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?

[ThrowEdNurse, BSN, 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).

HERE'S REAL:

We see a couple hundred daily in a 30 bed ER, sorry don't know exacts. But I do know that our PGs jumped from 56 to 87. Don't see how straight volume is relevent either. Remember, you are mad at PG, not me!

[glneo]

I don't think good Press Gainey scores are possible. We have everything you can think of- food, TV's, phones, mid-levels, less than 1 hr wait times, etc. and scores are still low. And we also get low scores of pain management and comfort of your blood draw. A blood draw is supposed to hurt at least a little bit...why are we asking people these questions?? I could go on but I won't!

I work in a 55 bed ED in Ohio that has over 90,000 pts come through each year and our Press Ganey is in the 90's (can't remember the exact number but management is always talking about it). Other hospitals have come to our facility benchmark and see what we are doing. So it is possible to have godd scores.

Our facility has TV's in every room but the fast track/minor area which seems to help a lot over our old facility that did not. We have glass doors that close to keep the area quieter and phones in the rooms. We allow one visitor in the room until the Doc has been in and then it is 2. I update my patients on what they are waiting on (this helps bunches!). There are many things we have in place but people in the ED will always get ****** about something, the question is how it is all handled. Don't want to write a book, just wanted to say good scores are possible...we have done it and are proud of it!

[RhiaRN75, RN]

Long post...

The problem with providing all those extra perks simply to improve scores it that it comes back to bite you. If there's a TV in every room, someone will eventually be upset. "The doc made me turn the TV off!" "Those people in the room next door were watching xyz and it offended me." "My child is not allowed to watch xyz, how could you offer that?"

I do think scores can be improved. We often overlook some fairly simple solutions. Before buying LCD's for every room, let's look at some basics. To begin with, all ER's have unique needs. I work in a small-town ER- some of my opinions will seem very odd to you folks at larger hospitals.

A good security force 24/7 is worth it's weight in gold. First off, if you head to the local ER because your favorite dealer has been locked up, you may reconsider your emergency if there's a competent and smiling person in uniform in the ER lobby. People tend to follow the mob- if you've waited a bit and the local frequent flyer is raising all heck to the poor register clerk, you're more likely to follow suit. If FF is trashing the hospital, you're more likely to decide that's the case. If granny fell and hit her head, or little Joey has strep, and you have to listen to a 19 yr old graphically describe the party on the cellphone beside of you, you're not likely to consider the experience 'excellent.' A good security officer decreases seeking visits, mob rule, flying F-bombs, and other assorted unpleasantness usually found in the ER lobby.

People get upset because we don't 'keep them informed.' This usually entails a triage nurse making rounds and apologizing for things that don't need an apology. Here's another solution. HIPPA hates trees, so we have to give every pt a paper explaining their privacy rights that no one ever reads. What do they do? Look at it, hmmmppphhhh, and flip it over. On the flip side should be a list of major secrets we've been with holding for years. Big letters, at the top, Did You Know? Then a list of basic info, starting with the concept of triage. Explain that labs, CT, etc. may need to be ordered, then explain that the results take time. Explain that watching and waiting is "watchful observation to ensure your recovery is well under way". Whatever your ER's top ten peeve list is, from refills to unrealistic expectations, you can sugarcoat it and phrase it in a manner that seems non-offensive and print it on the back of the HIPPA form. HIPPA can work for you!

While we're at it, it's time to start enforcing the visitation rules. I personally feel we should state only one visitor allowed, then if it's appropriate we can make exceptions. If you're really sick, you don't need more then two visitors. If momma's about to die, it's a different story.

Every ER should participate in an online controlled substance monitoring program. I feel it's only right that we are up front with the fact- a nicely worded sign about 'due to serious risk of unintentional overdose or medication reaction, we use the xyz controlled substance report' should hang in every ER.

Then the duh-huh's. Once a pt gets to the ER room, they need a pillow-shaped object, a blanket, a stretcher that doesn't look like it served proudly in some recent war, a gown that is post 1990, and a puzzle book. Forget the magazines, but almost everyone can occupy themselves with a simple word-seek magazine. Highlights or similiar for the kids. Basic beverages and crackers should be provided for those who can have them, directions to the vending machine should be provided for those who require name brand munchies. The bathroom should have adequete TP and towels.... why is TP harder to find then fentanyl? I hate to say it, but we need musak as well. If you don't think musak is neccessary in your ER, go in a room while it's fairly busy and sit for about ten minutes and consider what you hear.

The ER is chaotic, busy on the eyes, super bright lights, noisy, and uncomfortable. A TV in every room or premium munchies won't make it better. In a small hospital, there's no room for a true fast track. It's all about perceptions and you need to meet basic needs. Generic background noise ala musak, security to ensure saftey and an f-bomb free environment, pillows, linen, and some frigging TP. Warm blankets, reasonable fluids, and some basic info provided. Crowd control. If you make it clear that the staff are respected, then people will respect the staff.

And yeah, good ER staff. It shouldn't take pt satisfaction scores to ensure that the staff is competent.

[inteRN]

We do a miniclinic run by midlevels. One sits in triage and puts orders in on every pt triaged as they are being triaged to atleast get basic labs, IVs, etc initiated on pts waiting for main ED beds. It makes them less likely to LWPA plus it decreases the wait because labs can be back by the time they get a main ED room and are seen by the MD. In the clinic we just send low triage priority pts and a midlevel runs it with an LPN. They see toothaches, minior lacs, colds, med refills, fxs, etc. It has really helped with satisfaction scores because our wait times have dropped. We still get knocked though because no one is ever satisfied with their pain management. Why do people c/o hand tingling/numbness want narcs for pain????

Withdrawals maybe? We have a ton of that where I am.

[ThrowEdNurse, BSN, RN]

We just have a ton of people who don't work who make money off of coming into the ER, for free, c/o fake pain, getting a rx for narcs that they then sell on the street for probably more money than I make in that same 12 hours work with my degree.....no, I'm not bitter....

[inteRN]

We just have a ton of people who don't work who make money off of coming into the ER, for free, c/o fake pain, getting a rx for narcs that they then sell on the street for probably more money than I make in that same 12 hours work with my degree.....no, I'm not bitter....

NOOOO...me neither. Especially when they say, "No I don't have a doctor, I just come here because I have medicaid and I don't have to pay for it"...

But I do?? How ass backwards is that??

[murphyle, BSN, RN]

My department has 40 beds and sees around 70-80K patients a year, and our PGs run in the high 80s (our last was 86%). Yes, we just got a shiny pretty new facility, but the scores actually predate that. Our secret is in staffing and workflow. We did a year-long lean process on our triage and ambulance-bay flow, which improved our door-to-treatment time by about 50%, and we're currently extending the process to acute care. We also have some absolutely outstanding people working our EC - secretaries, techs, nurses and physicians all - and our administration makes a point of being involved in the department's daily operations. (For example, on day shift there's always at least one nursing administrator in scrubs and on the floor in addition to the shift ANM, and if we're getting hammered they'll volunteer to take our "RN transport" patients upstairs so we don't have to lose a staff nurse for transports.) Our charge nurses are also really, really good about moving long-stay patients to Observation or the Express Admission Unit (a miniature med-surg area that we co-staff with EC and floor nurses). If you're going to wait, we can at least give you a proper hospital bed and a quiet room for it.

Other little things we do, along Rhia's lines: Every room has a placard indicating wait times for labs, imaging and the like. We're in the room every twenty minutes or so for re-evals and updates, and the last thing we always ask is "Is there anything else I can get for you?"