Patient Satisfaction and Likelihood to Recommend Between Academic Teaching and Community Emergency Departments

Document Type

Conference Proceeding

Publication Date


Publication Title

Academic Emergency Medicine


Background and Objectives: Patient surveys are a common means of collecting information on patient satisfaction and likelihood to recommend, both of which are important barometers of a patient’s emergency department (ED) experience. We sought to assess the impact of treatment in an academic teaching vs. community ED on a patient’s likelihood to recommend.

Methods: We performed a retrospective analysis of all completed patient surveys (Press Ganey) of discharged patients across 5 EDs within an integrated health system from January 2019 through June 2020. Two EDs were at academic teaching hospitals with EM residencies and 3 were community EDs. Patient responses were dichotomized to “favorable” or “not favorable”, wherein “favorable” denoted a likelihood to recommend of 4 or 5 on a 5-point Likert scale. Operational time metrics were assessed in 10-minute intervals. The analysis included univariate comparisons and generalized linear modeling to adjust for the site, demographic, and operational metrics. We report adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).

Results: There were 7,694 surveys completed. The majority of respondents were female (64.4%), >50 years (68.2%), and presented to a teaching hospital (54.0%). In univariate analysis, male sex, white race, older age, treatment in a community ED, shorter time to a room, and shorter overall ED length of stay were associated with a higher likelihood of a favorable survey response. In adjusted analysis, the odds of a favorable response were higher in males (aOR 1.25, 95% CI 1.12 - 1.39), white patients (aOR 1.16, 95% CI 1.02 -1.32), and older adults (aOR 1.02, 95% CI 1.01-1.02 with each year of increasing age). Time metrics such as longer overall length of stay (aOR 0.95, 95% CI 0.93-0.97) and longer time to be placed in a room (aOR 0.95, 95% CI 0.93 -0.97) were associated with lower odds of a favorable response. Patients managed at an academic teaching site had significantly lower odds of a favorable response compared to community EDs (aOR 0.54, 95% CI 0.48 – 0.61) in adjusted analysis. Factors not associated with a favorable response included ethnicity, emergency severity index, mode of arrival, arrival time, and arrival day of the week.

Conclusion: When adjusted for operational and demographic metrics, academic teaching sites had lower associated rates of a favorable response from patient satisfaction surveys.





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