ED After-Care Boosts Patient Satisfaction Scores

After seeing an emergency department physician, a patient may be sent home with instructions to contact his own primary care doctor, along with a note on what medications to take, and wishes to feel better soon.

By the time the patient returns to the ED, maybe months or a year later, he may think, "Oh yeah, remember that great doc? What was his (or her) name?"

The odds are good that once the patient leaves the ED, the attending physician may not be heard from or seen again, or even remembered. Does it matter?

Some think it does. Now there is a move afoot by physicians to make the ED a greater presence in patient "after-care." Here's the prevailing wisdom: As hospital physicians step up their interactions with patients at discharge, so should ED docs.

After-care is another way to improve patient satisfaction, and possibly to prevent some of the complications that can land patients in the ED again, says Pankaj Patel, MD, an emergency department physician and former department chairman at Kaiser Permanente Medical Center in Roseville, CA, part of the Kaiser Permanente integrated healthcare system, which serves 3.3 million members at 21 hospitals and more than 160 medical offices.

Patel is lead author of a study published in the Annals of Emergency Medicine that showed ED patients who received follow-up calls or emails from emergency physicians reported that they were more satisfied with their experience than those who were not contacted after treatment.

"Patients want the ability to communicate with their doctor," Patel says. "This is a new avenue of communication between a patient and someone who would otherwise be a 'stranger' physician in the ED. That doctor may be someone a patient sees once in a lifetime."

A brief conversation outside the "rushed and stressful" environment of the ED between patient and physician can also significantly improve the patient's impression of the ED experience, he adds.

In Patel's study, 42 emergency physicians either emailed or phoned 1,000 patients within 72 hours of being discharged from Kaiser. At least 87% expressed satisfaction about the follow-up contact. Those patients who were provided no follow-up also were satisfied, but not as many. This group had a 79% satisfaction rate.

That 8% difference can be significant in terms of patient satisfaction ratings. The findings show that patients would certainly feel better about their overall ED experience if they received follow-up, Patel says.

It's no secret that many physicians are reluctant to embrace technology, even if it's as simple as sending an email. But "patient satisfaction was higher when emergency physicians contacted patients briefly after their visit, either by e-mail or by telephone," the report states. "Given that emergency care is generally more rushed than inpatient care, the ED patient might have even more to gain," he says.

The Kaiser Permanente Medical Center in Roseville, CA has begun using the e-mail and phone call system for ED physicians, says Patel. Kaiser Permanente uses a secure email system compliant with HIPAA, he says. The e-mail and call protocol "has become a standard of practice for most ED physicians in Northern California Kaiser," Patel says.

The study reveals that patients showed "more appreciation that the physician cared enough to make contact," Patel says. "There's been a reaction of, 'Wow, thank you for the call,' " he adds. "There is 'thanks' for showing caring and concern and following up."

While the study has not focused on potential impacts on outcomes, Patel says he believes the added communication would have a beneficial effect. "Any time there is communication between physician and patient, it can improve outcomes," Patel explains.

"Having the opportunity to contact the patient after the ED visit, physicians can stress the importance of care," Patel adds. For instance, if the post-ED care instructions are to "keep your arm elevated," the physician can reiterate that important pointer. "It gives a second chance to confirm information," he notes.

In the complex and expensive world of healthcare, the ED email and phone exchanges can be of "critical importance because you can't cut costs unless you involve a patient in healthcare," Patel says. "This is a simple and efficient way to have physicians and patients involved."