STATEMENT OF PROBLEM
Changes in the healthcare delivery system have greatly affected patient care in the emergency department (ED). Increasing numbers of ED patient visits, delays at discharge, longer ED stays, overcrowding, and diversion to other ED facilities may lead to decreased quality of care and patient dissatisfaction.1,2 The national shortage of nurses is also creating a perception that EDs may have difficulty providing quality care.3 Many of these changes create the potential for breakdown in customer relationships and patient satisfaction.
Patients and their families are influenced by the actual care and conditions that they encounter during their ED visit. Their satisfaction with care may also be influenced by the increasing media coverage concerning the quality of healthcare in the United States, particularly in EDs. Although many patients and families are more informed about healthcare services, for some, an ED visit is a frightening experience.4 In addition, the patient's ED experience may influence the overall satisfaction with the institution, as the ED serves as the link between the community and the inpatient facility.5
In the ENA National Benchmark Guide: Emergency Departments, 1380 ED managers reported that 88% of their patients rated their satisfaction with the ED as good to excellent.6 Formal patient satisfaction surveys were used by 76% of the EDs. In addition, 96% of patients rated the quality of their ED care as good or excellent. Quality of care was measured using a formal survey by 59% of the EDs. Ongoing monitoring is needed to determine whether quality and satisfaction are improving, remaining stable, or declining.
Distributing surveys and encouraging staff to be "nicer and work harder" are sometimes the only steps taken by institutions to address customer service.4 Improving customer service and satisfaction often requires staff training programs and process improvement programs.4,5,7 In a 72,000 visit ED, an 80% reduction in patient complaints and a 100% increase in patient compliments was achieved following a training program on customer service.7 Following training, another ED reported a 100% increase in compliments and a 70% reduction in patient complaints (from 2.6 to 0.6 per 1000), well below the national average of 3 to 5 per 1000 visits.4 After initiating a customer-oriented approach, an ED reported improved patient satisfaction scores for the first time in 3 years.5
ASSOCIATION POSITION
The Emergency Nurses Association believes that
a. the primary customers of the ED are patients, families, and significant others;
b. respect for the diversity of patients, families, and significant others is inherent in emergency nursing practice; and
c. the actions and interactions of the emergency nurse consistently demonstrate efforts to meet customers' needs for respect, dignity, and quality care.
The Emergency Nurses Association recognizes that
a. the ED is a unique healthcare delivery system and that instruments to measure customer service, quality of care, and patient satisfaction must recognize that uniqueness;
b. standardized measurement and monitoring of customer service, quality of care, and patient satisfaction should be an ongoing process within the ED and at the national level;
c. the dissemination of accurate information about ED services to the public is critical to the perceptions of patients and their families concerning the care they can expect to receive; and
d. continuing education on customer service may improve both patient and staff satisfaction with ED care delivery.
The Emergency Nurses Association supports research to measure patient outcomes related to the quality of care in EDs.
RATIONALE
Changes in healthcare delivery have required a change in focus that has challenged nurses providing emergency care. Customer service and patient satisfaction, with their recognized link to fiscal viability, have greatly increased in importance. The role of the emergency nurse is essential in the provision of quality customer service.
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