The Use of Performance Improvement Methods to Enhance Emergency Department Patient Satisfaction in the United States: A Critical Review of the Literature and Suggestions for Future Research

Boudreaux, Edwin D.; Cruz, Brian; Baumann, Brigitte M.

doi:10.1111/j.1553-2712.2006.tb01725.x

Cited by 18 publications

(9 citation statements)

References 31 publications

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“…Adequate representation is critical to identifying the full range of what needs to be measured and to avoiding measures that will influence behaviors in negative unintended ways. The actors’ confidence and trust in the validity of the measures. This is achieved by selecting metrics that are seen to accurately capture what is intended to be measured (e.g., identifying a metric that both clinicians and patients agree actually measures “patient‐centeredness”) (Boudreaux, Cruz, and Baumann 2006; Burstrom 2009; Conway et al 2006). The actors’ understanding of “what the numbers mean” (including a nuanced understanding of what a change—or lack of change—in a particular metric signifies).…”

Section: Resultsmentioning

confidence: 99%

“…The actors’ confidence and trust in the validity of the measures. This is achieved by selecting metrics that are seen to accurately capture what is intended to be measured (e.g., identifying a metric that both clinicians and patients agree actually measures “patient‐centeredness”) (Boudreaux, Cruz, and Baumann 2006; Burstrom 2009; Conway et al 2006).…”

Section: Resultsmentioning

confidence: 99%

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Large‐System Transformation in Health Care: A Realist Review

et al. 2012

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Context: An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient-and family-centered care, primary health care renewal, quality improvement, and surgical wait lists. The aims of the review were to analyze examples of successful and less successful transformation initiatives, to synthesize knowledge of the underlying mechanisms, to clarify the role of government, and to outline options for evaluation. Methods:We used realist review, whose working assumption is that a particular intervention triggers particular mechanisms of change. Mechanisms may be more or less effective in producing their intended outcomes, depending on their interaction with various contextual factors. We explain the variations in outcome as the interplay between context and mechanisms. We nested this analytic approach in a macro framing of complex adaptive systems (CAS). Findings:Our rapid realist review identified five "simple rules" of LST that were likely to enhance the success of the target initiatives: (1) blend designated leadership with distributed leadership; (2) establish feedback loops; (3) attend to history; (4) engage physicians; and (5) include patients and families. These principles play out differently in different contexts affecting human Conclusions:Realist review methodology can be applied in combination with a complex system lens on published literature to produce a knowledge synthesis that informs a prospective change effort in large-system transformation. A collaborative process engaging both research producers and research users contributes to local applications of universal principles and mid-range theories, as well as to a more robust knowledge base for applied research. We conclude with suggestions for the future development of synthesis and evaluation methods.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Large‐System Transformation in Health Care: A Realist Review

et al. 2012

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“…A systematic review found weak evidence that observation units reduce the length of stay and reduce admissions [12]. It has been shown that short stay units improve patient satisfaction and quality of life [13,14]. …”

