutes to email or call patients after discharge. Not only can it go a long way toward increasing satisfaction for patients, but it can also serve as a valuable addition to improve outcomes and ED staff satisfaction so that everybody wins.”
Readings & Resources (click to view)
Patel PB, Vinson DR. Physician e-mail and telephone contact after emergency department visit improves patient satisfaction: a crossover trial. Ann Emerg Med. 2013 Feb 25. [Epub ahead of print]. Available at: http://www.annemergmed.com/webfiles/images/journals/ymem/FA-5365.pdf.
Worthington K. Customer satisfaction in the emergency department. Emerg Med Clin North Am. 2004;22:87-102.
Welch SJ. Twenty years of patient satisfaction research applied to the emergency department: a qualitative review. Am J Med Qual. 2010;25:64-72.
Wong RK, Tan JS, Drossman DA. Here’s my phone number, don’t call me: physician accessibility in the cell phone and e-mail era. Dig Dis Sci. 2010;55:662-667.
Ezenkwele UA, Sites FD, Shofer FS, et al. A randomized study of electronic versus telephone follow-up after emergency department visit. J Emerg Med. 2003;24:125-130.