Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

EMS Garage on Press Ganey – Should We Reward High Scores


Continuing from EMS Garage on Wait Times, the discussion of Monday night on the EMS Garage with Buck Feris titled The Prodigal: EMS Garage Episode 132.

Anne Robinson took the position that Press Ganey scores are useful in evaluating quality. Somebody suggested that a debate between a nurse and me is not the place to be, but there is no reason to assume that there is any benefit, or handicap, in being a nurse in this debate. Am I supposed to disagree more strongly just because the person I do not agree with is a nurse?

What are Press Ganey scores?

Press Ganey scores are evaluations of the care received in the emergency department by the patients who have been seen in the ED (Emergency Department) and discharged from the emergency department.

Patients admitted to the hospital and patients transferred to other hospitals do not receive Press Ganey emergency department satisfaction surveys. While some questions about the emergency department may be included on inpatient surveys, the answers to those questions count toward the inpatient satisfaction scores, not the emergency department satisfaction scores.[1]

In other words, the Press Ganey scores of patients admitted through the ED will not affect the ED’s Press Ganey scores, but the Press Ganey scores patients who never needed to be seen in the ED will.

Press Ganey is just a way for those who abuse the ED to make ED treatment more to their liking.

If the main reason for EDs to exist is supposed to be for the patients with life threatening emergencies, why is Press Ganey evaluate the satisfaction of those who should not be in the ED?

What does a Press Ganey score have to do with improved outcomes?

Absolutely nothing.

AP Photo/Julio Cortez
The wait time at the Bayonne Medical Center’s emergency room is seen on a billboard on Tuesday, April 12, 2011 at Journal Square in Jersey City, N.J.[2]

How are wait times any better at determining the quality of care delivered?

Outside of cardiac arrest, how are EMS response times any better at determining the quality of EMS delivered?

We do a great job of measuring the wrong things.

In EMS, we like to focus on better looking vital signs at the time of patient transfer, although this often leads us to give treatments that endanger the survival of the patient. We are EMS. We just care about the documentation.

We need to change our focus to assessing outcomes, rather than making the paperwork pretty for the QA/QI/CYA departments and their myopic obsession with vital signs trends, policy compliance, and other things that cannot be shown to improve outcomes. We need to start doing what is in the best interests of the patient, not what the lawyers claim is in the best interests of the organization.

Therefore, maybe we should be rewarding those with the worst Press Ganey scores.

These may be the doctors and EDs that the abusive patients don’t like.

Why don’t we find out what the outcomes are for the patients treated by those with the worst Press Ganey scores?

What will we find?

Unfortunately, Press Ganey scores are often based on sample sizes that are too small be anything other than random number generators, but rewarding low Press Ganey scores is definitely something to consider.

Footnotes:

[1] 2+2=7? Seven things you may not know about Press Ganey Statistics
by William Sullivan, DO, JD & Joe DeLucia, DO
September 22, 2010
Emergency Physicians Monthly
Article

[2] N.J. Hospital Debuts Wait-Time Billboards
Posted: Friday, April 15, 2011
Updated: April 15th, 2011 03:45 PM CDT
EMS World
Article

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Comments

  1. In Feb I did a podcast that talked about ED’s posting these times, texting people wait times and even making appointments at off peak hours to the ED. One article states you can get wait times texted for the Trauma Center. WTF? Maybe we should take the “Emergency” out of this whole thing and be done with it. Here’s the show link. There are links there with articles on this as well.
    http://emsofficehours.com/2011/02/10/if-you-pay-for-an-er-appointment-is-there-an-emergency/

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