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ED Patient Satisfaction Scores Unaffected by Opioid Prescribing

WORCESTER, MA – Just in case you were worried, refusing to prescribe opioids to patients won’t hurt your emergency department’s patient satisfaction scores.

That’s according to a new study published recently in the Annals of Emergency Medicine, which found no correlation between opioids administered in the ED setting and patient satisfaction scores, researchers report. Wait times and physician and nurse communication were far more significant in affecting the Press Ganey ED patient satisfaction scores, according to the study from University of Massachusetts Medical School researchers.

"Right now there is an epidemic of opioid-related deaths and the FDA has identified prescribers as essential to the reduction of opioid misuse," said study author Kavita Babu, MD, associate professor of emergency medicine and director of the medical toxicology fellowship at UMass. "When we identify modifiable factors, things that we can change, in order to curb this epidemic, one of the issues that comes up frequently is responsible opioid prescribing."

The study notes that ED physicians often are called on to treat painful conditions but the lack of familiarly with the patient, time constraints, and patient safety concerns can make it difficult to know what to do. Those decisions are further complicated when compensation and metrics of care are linked to Press Ganey ED patient satisfaction scores, which may be perceived to be adversely influenced by the failure to administer opioids, the authors point out.

"In conferences and settings where we teach physicians about responsible opioid prescribing, one of the obstacles frequently mentioned is patient satisfaction and the idea that physicians might be chastised or receive less compensation because their patient satisfaction scores are low," Babu said.

To find out if that’s true, the researchers matched patient satisfaction responses to the corresponding de-identified electronic medical record data of 4,749 patients seen in two New England hospital EDs. Patient survey responses were reviewed in the retrospective analysis, as were medication orders, age, sex, race, health insurance status, time of arrival at ED, wait time to see a physician, total length of stay, patient-reported pain levels, and year and month of visit.

Of the 4,749 patients who returned surveys, 48.5% received analgesic medications, and 29.6% received opioid analgesics during their ED visit. In the multivariable analysis, however, receiving analgesic medications or opioid analgesics was not associated with overall patient satisfaction scores, and receipt of greater morphine equivalents was inconsistently associated with lower overall scores.

"Based on these findings the administration of opioids in the emergency department setting does not make patients more satisfied," said Babu. "This suggests that emergency physicians should act in the best interest of the patient when deciding whether to prescribe or administer opioids."