Good Press Ganey for ER. Possible??

[5n2_is4u]

I work in a small ER that sees a large number of frequent fliers. The patient satisfaction scores are pretty low. How do you increase the satisfaction level of a public that feels "their needs are met" when they receive narcotics as fast as possible? Any ideas? What do you do in your ER's?

[CraigB-RN, MSN, RN]

Having been a CNO in the past and spent many an hour listining to press ganey breifings, I can tell you it is possible. But suprisingly the one thing that actually works, is the thing that most hosptials fail to accomplish. One of the first things you hear at an initial Press Ganey briefing is that in order to have patient satisfaction, you have to have staff satifaction. When looking at the hosptials that actualy have 90+% scare in their ED, they have happy staff. I wonder why that is the first thing that people forget when they leave the briefing.

[Rickbos]

I did have an idea that was not put into play that addresses the "Frequent Flyers" you originally asked about. It was a "Frequent Flyer Card". The patient has to present it in Triage every time they come to the ER. You would punch it on the bottom and after 10 visits they are guaranteed a minimum of 20 oxycodone and get their next ER visit free. I really thought this would get us better PG scores. Can't understand why we didn't do that???

[ThrowEdNurse, BSN, RN]

I think one of the major things I failed to mention in my previous post is that we also have a dedicated RN for charge of the front. So, the triage nurse triages, and as that process is occurring, the midlevel listens and puts in appropriate orders, they may or may not pipe in with their own questions or listen to breath sounds briefly, etc, but there is a dedicated RN to manage all the waiting pts. The triage nurse is only responsible for a thorough and competent triage getting done. The front end charge nurse is in charge of all pts waiting in the lobby. She gets all ordered motrin and tylenol given, IV access done, blood work drawn, UA's collected, etc. It's normally basic stuff any of us would do on a pt waiting to be seen, but this pt is in the lobby. So, they come back and are given a temporary chair/bed for the procedures and hang around waiting. They wait in the hall or lobby. They stay and wait longer because their medical needs are being met although many still think if they aren't lying in a bed, they aren't being seen or treated. We can get CT scans from the lobby, breathing txs in hallways, etc. It expedites everything and one nurse is in charge of who gets what done when and who gets the next bed, in as far as front door pts are concerned. The only downfall is you have to have nurses willing to manage sometimes up to 30 pts, of all triage levels, who are good at time management and customer servie. Pts sometimes c/o feeling like cattle, but if it gets the job done...It's a hard, sticky job and is not for everyone, but it has cut our LWPA's down to 3/4's of what it used to be. Our satisfaction surveys reflect that. It's a big, hard to implement, difficult change, but has made a huge differenced. No change is met without resistance, though.

[Altra, BSN, RN]

Just my and nothing more, but I do not support the practice of treating patients in the waiting room. My reasons are as follows.

1. Physical exam is extremely limited when patient can't get undressed and this may well affect the diagnostics ordered based on the chief complaint.

2. To do so encourages the speed = quality mindset that now seems to plague the public in regard to emergency care. Practices such as this, and the proliferation of retail urgent care clinics, encourage the view that healthcare is a consumer service to be purchased a la carte from a provider du jour when convenient.

3. The nightmare logistics: medicating for nausea in the waiting room leads to the slippery slope of medicating for pain and the subsequent LWTCs. How to prevent a patient from walking out with IV in place to smoke? Are people drinking contrast to prep for abdominal CTs? Are these people requiring nausea meds, etc.? What about treating adverse reactions to meds given in the waiting room?

Packed waiting rooms are a system problem that require multifaceted intervention. If beds are being occupied by boarding patients who should be in the inpatient units -- let's work on getting them out of the ER. Patients and families who repeatedly use the ER as a convenience need to be redirected to their PCP, if they have one.

[ThrowEdNurse, BSN, RN]

The midlevels don't order scans from the lobby. Anyone with an IV sits in a main ER room right next to the lobby, inside the locked down unit. It's dedicated to pts only and the bed is removed and the room is full of chairs. Pain is only tx with NSAIDS, compazine, etc. No narcs. The process works though because we get labs and xrays done and people ar less likely to LWPA.

[5n2_is4u]

The risk of pts leaving the waiting room with intact IV's or meds on board opens up a whole new issue of liability. I do think the RN in the front to evaluate pts prn during the stay in the waiting room is a good one. The concept of "rounding every hour" in the waiting room by RN's trying to keep up with the flow of the pts in rooms is a bit scary! Folks waiting for their "urgent needs" are rarely pleasant. To present yourself and ask them how they are doing is like waving a flag in front of an angry bull. Does anyone out there do this? How about bedside report? These are some concepts that are proposed. I see the value in a bedside report in ICU, maybe even Med-Surg but in the ED??

