Satisfaction and emergency department revisits in patients with possible acute coronary syndrome.
BACKGROUND
Patients with possible acute coronary syndrome (ACS) are typically instructed to return to the emergency department (ED) if their condition worsens. Little is known about the relationship between patient satisfaction in the ED and subsequent return visits.


OBJECTIVE
Our aim was to determine the association between satisfaction with ED care and subsequent ED return visits.


METHODS
One thousand and five consecutive ED patients with symptoms of possible ACS who participated in a prospective guideline implementation trial at two university hospitals completed a telephone survey at 30-day follow-up. Satisfaction with care at the initial ED visit was measured using items from the Press Ganey satisfaction questionnaire. Logistic regression was used to determine the association between individual satisfaction items and the occurrence of any ED revisits, and the association between satisfaction items and return visits to the same ED.


RESULTS
Patients who reported superior ratings of person-centered care ("staff cared about you as a person") were significantly less likely to return to any ED during 30-day follow-up: 59 vs. 71%, adjusted odds ratio = 0.57 (95% confidence interval 0.37-0.87). Among those with ED revisits, superior ratings of personal care and perceived waiting time for emergency physician evaluation were significantly associated with return to the same ED.


CONCLUSIONS
Although diagnostic workup and risk stratification are the primary focus in evaluating patients with possible ACS, greater attention to the patient's experience of care may have the positive impact of reducing ED return visits and increasing the likelihood that patients will return to the same ED for re-evaluation.
Division of General Internal Medicine, University of Iowa Carver, College of Medicine, Iowa City, Iowa; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, Iowa.
David A
DA
Katz
Tom P
TP
Aufderheide
Gary
G
Gaeth
Peter S
PS
Rahko
Stephen L
SL
Hillis
Harry P
HP
Selker
D054058:Acute Coronary Syndrome / Q000628:therapy*; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000592:standards*; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000592:standards; D011795:Surveys and Questionnaires; D014922:Wisconsin
acute coronary syndrome; chest pain; hospital emergency service; patient acceptance of health care; patient satisfaction