ALiEM-AnnalsEM-SquareThis ALiEM-Annals of EM Global Journal Club features the Annals of EM journal club by Schwartz et al. entitled “Lack of Association Between Press Ganey Emergency Department Patient Satisfaction Scores and Emergency Department Administration of Analgesic Medications.” We hope you will participate in an online discussion based on the clinical vignette and questions below from now until Dec 5 2014. Please respond by commenting below or tweeting using the hashtag #ALiEMJC. In a few months, a summary of this journal club will be published in Annals of EM.

On Dec 4, 2014 at 1300 PST (1600 EST), we will host a live Google Hangout with the authors Drs. Tayler Schwartz and Kavita Babu.

Google Hangout with Drs. Schwartz and Babu: Dec 4, 2014

[su_spoiler title=”Timestamps” style=”fancy” icon=”chevron-circle”]
  • 00:00 Dr. Lin introduces the expert panelists (Schwartz, Babu, Henseley, Westafer, and Shaikh)
  • 01:35 Schwartz and Dr. Babu discuss behind the scenes regarding the impetus for conducting this study.
  • 03:00 Dr. Westafer summarizes the paper.
  • 04:34 Dr. Babu discusses Press Ganey satisfaction surveys and general limitations of the instrument.
  • 05:55 Schwartz explain more about the limitations of the study
  • 07:13 Dr. Babu talks about whether these study results  on in-ED analgesic administration can be extrapolated to discharge opiate prescriptions, even though Press Ganey surveys specifically address their in-hospital stay. She also shares a mid-study hiccup whereby the electronic medical record company no longer was able to extract discharge information data. Hear what her best hypothesis is regarding discharge opiate prescriptions and their impact on patient satisfaction scores.
  • 12:15 Dr. Westafer asks what clinical factors actually impact patient satisfaction scores. Schwartz and Dr. Babu talk about pain management needs, ED length of stay, ED wait times, and patient-nurse communications. Ultimately there is a lot of variability depending on your patient population. Dr. Westafer re-emphasizes that a great deal revolves around communication. Dr. Henseley nicely summarized three main types of negative patient encounters being unindicated exam, unindicated medication, or not meeting expectation for expedited surgery or appointment
  • 16:36 Dr. Babu reminds us how hard it is to balance prescribing opioids wisely while also to remain compassionate about treating patients’ pain. It’s important to have the conversation from the perspective of care and compassion when having the conversation about discharge opioid medications. The key is all about engaged communication with patients.
  • 17:50 Schwartz shares her excitement that their study findings show that satisfaction scores do not correlate with in-ED analgesic medications. This seems to demonstrate that clinicians continue to be driven by patient-centered, compassionate care — doing what’s right for the patient and not what’s better for their score, administrative benchmarks, or wallet.
  • 18:13 Dr. Babu empathizes with the community practitioners especially in the non-ED setting who are more driven by patient satisfaction scores.
  • 20:08 Dr. Henseley asks about response bias concerns. Schwartz nicely discusses the limitations of biases which are inherent to all survey-type methodologies. Dr. Babu talks about how this study could have been better, if this were a much bigger funded study. Dr. Henseley makes a great analogy to Yelp.
  • 23:45 Dr. Henseley noted that half of the included study patients received analgesics and half didn’t. Did this reflect similar proportions for the study ED overall? Dr. Babu elaborated more about this point.
  •  25:40 Dr. Babu further elaborates about Press Ganey survey response rates and how they can muddle the picture.
  • 28:02 The panelists leave us each with one take-home point.

Journal Club Paper

Lack of Association Between Press Ganey Emergency Department Patient Satisfaction Scores and Emergency Department Administration of Analgesic Medications.1


STUDY OBJECTIVE: We explore the relationship between Press Ganey emergency department (ED) patient satisfaction scores and ED administration of analgesic medications, including amount of opioid analgesics received, among patients who completed a patient satisfaction survey.