The area I work in has had layoffs of clinical nurses, so the option of adding another staff member is not feasible.

I do think the Frequent Flier Card should be presented to senior leadership though!

[5n2_is4u]

You are so right! Administration seems to have overlooked that option. A happy nurse can provide the best care in a very compassionate manner. Wonder why that never seems to be the focus?

[snoopy29]

For me the issue is not about resources its about patient expectation.

Meet group 1 - the reason we come to work. These patients arrive genuinely unwell. They accept any tests or procedures without complaint and are grateful for pain relief, IV fluids etc. If they need cleaning up they apologise profusely. They wait to see the doctor without complaint and will say "I am sure there are people here sicker than me" If i bring their realtives a drink they will expect to pay for it. When it's time for them to go they will take my hand, thank me and tell me that they think all nurses are angels and that the NHS is wonderful.

Now group 2!! They attend with a condition that is neither accident or emergency but if I suggest a visit to the GP they will tell me they "know their rights". They will not have taken pain relief becasue "nothing works" but expect pain relief!! They will tut louldy when I explain the 2-3hour wait and mutter something about "paying my wages" They will moan that the BP cuff hursts and that taking blood "kills". They will sit in the waiting room talking louldly on the phone and popping out for the odd cigarette and come up to triage every 5 minutes to see "how much longer". When they are seen and told there is little that needs doing as their is little wrong they tut again but this time louder!!

Whilst I accept completely that A and E nursing means treating both groups without judgement and with respect, over the years I have have learnt that based on their own expectations some will always remain unhappy. When you are genuinely unwell the last thing you want or need is a telly, refreshments etc you just want the pain and any other symptoms to go away. For me its not about us nurses and our care it's about them!! :)

[gardengal1, ASN, RN]

Let's get realistic here and, how many patients do you see in 24 hours? We have instituted every single measure you have mentioned over 2 years ago. Have shaved times off turn-around for labs and radiology and know what, our scores jumped a whole 2 points!!!!!! I do not believe anyone has the ability to make sick people happy/satisfied with their care. That is why the medical floors consistently get higher scores (people are getting well).

[Joe B1]

I've worked in several ERs now and I believe that good Press Gainey Scores are a result of:

--The staff doing their best to keep pt's and families informed and comfortable

--The length of stay and quickness of access to care

--The presence of a television in the treatment room

--The willingness of the staff to use lots and lots of narcotics

--The willingness of the staff to seem like they believe lots and lots of BS

--A low percentage of low/no income/public assistance pts

This is not to say that low/no income/public assistance pts are always ungrateful or have a huge entitlement mentality, but it certainly seems so.

Joe

[Altra, BSN, RN]

We have instituted every single measure you have mentioned over 2 years ago. Have shaved times off turn-around for labs and radiology and know what, our scores jumped a whole 2 points!!!!!! I do not believe anyone has the ability to make sick people happy/satisfied with their care. That is why the medical floors consistently get higher scores (people are getting well).

This is an important point. Emergency medicine is associated with the patient's Very Bad Day -- they got sick, had an MVA, did something stupid with a power tool, or had something else happen ranging from the very inconvenient to the truly terrible and traumatic. They're ****** off before they even get to the ED and unlikely to want to remember the experience fondly. Why do hospital managers not understand this?

[mwboswell]

The bottom line to get good customer service scores, is you MUST identify what it is that the patient expects during the encounter.

If we fail to make good on their expectation, of what their unique need is, then we will score poorly.

Whether it's right or wrong on what their need is, that's the bottom line.

If the patient simply wants their chest pain to be relieved and they get it, then they will score us higher.

If the patient wants you to tell them that the rash/fever on their child isn't meningitis, and we can do that, they will score us higher

If the patient knows that they have chronic pain issues and that sometimes they don't get a RX from us, but they EXPECT that they will be treated with human dignity and respect regardless, and we do that - we will get scored higher.

likewise, I like the prior comment about you have to have satisfied staff before you can have satisified customers...

Take that statement and apply it to the last time you were the customer and you had to return something to Wal-Mart (or similar) versus returning something to a higher-end store (Macy's, Rich's). Undoubtedly there is/will be a difference in the customer service experience.