Section: Discussionmentioning

confidence: 99%

Brief hospitalizations of elderly patients: a retrospective, observational study

Strømgaard

Rasmussen

Schmidt

2014

Scand J Trauma Resusc Emerg Med

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BackgroundCrowded departments are a common problem in Danish hospitals, especially in departments of internal medicine, where a large proportion of the patients are elderly. We therefore chose to investigate the number and character of hospitalizations of elderly patients with a duration of less than 24 hours, as such short admissions could indicate that the patients had not been severely ill and that it might have been possible in these cases to avoid hospitalization.MethodsMedical records were examined to determine the number of patients aged 75 or more who passed through the emergency department over a period of two months, and the proportion of those patients who were discharged after less than 24 hours. The reasons for the hospitalization, the diagnoses and the treatment given were noted.ResultsThere was a total of 595 hospitalizations of patients aged 75 or above in the emergency department during the period. Twenty-four percent of the older patients were discharged after less than 24 hours. Of these, 40% were discharged from the emergency department. The most common problems leading to hospitalization were change in contact or level of consciousness, focal neurological change, red, swollen or painful leg conditions, dyspnea, suspected parenchyma surgical disease and problems with the urinary system or catheters. The most common diagnoses given at hospital were chronic cardiovascular disease, bacterial infection, symptoms deriving from bone, muscle or connective tissue, liquid or electrolyte derangement and observation for suspected stroke or transient cerebral ischemia. Eight percent of the patients required telemetry, 27% received intravenous liquids, 30% had diagnostic radiology procedures performed and 3% needed invasive procedures. Other types of treatment given included electrocardiography, laboratory examinations, oxygen supplements, urinary catheterization and medicine administered orally, subcutaneously, as an intramuscular injection or as an inhalation.ConclusionThere appears to be a group of patients who cannot be adequately handled with the resources of the primary health care sector, yet who do not belong at the emergency department. Further studies are needed to create a suitable service for these patients, and to improve the continuity of the treatment and the cooperation between hospitals and the primary health care sector.

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“…Boudreaux et al. () further provided the theoretical foundation that patient satisfaction is dependent on physician performance. Therefore, as a physician's ability to speed up processing or handle more complex patients is associated with high RVUs/hr Index, we posit that physicians with high RVUs/hr Index will exhibit better PG scores relative to their peers (see the right‐side of Figure b).…”

Section: Theoretical Frameworkmentioning

confidence: 99%

“…Together, we anticipate that as a physician's productivity (RVUs/hr = RVUs/Patients 9 Patients/Hr) increases, patients will perceive that the physician is both highly skilled and focused, leading to higher PG percentile rank scores (hereafter abbreviated as PG scores), resulting in a higher PG Index. Boudreaux et al (2006) further provided the theoretical foundation that patient satisfaction is dependent on physician performance. Therefore, as a physician's ability to speed up processing or handle more complex patients is associated with high RVUs/hr Index, we posit that physicians with high RVUs/hr Index will exhibit better PG scores relative to their peers (see the right-side of Figure 2b).…”

Section: Factors Impacting Physician Performancementioning

confidence: 99%

Leveraging Big Data to Balance New Key Performance Indicators in Emergency Physician Management Networks

Foster

Penninti

Shang

et al. 2018

Production and Operations Management

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Managing emergency physicians is a complex task and has increasingly intensified with the recent consolidation of many emergency departments (EDs). Large‐scale physician groups are facing challenges in resource deployment and performance evaluation. To objectively evaluate physicians across facilities, we leverage big data from an emergency physician management network and propose data‐driven metrics using a large‐scale database consisting of 84 hospitals, 1,079 physicians, and 10,615,879 patient visits in 14 states over 600,000 clinical shifts from 2010 to 2014. To ensure physicians are fairly evaluated and compensated within diverse facilities, we propose an index system and use clustering to help identify factors which might impact physician performance. The proposed indices benchmark physicians from the perspectives of revenue potential, patient volume, patient complexity, and patient experience by controlling for exogenous factors at the facility level. We empirically show the volume and complexity indices are key elements of the revenue potential index, and use two‐stage least squares regression to relate volume and complexity and uncover their drivers. Revenue potential and patient experience are found to be positively correlated, which suggests productive physicians are often liked by their patients. Through implementing the proposed evaluation system, administrators can better manage and incentivize physicians and provide directions for performance improvement, while controlling for location idiosyncrasies. The proposed framework can also be adapted to non‐medical professional settings such as value chains, where employees often provide services in various profit‐ and cost‐centers.

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The Use of Performance Improvement Methods to Enhance Emergency Department Patient Satisfaction in the United States: A Critical Review of the Literature and Suggestions for Future Research

Cited by 18 publications

References 31 publications

Large‐System Transformation in Health Care: A Realist Review

Large‐System Transformation in Health Care: A Realist Review

Brief hospitalizations of elderly patients: a retrospective, observational study

Leveraging Big Data to Balance New Key Performance Indicators in Emergency Physician Management Networks

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