METHODS: We conducted a secondary data analysis of Press Ganey ED patient satisfaction surveys from patients discharged from 2 academic, urban EDs October 2009 to September 2011. We matched survey responses to data on opioid and nonopioid analgesics administered in the ED, demographic characteristics, and temporal factors from the ED electronic medical records. We used polytomous logistic regression to compare quartiles of overall Press Ganey ED patient satisfaction scores to administration of analgesic medications, opioid analgesics, and number of morphine equivalents received. We adjusted models for demographic and hospital characteristics and temporal factors.

RESULTS: Of the 4,749 patients who returned surveys, 48.5% received analgesic medications, and 29.6% received opioid analgesics during their ED visit. Mean overall Press Ganey ED patient satisfaction scores for patients receiving either analgesic medications or opioid analgesics were lower than for those who did not receive these medications. In the univariable polytomous logistic regression analysis, receipt of analgesic medications, opioid analgesics, and a greater number of morphine equivalents were associated with lower overall scores. However, in the multivariable analysis, receipt of analgesic medications or opioid analgesics was not associated with overall scores, and receipt of greater morphine equivalents was inconsistently associated with lower overall scores.

CONCLUSION: Overall Press Ganey ED patient satisfaction scores were not primarily based on in-ED receipt of analgesic medications or opioid analgesics; other factors appear to be more important.



Open Access Online Content on Topic

EM Literature of NoteThe Pain of Patient SatisfactionRadeckiBlogUSAMay 5, 2014

Featured Questions

Four questions are featured here to spark discussion and reflection about the highlighted paper. For more of a deep-dive into the methodologies, check out the Journal Club questions published in Annals of EM [free PDF] . If you have additional questions, feel free to pose them!

Q1. This study evaluated the association between analgesics provided in the emergency department (ED) and patient satisfaction scores. Do you think analgesia in the department can be extrapolated to satisfaction of analgesic prescriptions dispensed at discharge from the ED?

Q2. The Press Ganey Instrument was used to measure patient satisfaction in this study. What are the limitations to using this instrument? Is there another way to measure patient satisfaction?

Q3. The authors studied only patients who returned the survey. How might that group differ from the others? What might these authors have done, given that they had treatment data on all patients, to explore the potential for response bias?

Q4. Based on your own clinical experience, do you think that there exists an association between positive satisfaction scores and discharge opioid prescriptions? Is pain control the largest component of satisfaction, or is it merely a small player? What other aspects of the patient experience can affect patient satisfaction? Would it be a monotonic positive association (ie, physicians who prescribe larger number of opioid pills have higher satisfaction scores)?

Please participate in the journal club by answering either on the ALiEM blog comments below or by tweeting us using the hashtag #ALiEMJC. Please denote the question you are responding to by starting your reply with Q1, Q2, Q3, or Q4.

Best Blog and Tweet

NEW! Contest for Best Blog Comment and Tweet

We are implementing a contest for the Best Blog Quote and Best Tweet. The winners will be announced in our Annals of EM publication curating this discussion.

Disclaimer: We reserve the right to use any and all tweets to #ALiEMJC and comments below in a commentary piece for an Annals of EM publication as curated conclusion piece for this global journal club.  Your comments will be attributed, and we thank you in advance for your contributions.

Voisin F, Sohier L, Rochas Y, et al. Ambulatory Management of Large Spontaneous Pneumothorax With Pigtail Catheters. Annals of Emergency Medicine. 2014;64(3):222-228. doi: 10.1016/j.annemergmed.2013.12.017
Justin Hensley, MD
Assistant Professor of Emergency Medicine
Texas A&M Health Science Center/CHRISTUS Spohn
Founder, Editor, Author of
Lauren Westafer, DO, MPH
Emergency Medicine resident
Department of Emergency Medicine
Baystate Medical Center / Tufts University
Co-founder of FOAMcast; Author, The Short Coat
Lauren Westafer, DO, MPH

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