Journal Review

Nerney MP, Chin MH, Jin L, et al. Factors associated with older patients’ satisfaction with care in an inner-city emergency department. Ann Emerg Med 2001; 38:140-145.

Older patients want specific things from an ED visit, say researchers from the University of Chicago. In this study, 778 patients aged 65 years and older who presented at an urban academic ED between 1995 and 1996 were given a survey on demographic information, medical history, and health-related quality-of-life information. A follow-up satisfaction survey asked patients to rate the care they received in the ED on a five-point scale, ranging from poor to excellent.

According to the study’s findings, 40% of respondents rated their ED care as "excellent." The patients who rated care as excellent also tended to report the following observations about their ED visit:

  • they perceived that the time spent in the ED was "not too long"
  • they felt that the ED physicians and nurses clearly answered their questions;
  • they had established a relationship of trust with an ED staff member;
  • they recalled being given explanations about why tests were being done;
  • they felt involved in decisions about their care;
  • their pain was addressed fully;
  • they had fewer comorbid conditions at the time of the ED visit.

The researchers noted that although patient’s perception of time as "not too long" was a strong predictor of patient satisfaction, the actual time spent in the ED did not vary significantly, regardless of how the patient rated the ED visit.

Elderly patients who believed that staff did everything possible to relieve the patients’ pain was a strong predictor of satisfaction, the study found. "Pain untreated or even unacknowledged by ED staff will only increase anxiety and contribute to the patient’s perception that health care providers are not concerned about them mentally or physically," the researchers wrote.

The study brought to light the special needs of many elderly patients, including poor social function that could limit the ability to provide a history or understand discharge instructions, unrelated health problems that complicate a patient’s treatment, and a perception of poor health status that leads to increased concerns, say the researchers. "Mindfulness of older adults’ special needs and concerns in the ED should improve their satisfaction with ED care," they conclude.