title: Inability of Physicians and Nurses to Predict Patient Satisfaction in the Emergency Department.
abstract: BACKGROUND
  Patient satisfaction is a commonly assessed dimension of emergency department (ED) care quality. The ability of ED clinicians to estimate patient satisfaction is unknown. We sought to evaluate the ability of emergency medicine resident physicians and nurses to predict patient-reported satisfaction with physician and nursing care, pain levels, and understanding of discharge instructions.
  
  
  METHODS
  We studied a convenience sample of 100 patients treated at an urban academic ED. Patients rated satisfaction with nursing care, physician care, pain level at time of disposition and understanding of discharge instructions. Resident physicians and nurses estimated responses for each patient. We compared patient, physician and nursing responses using Cohen's kappa, weighting the estimates to account for the ordinal responses.
  
  
  RESULTS
  Overall, patients had a high degree of satisfaction with care provided by the nurses and physicians, although this was underestimated by providers. There was poor agreement between physician estimation of patient satisfaction (weighted κ=0.23, standard error: 0.078) and nursing estimates of patient satisfaction (weighted κ=0.11, standard error: 0.043); physician estimation of patient pain (weighted κ=0.43, standard error: 0.082) and nursing estimates (weighted κ=0.39, standard error: 0.081); physician estimates of patient comprehension of discharge instruction (weighted κ=0.19, standard error: 0.082) and nursing estimates (weighted κ=0.13, standard error: 0.078). Providers underestimated pain and patient comprehension of discharge instructions.
  
  
  CONCLUSIONS
  ED providers were not able to predict patient satisfaction with nurse or physician care, pain level, or understanding of discharge instructions.
authors.affiliation: University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: DeLaney
authors.affiliation: University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.
authors.forename: David B
authors.initials: DB
authors.lastname: Page
authors.affiliation: University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.
authors.forename: Ethan B
authors.initials: EB
authors.lastname: Kunstadt
authors.affiliation: University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.
authors.forename: Matt
authors.initials: M
authors.lastname: Ragan
authors.affiliation: University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.
authors.forename: Joel
authors.initials: J
authors.lastname: Rodgers
authors.affiliation: University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004636:Emergency Service, Hospital; D006786:Hospitals, Urban; D006801:Humans; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D010146:Pain / Q000175:diagnosis; D010147:Pain Measurement; D010351:Patient Discharge; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires