customer satisfaction in the er

CrunchRN, ADN, RN · Jan 14, 2005

I am really sorry for what you are going through. How about working at an urgent care? You can work shifts as most are open late, it's more minor problems, but that is appropriate in that setting so it wouldn't be frustrating. The pace will be more reasonable, and they would be thrilled to have someone with your skills.

RNCENCCRNNREMTP · Jan 14, 2005

As long as hospitals treat healthcare as a business and not caring for patients you/me will always have to have "keep the patient (oops, customer) happy at all costs". Our hospital also uses Press-Ganey which is the biggest joke foisted upon hospitals since managed care and team nursing. Medicine and nursing is about caring for patients. ER medicine and nursing is about caring for patients based upon OUR determination of their need. MI vs Toothache? MI everytime. Who will complain? The toothache! What will administration see? NOT that we saved an MI patient from the jaws of death but that a piss poor toothache had to wait a couple of hours.

I for one will never change or apologize for how I run my ER. If you come to the ER you will be seen, if you wait around long enough if you are non-urgent or right away if you are on deaths door BUT YOU WILL BE SEEN. I make no promises or guarantees for when, unless you are trying to die and then it will be right now! If you stubbed your toe, or have a sore throat (and airway is intact as evidenced by you eating a candy bar and drinking a soda) or have a toothache have a seat in our crowded waiting room with the rest of them and get comfy, it is going to be a long night.

I am sorry that is how it is but when medicine in this country decided to adopt the attitude that an emergency is what the patient calls it we lost all control.

Read "Critical Condition" by Barlett and Steele and it will open your eyes to what has gone wrong with medicine in this country.

Andrew Bowman

RNCENCCRNNREMTP · Jan 14, 2005

Also, my hospital was recently bought out by a Catholic organization (Boooo, and I was born/raised as such). We all had to watch a video about "Sacred Work". I adopted a Sacred Work attitude right away. Whenever an ER patient needs a ride home (because they came by ambulance for their cough/cold) I pass out a hospital paid cab voucher. That is my sacred Work, to get you home as soon as possible. What's that? You live 40 miles away? Here, have a nice cab trip at our expense. Catholic charity in action! Have not been dogged about it yet but I am sure it is coming.

needsmore$ · Jan 15, 2005

"as long as hospitals treat healthcare as a business and not caring for patients you/me will always have to have "keep the patient (oops, customer) happy at all costs". our hospital also uses press-ganey which is the biggest joke foisted upon hospitals since managed care and team nursing. medicine and nursing is about caring for patients. er medicine and nursing is about caring for patients based upon our determination of their need. mi vs toothache? mi everytime. who will complain? the toothache! what will administration see? not that we saved an mi patient from the jaws of death but that a piss poor toothache had to wait a couple of hours.

i for one will never change or apologize for how i run my er. if you come to the er you will be seen, if you wait around long enough if you are non-urgent or right away if you are on deaths door but you will be seen. i make no promises or guarantees for when, unless you are trying to die and then it will be right now! if you stubbed your toe, or have a sore throat (and airway is intact as evidenced by you eating a candy bar and drinking a soda) or have a toothache have a seat in our crowded waiting room with the rest of them and get comfy, it is going to be a long night.

i am sorry that is how it is but when medicine in this country decided to adopt the attitude that an emergency is what the patient calls it we lost all control."

excellent post!!!

anne

stbernardclub · Jan 15, 2005

While working for a agency, I was working in a very busy E.R. My rooms were always ortho, since I was not part of the regular staff. One day as I was walking thru the waiting room I seen a woman there with blood dripping from her chair. I ran over and asked triage if they knew about her. Was told yes, but there was not a room open yet. As I ran to get help and we got this woman into the back room, I was told her chair would have to be thrown out, it was totally saturated in blood. That was my last night at this hospital. If this is a emergency room, I would hate to see their walk in clinic.

RNCENCCRNNREMTP · Jan 15, 2005

While working for a agency, I was working in a very busy E.R. My rooms were always ortho, since I was not part of the regular staff. One day as I was walking thru the waiting room I seen a woman there with blood dripping from her chair. I ran over and asked triage if they knew about her. Was told yes, but there was not a room open yet. As I ran to get help and we got this woman into the back room, I was told her chair would have to be thrown out, it was totally saturated in blood. That was my last night at this hospital. If this is a emergency room, I would hate to see their walk in clinic.

Then she was not properly triaged. If I have no "rooms" there is always the hall. Bleeding patients get a bed "somewhere" and an IV and the workup begins in earnest. As soon as possible a less urgent patient gets moved out for the more urgent one.

Do the less urgents complain? You betcha'. Do I care? Only to the point that I am sorry I had to move them from their room to the hallway. "Sorry, this person is trying to die, you are not" That is what the ER is for!

And the complaint pile gets deeper.

Andrew Bowman

KRVRN, BSN, RN · Jan 15, 2005

This is just my personal experiences, but I have to agree that part of the problem is primary care doctors directing pts to go to the ER for problems that should be handled in an office visit.

I had what I pretty much knew was either cellulitis or an abcess on my upper ear. I tried to self treat for about a week with tylenol and hot compresses. Finally it was so bad I couldn't work... couldn't use a stethoscope! So i call my doctor's office and say I need either a same-day or next-day appt. They say there are none, you will have to wait for the next available appt, 5 weeks from today! OMG, in 5 weeks, I will be either dead from sepsis or completely cured, so why not just say "piss off we're not seeing you at all." ???? I say that 5 weeks is too long to wait and I'm told, "well then your doctor recommends going to the ER." A cop out answer, I'm sure.

Come on, I'm a nurse, I know what I have is NOT and emergency and not only would I hate to go the ER and wait for hours, I would be embarrassed to do it! I ended up settling for an urgent care (and still feeling somewhat embarrassed), where I was seen almost immediately and out in about 1.5 hours with antibiotic Rx in hand and a very nice experience. I filled out my pt satisfaction survey very favorable.

But come on, in large healthcare networks like I'm in, shouldn't they limit how many pts one doctor can keep to avoid problems such as this? Whenever I get sick (rarely, thank goodness), I cringe because I'm afraid it will get bad enough that I need to see a doctor, and then not be able to. I have 2 other stories similar to the one I described of not being able to get an appt. It's just another part of this large problem.

RNCENCCRNNREMTP · Jan 15, 2005

This is just my personal experiences, but I have to agree that part of the problem is primary care doctors directing pts to go to the ER for problems that should be handled in an office visit.
I had what I pretty much knew was either cellulitis or an abcess on my upper ear. I tried to self treat for about a week with tylenol and hot compresses. Finally it was so bad I couldn't work... couldn't use a stethoscope! So i call my doctor's office and say I need either a same-day or next-day appt. They say there are none, you will have to wait for the next available appt, 5 weeks from today! OMG, in 5 weeks, I will be either dead from sepsis or completely cured, so why not just say "piss off we're not seeing you at all." ???? I say that 5 weeks is too long to wait and I'm told, "well then your doctor recommends going to the ER." A cop out answer, I'm sure.
Come on, I'm a nurse, I know what I have is NOT and emergency and not only would I hate to go the ER and wait for hours, I would be embarrassed to do it! I ended up settling for an urgent care (and still feeling somewhat embarrassed), where I was seen almost immediately and out in about 1.5 hours with antibiotic Rx in hand and a very nice experience. I filled out my pt satisfaction survey very favorable.
But come on, in large healthcare networks like I'm in, shouldn't they limit how many pts one doctor can keep to avoid problems such as this? Whenever I get sick (rarely, thank goodness), I cringe because I'm afraid it will get bad enough that I need to see a doctor, and then not be able to. I have 2 other stories similar to the one I described of not being able to get an appt. It's just another part of this large problem.

It is precisely these large networks that contribute to the problem. For any profit to be made they have to squeeze as many patients into the day as possible. This means, as you experienced, there is no chance for a "sick" appointment which means either an urgent care or an ER for you.

I encourage everyone to read "Critical Condition" by Barlett & Steele. It gives a very well researched address to how medicine stopped being about caring for patients and how it became about business.

I remember in nursing school. Patients suddenly became customers. Almost overnight it seemed. Sorry, not in my book. I always took the few points off they gave me for every "patient" reference in my papers and such.

As long as hospitals and practice groups see themselves as businesses first then the system will only get worse. Businesses are only about cheapest practice, not always safest practice. Which is why you have 1 nurse for 10+ patients and why nurses are leaving the profession. Hospitals see us as expendable and replaceable by cheaper, less intelligent and less professional unlicensed personnel.

If you ever have to be an in-patient, take a family member or friend who knows a little about basic nursing care to help with your daily needs. It is likely your primary nurse will not have time to do much for you (my personal experience for my in-patient treated pneumonia).

I am also sorry to say if you had come to my ER, it would have been a lot longer than 1.5 hours door to door. try 4-6. Sorry, just too many patients and not enough beds or staff.

Andrew Bowman

sadrn · Jan 21, 2005

I have a theory on the Press-Ganey thing, as we are also under that microscope. The main complaint we get in our ER is wait times and the doctors are not attentive to the patients pain needs. I really get aggrivated when I hear at every staff meeting how we need to improve on the scores. My theory is; first of all, do they ever send those things to people who are satisfied with their service? Second, i have resigned myself to believe that unless a patient is carried to the room by the doctor, immediately given a pain shot, warm blanket and a cup of ice, he/she will not give us a good score. It has been so frustruating to hear the same story over and over. Especially when I know I am going above and beyond the call of duty day after day in a generally thankless job. The way I (and others I work with) look at it is........if I can go home at the end of the shift and truely feel that i have done the best I can do for my patients, then I did my job..........and to hell with the surveys. We can't change the world or patients minds for that matter. A lot of patients come in to the ER with a bad attitude in tow.............Just do your best, smile....and when you walk out the door....Exhale.

Thank you so much. We all let these stupid scores bring us down. You are right- all you can do is smile and know that you have done the best job that you could have done for your patients. Thank you again.

katrinamay · Jan 21, 2005

i work here in australia ER too. Our waiting times are average 4 hours. In other parts of australia is about 6 hours average. Two hour waiting time is pretty good. You can only do what you can. You cannot make everybody happy. Emergency is for emergency cases. The reason they are waiting that long is that they do not require emergency treatment. Good luck!

I have been an ER nurse for 22 years now and this has to be one of the hardest parts of my job, customer satisfaction and Press Ganey. I work in an ED that sees 135 patients daily with the highest volumne during my shift 7p-7a. The problem I am having as well as many of my co-workers is that the hospital has decided for the last two years to use the Press Ganey survey company to evaluate our hospital. That in its self isn't much of a problem but when they start staying on us to the point it is interfering with our jobs it gets to be quite a head ache.
We as an ER have an average wait time of 2 hours or so. I think that is very good considing there are only 5 nurses on each shift . We have 2 doctors during peak times with a fast track open on weekends for even higher volumne.
My question is if anyone else has similiar problems keeping patients happy while still covering the TRUE emergencies. Even when I have a great day and don't let anyone fluster me I still can't seem to make the majority of patients happy. They get mad about the wait time, the lab wait time, the doctor attitude and the list goes on. Has any one out there got any ideas that I can take back to my ED customer satisfaction comittee to improve our scores. This is getting so old and it definitely takes the little bit of fun out of a very demanding job.
Thanks for any help any one can provide.

acutecarenp · Feb 8, 2005

Our ER has employed customer service reps. They walk around and talk with patients, get blankets, hand our coloring books and crayons to kids and most importantly explain wait times. I think it has helped a little in relations, but the Press-Ganey scores still suck. Press-Ganey, however doesn't take in to accout the sheer volume that we and other ER's do. We see well over 100 patients on a daily basis. Our patient to nurse ratio is 8-1. With numbers like that, it is nearly impossible to think we can please every one. I think on the other hand that pts seen in my ER get damn good care. You would be hard pressed to find a more caring group of people.

I work in a small community hospital with valet parking for ED patients...VALET FREAKING PARKING!

There is a huge emphasis on the Press Gainey scores. Much of the time in satff meetings is dedicated to dicussion of the scores and how we can make them better....

My question is: If I am doing my best to provide competent care to the patients I have in front of me, and, at the end of my shift I can say I have achieved that goal.... Why should I care what the Press Gainey scores are?

When I am taking care of 8 patients, 4 of whom are admitted and of the other 4, only 3 of them are breating with any regularity...and the medics are on the way with a 17 year-old, intubated drug OD...and I need to decide which of my telemetry patients I need to put in the hall on a portable monitor (and still have a license tomorrow)...

It's a pretty good bet that I don't give a rats a** how long the person with a cold for 6 days is sitting in the lobby, waiting to see a doc...And, if you have any sense of self-preservation, DO NOT be the customer service rep who comes to me and asks how long URI boy has to wait...because you are concerned about some survey!....

Gainey-Shmainey...

JUST GET AWAY FROM ME!

Ok I feel better now....can you tell this just happened to me last night?