Ultrasound in Emergency Medicine
Bedside Ultrasound Maximizes Patient Satisfaction

Work informally presented as a poster at American Academy of Emergency Medicine/Journal of Emergency Medicine Resident and Student Research Competition Scientific Assembly, Orlando, FL, February 2011 and as oral presentation at the American Institute of Ultrasound in Medicine Annual Convention, Phoenix, AZ, April 2012.
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Abstract

Background

Bedside ultrasound (US) is associated with improved patient satisfaction, perhaps as a consequence of improved time to diagnosis and decreased length of stay (LOS).

Objectives

Our study aimed to quantify the association between beside US and patient satisfaction and to assess patient attitudes toward US and perception of their interaction with the clinician performing the examination.

Methods

We enrolled a convenience sample of adult patients who received a bedside US. The control group had similar LOS and presenting complaints but did not have a bedside US. Both groups answered survey questions during their emergency department (ED) visit and again by telephone 1 week later. The questionnaire assessed patient perceptions and satisfaction on a 5-point Likert scale.

Results

Seventy patients were enrolled over 10 months. The intervention group had significantly higher scores on overall ED satisfaction (4.69 vs. 4.23; mean difference 0.46; 95% confidence interval [CI] 0.17–0.75), diagnostic testing (4.54 vs. 4.09; mean difference 0.46; 95% CI 0.16–0.76), and skills/abilities of the emergency physician (4.77 vs. 4.14; mean difference 0.63; 95% CI 0.29–0.96). A trend to higher scores for the intervention group persisted on follow-up survey.

Conclusions

Patients who had a bedside US had statistically significant higher satisfaction scores with overall ED care, diagnostic testing, and with their perception of the emergency physician. Bedside US has the potential not only to expedite care and diagnosis, but also to maximize satisfaction scores and improve the patient–physician relationship, which has increasing relevance to health care organizations and hospitals that rely on satisfaction surveys.

Introduction

Bedside emergency ultrasound (EUS) performed by the emergency physician (EP) has become routine practice in emergency departments (EDs) and is a required part of residency training in emergency medicine. There are many factors that influence whether or not an EUS is performed on any given patient, including certainty of clinical diagnosis, patient presentation and acuity, other recent imaging, machine availability, ease of obtaining consultative imaging, and physician comfort level performing and interpreting EUS, among others. Earlier research about EUS has largely focused on its accuracy, safety, training, efficiency, effect on outcomes, and optimal clinical use. What has not been examined in the literature are patient attitudes towards EUS and patient perception of the clinician who performs the EUS examination.

Patient satisfaction is becoming increasingly important as a marker of health care quality. As many hospitals grade physician performance and base reimbursement on patient satisfaction scores, clinical interventions that improve these ratings have become increasingly important. In addition to it being a marker of ED service and performance, there is evidence that patient satisfaction is associated with greater medical compliance, willingness to return or recommend the ED to others, and decreased litigation 1, 2, 3, 4. That decreased length of stay (LOS) improves patient satisfaction is both intuitive and supported by the literature (5).

Three previous studies have reported high patient satisfaction with bedside ultrasound. A Swedish study showed that on leaving the ED, patients with acute abdominal pain who underwent EUS had a small but significant increase in satisfaction compared with those who did not (6). Another study showed comparably high overall patient satisfaction for both EP-performed and radiologist-performed ultrasound compared to no EUS (7). Finally, a small study of patients who presented to the ED with threatened miscarriage also showed higher satisfaction when EUS was used in their evaluation. These women also had increased confidence in their physician's diagnosis (8).

No study has yet compared the satisfaction of a group of ED patients who received a bedside ultrasound by EPs as part of their standard care with those that did not and, furthermore, there are no published studies that assess patient attitudes toward EUS and the perception of their interaction with the clinician performing the examination. In this investigation, we aim to assess the effect of ultrasound on patient satisfaction in ED patients, on the interaction between the patient and physician, and to evaluate patient feelings about EUS when compared with a group of patient who did not have EUS.

Section snippets

Methods

This was a prospective cohort study enrolling a convenience sample when investigators were available from July 2010 through April 2011.

We conducted this investigation at a single, large urban academic medical center with an annual ED census of 90,000 patients. A convenience sample of patients who received a diagnostic bedside ultrasound by an EP in the ED as part of their care were enrolled by a study investigator who was not involved in their care. Surveys were administered at times when the

Results

During the 10-month enrollment period, 70 patients (35 matched pairs) were surveyed. Patients in each study arm were statistically comparable (Table 1). The intervention group had significantly higher scores on questions assessing overall ED satisfaction (4.69 vs. 4.23; mean difference 0.46; 95% confidence interval [CI] 0.17–0.75), diagnostic testing (4.54 vs. 4.09; mean difference 0.46; 95% CI 0.16–0.76), and skills/abilities of the EP (4.77 vs. 4.14; mean difference 0.63; 95% CI 0.29–0.96).

Discussion

Patient satisfaction plays an increasingly important role in health care today. In addition, patient satisfaction is also related to physician satisfaction—helping make patients feel better and happy is part of the altruistic essence of why many choose medicine as a profession, and is good for the patient and physician alike. However, patient satisfaction affects multiple other factors as well. Satisfied patients have been shown to have an increased compliance with discharge instructions (4).

Conclusions

Our study suggests that bedside EUS can increase patient satisfaction. In light of increasing hospital and health care organization emphasis on satisfaction metrics, there is more reason than ever to utilize bedside EUS. As more health care organizations and hospitals emphasize satisfaction surveys, the argument in favor of EP ultrasound performance becomes stronger, not just to expedite care and improve care and diagnosis, but also as a simple tool to maximize satisfaction scores and improve

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Zoe D. Howard, md is currently at the Division of Emergency Medicine, Stanford University Medical Center, Stanford, California.

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