Influences on Patient Satisfaction Among Patients Who Use Emergency Departments Frequently for Pain-Related Complaints



      The primary purpose of this study was to assess relationships between opioid prescribing practices, patient and ED attributes, and patient satisfaction ratings of nursing and physician care among patients with high utilization of the emergency department for pain relief.


      A retrospective cohort study was conducted to examine 305 individual patient satisfaction surveys from users with high ED utilization for pain complaints. Responses were compared with an age-matched control group (n = 305) of nonfrequent ED users. Patient satisfaction survey responses and electronic medical records were used to model relationships between patient satisfaction and predictor variables.


      ED frequent users with pain complaints were 75% less likely to return a satisfaction survey compared with other patients (odds ratio = 0.2488; P < .0001). Patient satisfaction with physician behavior was largely accounted for by ED cleanliness, pain control, wait time for the physician, satisfaction with nursing, and feelings that ED staff cared about the patient personally. On the other hand, patient satisfaction with nursing care was largely accounted for by perceptions that nursing care was compassionate, feelings that the patient mattered personally, perceptions of safety precautions, and wait times. Receipt of prescriptions for scheduled drugs did not significantly influence patient satisfaction with physician or nursing behaviors.


      Emergency nurses can influence patient satisfaction scores by promoting clean, caring environments and prioritizing patient flow and pain management. ED providers can withhold opioids when appropriate without fear of a significant impact on patient satisfaction.
      Contribution to Emergency Nursing Practice
      • Patient satisfaction with nursing care in the emergency department overall is dependent on wait time, precautions taken to protect patient safety, ability of staff to convey that they care about the patient as a person, and compassion shown by caregivers.
      • Patient satisfaction with physicians is more dependent on ED cleanliness, pain control, wait time, and satisfaction with nursing care than on prescriptions for medication.
      • Nurses can advocate for ED pain management protocols that align with best practices to limit opioid use without fear of poor patient satisfaction.
      • Caring, clean, efficient ED environments are linked to improved patient satisfaction.


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      Patricia Newcomb is Nurse Scientist, Texas Health Harris Methodist Hospital, 1301 Pennsylvania Ave, Fort Worth, TX.


      Marian Wilson is Assistant Professor, Washington State University College of Nursing, Spokane, WA.


      Ralph Baine is President, Emergency Medicine Consultants, Ltd, Fort Worth, TX.


      Terence McCarthy is Chief of Staff, Texas Health Harris Methodist Hospital, and Medical Director, Fort Worth Emergency Services Collaborative, Fort Worth, TX.


      Nicholas Penny is Data Warehouse Manager, Texas Health Harris Methodist Hospital, Fort Worth, TX.


      Caroline Nixon is Director, Patient Experience Data Analytics & Survey Administration, Texas Health Resources, Arlington, TX.


      Justin Orren is an Osteopathic Medical Student, Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY.