Improving patient experience for the millions who visit an ED annually

(Press-News.org) INDIANAPOLIS -- A large scale study by researchers from the Regenstrief Institute and the Indiana University School of Medicine has found that patient pain upon arrival to the Emergency Department (ED) as well as the use of hallway beds and radiology studies in the ED are associated with patient experience, although not in the same ways.

The study’s tens of thousands of observations including clinical and operational data revealed that regardless of how promptly or successfully pain was treated in the ED, the amount of pain the patient was in when they arrived was associated with patient experience – the more pain when the patient entered the ED, the poorer the experience they reported.

All other things being equal, patients who had been placed in hallway beds, often employed to facilitate care when a facility is crowded, indicated having had a less positive experience in the ED, whether or not they received timely care.

While pain upon arrival and placement in hallway beds were associated with worse patient experience, receiving a radiology study such as an X-ray, ultrasound, CT, or MRI scans generated more positive experience scores in patients surveyed.

The study notes that these associations may represent proxies for interpersonal elements of care. For example, perhaps patients in hallway beds receive more rushed communication from clinicians or additional radiology orders were placed for ED patients when thorough and patient-centered histories were taken.

“Emergency departments are busy places where patients receive lifesaving care. EDs have surges, such as the cold and flu cases that currently are flooding EDs in many parts of the country. We recognize that if you're sitting in the waiting room, behind 40 other patients, it’s hard to have a good experience,” said study senior author Paul Musey, Jr., M.D., MSc, a Regenstrief Institute research scientist and a faculty member of the IU School of Medicine. “But we as emergency clinicians want our patients to be able to walk out of the emergency department secure in their knowledge that they don't have a life threat and that for the ones who do have a serious problem, we've been able to catch it and mitigate it. That's an important patient outcome.

“We really want to make the patient experience better for patients in the emergency department. It's important to patients and it's important to clinicians. It's also important to the healthcare system as a whole. What we were trying to understand in this study when we asked questions on the patient experience survey is what contributes to responses. And it’s not as obvious as it might seem. Understanding some of the underlying factors -- both clinical and operational factors in the ED and hospital wide -- can help EDs and physicians improve their patients’ experiences.” 

A total of 58,622 patient visits to 13 Indiana University Health EDs of varying sizes were included in the study’s analysis of data obtained from surveys administered following ED discharge. The survey population was 55 percent female. Approximately a quarter of all respondents were the parent or guardian of a pediatric patient.

“We need patients as collaborators and as key stakeholders in helping us solve issues we identified in this paper. But the solution isn't going to be one size fits all,” said study first author Diane Kuhn, M.D., PhD. “There may be patients who would rather wait an hour and be seen in a private room than be seen right now in a hallway bed. There may be patients who have a critical work meeting or they have kids whom they need to get home to now, and they're absolutely fine with being seen in a hallway as long as they can speak with the clinician now. We need to figure out those pieces to take care of everyone with their diverse needs in the best manner possible.

“We're going to be involving patients in future research to figure out how we can do the best job for them because only patients know what's important to them. We also need to effectively engage clinicians as we all have the same goals of improving the patient experience. We may have different perspectives on what needs to be done or what is being done. But I think that some sort of collaboration with others involved in the process can lead to effective solutions, even within the setting of limited resources.” Dr. Kuhn is a Regenstrief Institute affiliate scientist and an assistant professor of emergency medicine at the IU School of Medicine.

Approximately 155 million visits were made to an ED in the U.S. 2022 (the most recent year for which statistics are available), according to the Centers for Disease Control and Prevention (CDC).

Hallway beds are temporary beds, often used in EDs during high demand for services, to increase capacity and decrease wait times.  

“Use of Hallway Beds, Radiology Studies, and Patients in Pain on Arrival to the Emergency Department Are Associated With Patient Experience” is published in Annals of Emergency Medicine. The study was supported by the Ralph W. and Grace M. Showalter Research Trust and the IU School of Medicine.

Both Dr. Musey and Dr. Kuhn are emergency medicine physicians who conduct health services and health policy research.

Regenstrief Institute research scientist Christopher Harle, PhD, is a co-author of this study as are Regenstrief Institute affiliate scientists Olena Mazurenko, PhD, M.D., M.S., and Peter Pang, M.D.

All authors and affiliations as listed in the paper:

Diane Kuhn, MD, PhD; Peter S. Pang, MD; Olena Mazurenko, MD, PhD; Nancy K. Glober, MD; Thomas A. Lardaro, MD, MPH; Xiaochun Li, PhD; Christopher A. Harle, PhD; Paul I. Musey, Jr, MD, MSc

Author affiliations as listed in the paper:

Department of Emergency Medicine (Kuhn, Pang, Glober, Musey Jr.), Indiana University School of Medicine, Indianapolis, IN; Center for Health Services Research (Kuhn, Pang, Mazurenko, Musey Jr.), The William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, IN; Department of Health Policy and Management (Mazurenko, Harle), Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN; Department of Emergency Medicine (Lardaro), Yale University School of Medicine, New Haven, CT; Department of Biostatistics and Health Data Science (Li), Indiana University School of Medicine, Indianapolis, IN; and Chief Information Officer (Harle), Regenstrief Institute.

Paul I. Musey Jr., M.D., M.S.

In addition to his role as a research scientist at Regenstrief Institute, Paul Musey Jr., M.D., M.S., is the Eskenazi Health Foundation Chair and Scholar of Emergency Medicine and associate professor and vice chair of research and innovation for the Indiana University School of Medicine Department of Emergency Medicine. He also is medical director, IU Health Enterprise Clinical Research Operations (ECRO).

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