Monday, May 5, 2014

The Pain of Patient Satisfaction

From a business standpoint, it seems entirely reasonable to value patient satisfaction.  However, from a medical standpoint, high-quality ethical care, with clear, honest communication ought to be the goal – with patient satisfaction a natural outgrowth of good clinical practice.  Focusing independently on satisfaction due to financial incentives or otherwise distorts this natural balance.

One issue Emergency Physicians have struggled with is the supposed marriage between opiate analgesia and patient satisfaction.  This study is a retrospective review of 4,749 Press Ganey patient satisfaction survey scores linked to ED visit information from two hospitals in Rhode Island.  Scores were compared between those who received no analgesia, those receiving analgesia, and those receiving opiate analgesia in the ED.  Many sub-analyses were undertaken, attempting to control for baseline differences between those receiving opiates and those who did not.  Essentially, across the entire survey, no consistent effects were observed between satisfaction, analgesia, and opiate analgesia.

There are two main issues with this data.  First, the Press Ganey instrument is, essentially, useless for measuring satisfaction.  The questions asked are certainly reasonable surrogates for patient satisfaction, but their proprietary tool has never been validated or compared against any other measurement device, and its discriminatory power and reliability have never been described.  Second, this study probably addresses an entirely incorrect question by focusing on pain control in the ED, rather than prescriptions at discharge.  I think Emergency Physicians are less concerned with using opiates to manage acute pain in the ED than they are with prescribing at discharge – and sending folks home without opiate prescriptions seems to be, at least anecdotally, the more challenging issue.

I wouldn’t let anyone quote this study to you as evidence opiate analgesia is not tied to patient satisfaction, other than in the narrowest of circumstances described here.

“Lack of Association Between Press Ganey Emergency Department Patient Satisfaction Scores and Emergency Department Administration of Analgesic Medications”
http://www.ncbi.nlm.nih.gov/pubmed/24680237

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