It Starts in ED: Why a Patient's "First Impression" Sets the Stage for HCAHPS Success

You might find it odd that we would zero-in on the Emergency Department when discussing an inpatient survey. But when you think about how your patients get to your hospital in the first place, it makes perfect sense.

The Emergency Department is the major point of entry for the largest number of patients arriving at most hospitals. Nationally, the ED accounts for 50 percent of inpatient admissions, 75 percent of plain radiographs, and 50 percent of CT scans and ultrasounds in the entire hospital.

First the bad news: Research performed during the HCAHPS testing period found that patients admitted through the Emergency Department rated care across all composites more negatively than those patients admitted through other avenues. Vendors that administer inpatient perception of care surveys have found that admission through the ED also negatively affects IP results.

The implication is clear. When a patient has a poor perception of the care he received in your Emergency De­partment, it's almost impossible to recover from it. That's why it's so critical to make a good "first impression"—to set the stage for a successful stay and, by extension, favor­able HCAHPS results.

Studer Group's own research shows that as ED per­ception of care results improve, so do inpatient results. Our partner data also indicates that by improving ED pa­tient perception of care results, hospitals can also expect to see higher HCAHPS results in all ten composites. The data below shows the relationship between ED percentile rank and HCAHPS "overall" percentile rank.

We looked at the 180 hospitals for which Studer Group has both ED perception of care results and HCAHPS results for patients discharged during the period Octo­ber 2008-September 2009. We found a statistically sig­nificant correlation between ED percentile ranking and HCAHPS percentile ranking for the "Patients who rated the hospital a 9 or 10" question (r=.486), meaning that as one goes up so does the other, and the likelihood that this occurs by chance is less than 1 percent.

We categorized each of the hospitals by their year av­erage ED percentile rank, as shown in the table below, and then looked within each category at the hospital's HCAHPS "percent 9s and 10s" average percentile rank. The chart below shows that as a hospital's ED percentile ranking increases, so does the HCAHPS "percent 9s and 10s" percentile ranking.

Organizations focused on improving their HCAHPS results would do well to focus on ensuring that ED pa­tients have the best possible experience.

Now the good news: EBL tactics designed for the in­patient environment are easily modified for the ED set­ting to drive consistency of the patient experience.  When you improve your Emergency Department, you improve your entire hospital—and your HCAHPS results, as well as your financial state, can only benefit.