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 Although doctors might act differently in an emergency room compared
to a calmer office setting, researchers say the results also suggest
that ratings are not a completely reliable measure of the quality of
care physicians give.
As healthcare payers put more focus on improving patient
experiences, said senior author Dr. Christopher Jones, of Cooper
Medical School at Rowan University in Camden, New Jersey, “these
scores are being used more and more to reward physicians and
hospitals which do well, and to punish those who don’t perform so
well.”
For the study in Annals of Emergency Medicine, the researchers
compared patient satisfaction surveys collected from three different
locations staffed by the same set of doctors. One setting was the
emergency department at Cooper University Hospital - a more
culturally diverse and urban environment, the researchers say. The
other two settings were urgent care sites in more suburban areas
nearby.
The study team used quality ratings of 17 doctors from both
emergency room and urgent care patients. Surveys were collected
between June 2013 and August 2014 by Press Ganey, an independent
quality assessment company.
The surveys asked patients to rate on a scale of 1 (very poor) to 5
(very good) how courteous the doctors were, how much doctors took
time to listen, whether they kept patients informed about their
treatment and their concern for patients’ comfort.
The study team hoped that looking just at the doctors’ ratings on
courtesy would rule out the influence of outside factors, such as
interactions with other healthcare staff, on patient perceptions of
the doctor.
Nevertheless, patients who saw doctors in the hospital emergency
room gave them consistently lower scores on all of the survey
questions compared to patients who saw the same doctors in urgent
care settings.
Based on 17 emergency department surveys and 79 from the urgent care
settings, all of the doctors' average scores for each courtesy
question were between one third and one half point lower in the
emergency department setting.
“As physicians it is also important to us that we are creating
strong patient-physician relationships, that our patients feel
respected, and that they are happy with the service they receive,”
Jones said by email.
However, it is hard to measure this relationship without the
influence of factors like wait times, other staff members and even
how the treatment center looks, he added.
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Doctors may also be influenced by the conditions of treatment
centers, said Gayle Prybutok, a nurse and professor who studies
emergency department conditions, who was not involved in the study.
Working conditions in hospital emergency rooms can be harsh, she
said by email. “Physicians who are exhausted from working 24 hour
shifts with frequent sleep interruptions often have difficulty being
cordial during patient interactions.”
Urgent care centers tend to have more limited hours and may have
shorter wait times, she said. “Interactions with all providers are
likely to be more cordial because stress in the environment is
limited.”
Prybutok suggested it might be better to use these scores to compare
quality ratings between similar types of settings and try to improve
the way services are delivered to patients.
“Comparing apples to apples is more useful than comparing apples to
oranges and trying to draw conclusions that lead to the design and
implementation of process improvements,” Prybutok said.
Interactions between patients and doctors should not feel rushed,
patients should be encouraged to ask questions and doctors should
make sure they understand and give written instructions in the
patient’s language, she said.
“Our study shows that satisfaction scores patients give their
physicians are influenced by factors other than just the
patient-physician relationship. Until we determine how to control
for these other factors, we should be very cautious about using
satisfaction scores to make comparisons between different
physicians,” Jones said.
SOURCE: bit.ly/21I79Ut Annals of Emergency Medicine, online February
11, 2016.
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