Determinants of patient satisfaction and willingness to return with emergency care

Study objective: To identify emergency department process of care measures that are significantly associated with satisfaction and willingness to retu rn. Methods: Patient satisfaction and willingness to return at 5 urban, teachin g hospital EDs were assessed. Baseline questionnaire, chart review, and 10- day follow-up telephone inter views were performed, and 38 process of care measures and 30 patient characteristic were collected for each respondent. Overall satisfaction was modeled with ordinal logistic regression. Willingn ess to return was modeled with logistic regression. Results: During a 1-month study period, 2,899 (84% of eligible) on-site que stionnaires were completed. Telephone interviews were completed by 2,333 pa tients (80% of patients who completed a questionnaire). Patient-reported pr oblems that were highly correlated with satisfaction included help not rece ived when needed (odds ratio [OR] 0.345; 95% confidence interval [CI] 0.261 to 0.456), poor explanation of causes of problem (OR 0.434; 95% CI 0.345 t o 0.546), not told about potential wait time (OR 0.479; 95% CI 0.399 to 0.5 77), not told when to resume normal activities (OR 0.691, 95% CI 0.531 to 0 .901), poor explanation of test results (OR 0.647; 95% CI 0.495 to 0.845), and not told when to return to the ED (OR 0.656; 95% CI 0.494 to 0.871). Ot her process of care measures correlated with satisfaction include nonacute triage status (OR 0.701, 95% CI 0.578 to 0.851) and number of treatments in the ED (OR 1.164 per treatment; 95% CI 1.073 to 1.263). Patient characteri stics that significantly predicted less satisfaction included younger age a nd black race. Determinants of willingness to return include poor explanati on of causes of problem (OR 0.328; 95% CI 0.217 to 0.495), unable to leave a message for family (OR 0.391; 95% CI 0.226 to 0.677), not told about pote ntial wait time (OR 0.561; 95% CI 0.381 to 0.825), poor explanation of test results (OR 0.541; 95% CI 0.347 to 0.846), and help not received when need ed (OR 0.537; 95% CI 0.340 to 0.846). Patients with a chief complaint of ha nd laceration were less willing to return compared with a reference populat ion of patients with abdominal pain. Willingness to return is strongly pred icted by overall satisfaction (OR 2.601; 95% CI 2.292 to 2.951). Conclusion: These data identify specific process of care measures that are determinants of patient satisfaction and willingness to return. Efforts to increase patient satisfaction and willingness to return should focus on imp roving ED performance on these identified process measures.