Title: 107 The Impact of Emergency Medicine Residents on Patient Satisfaction Scores in a Pediatric Emergency Department
Abstract: The purpose of this study was to assess the impact of emergency medicine residents (EMRES) at different levels of training on patient satisfaction scores in pediatric emergency medicine. A retrospective chart review was conducted on discharged emergency department (ED) patients who completed NRC Picker satisfaction surveys at two academic children’s ED’s. Surveys were collected between July 2015 and December 2018. Outcomes were responses to the following questions:a)Four doctor-specific (Table 3) questions, measured on a 4-point Likert scale, with responses collapsed into binary groups (Always vs. Usually/Sometimes/Never (referent category)b)Overall facility rating, measured on a 10-point scale, with responses collapsed into binary groups (9&10 vs 0-8).c)Absolute percentage point differences were also calculated for both groups. Outcomes were analyzed with mixed effect logistic regression, using the attending as a random effect and adjusting for patient level characteristics (length of service, acuity and site). Between July 2015 and December 2018, 483,228 patients were seen, 88% were discharged. 30% of the discharged patients were randomly surveyed, with a 9% (11,454) return rate. Of these surveys, 77 were excluded, because the patients were seen by an attending (ATT), resident (RES) and fellow (FEL) combined. Of the remaining 11377, there were 6542 ATT and 1,110 EM RES surveys with 517 EM1, 284 EM2 and 309 EM3 surveys. Trainee characteristics are noted in Table 2. The two groups were well matched for sex and payor mix, but there were statistically significant differences in patient age, acuity and length of stay with the EM RES’s seeing an older age group, higher acuity with longer length of stay. The percentage scores for all survey questions except “doctor explained things understandably” were higher for the ATT surveys compared to the EMRES surveys. The average ATT scores for “confidence/trust in doctor” were 1.5% higher than the EMRES’s; however, when stratified by postgraduate level EM2’s scored 4.1% higher, but EM1’s and EM3’s scored lower (-3.1% and -4% respectively). For all 5 questions the average EM2 scores were higher than the ATT and EM1 and EM3 scores were lower. EM3 scores were even lower than EM1’s for all questions except “overall facility rating” where EM3’s were slightly higher than EM1’s. Table 2 provides odds ratios and confidence intervals. EM2 residents have a positive impact on patient satisfaction scores, while EM1’s and EM3’s may have a negative impact. The proportion of EM residents by year of training can have a significant impact on pediatric emergency department patient satisfaction scores. This impact should be taken into consideration when setting department goals and national benchmarks. Further studies will be needed to determine why EM3 scores are the lowest. Meanwhile, attending physicians should be cognizant of the impact of EMRES’s on patient satisfaction scores and try to mitigate this impact during the ED visit and provide appropriate education to the learners.