Katz David A, Aufderheide Tom P, Gaeth Gary, Rahko Peter S, Hillis Stephen L, Selker Harry P
Division of General Internal Medicine, University of Iowa Carver, College of Medicine, Iowa City, Iowa; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, Iowa.
J Emerg Med. 2013 Dec;45(6):947-57. doi: 10.1016/j.jemermed.2013.05.029. Epub 2013 Aug 9.
Patients with possible acute coronary syndrome (ACS) are typically instructed to return to the emergency department (ED) if their condition worsens. Little is known about the relationship between patient satisfaction in the ED and subsequent return visits.
Our aim was to determine the association between satisfaction with ED care and subsequent ED return visits.
One thousand and five consecutive ED patients with symptoms of possible ACS who participated in a prospective guideline implementation trial at two university hospitals completed a telephone survey at 30-day follow-up. Satisfaction with care at the initial ED visit was measured using items from the Press Ganey satisfaction questionnaire. Logistic regression was used to determine the association between individual satisfaction items and the occurrence of any ED revisits, and the association between satisfaction items and return visits to the same ED.
Patients who reported superior ratings of person-centered care ("staff cared about you as a person") were significantly less likely to return to any ED during 30-day follow-up: 59 vs. 71%, adjusted odds ratio = 0.57 (95% confidence interval 0.37-0.87). Among those with ED revisits, superior ratings of personal care and perceived waiting time for emergency physician evaluation were significantly associated with return to the same ED.
Although diagnostic workup and risk stratification are the primary focus in evaluating patients with possible ACS, greater attention to the patient's experience of care may have the positive impact of reducing ED return visits and increasing the likelihood that patients will return to the same ED for re-evaluation.
疑似急性冠状动脉综合征（ACS）的患者通常会被告知，如果病情恶化需返回急诊科（ED）。关于患者在急诊科的满意度与后续复诊之间的关系，目前知之甚少。
我们的目的是确定对急诊科护理的满意度与后续急诊科复诊之间的关联。
在两家大学医院参加一项前瞻性指南实施试验的1005例连续出现疑似ACS症状的急诊科患者在30天随访时完成了一项电话调查。使用Press Ganey满意度调查问卷中的项目来衡量对首次急诊科就诊护理的满意度。采用逻辑回归来确定各个满意度项目与任何急诊科复诊发生之间的关联，以及满意度项目与返回同一家急诊科复诊之间的关联。
报告对以患者为中心的护理评价较高（“工作人员关心你这个人”）的患者在30天随访期间返回任何急诊科的可能性显著降低：分别为59%和71%，调整后的优势比=0.57（95%置信区间0.37 - 0.87）。在复诊患者中，对个人护理的较高评价以及对急诊医生评估的等待时间感知与返回同一家急诊科显著相关。
虽然诊断检查和风险分层是评估疑似ACS患者的主要重点，但更多地关注患者的护理体验可能会产生积极影响，即减少急诊科复诊次数，并增加患者返回同一家急诊科进行重新评估的可能性。
