Emergency Department Patient Experience of Care Survey

The Centers for Medicare & Medicaid Services (CMS) have implemented Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys to assess patient experience in a number of settings. However, none of these surveys address patients' experiences with emergency department (ED) services. As a result, CMS entered into a contract with RAND to design and field test an Emergency Department Patient Experience of Care (EDPEC) Survey.

Following CAHPS principles, we designed and tested three survey instruments for use with adult patients who have visited the ED. One instrument is for use with those patients who are discharged to the community following their ED visit; the other two instruments are for use with those patients who are admitted to the hospital from the ED (one for use on its own and one to supplement an existing inpatient survey). The surveys were developed using a call for topic areas published in the Federal Register, a literature review, focus groups, a technical expert panel, and cognitive testing with patients.

We conducted a field test of these instruments in 12 hospitals in late 2013 and early 2014 and analyzed the resulting data from 4,101 ED patients. We developed a case-mix adjustment model to enable fair comparisons among EDs and assessed modes of survey administration (telephone, mail, and mixed telephone/mail mode), hospital-level reliability, and missing data.

Based on the results of these analyses, we present the three English-language draft instruments resulting from the field test:

• Discharged to Community: 35 questions regarding ED experience, plus 18 questions regarding the respondent's characteristics, for those patients who were discharged directly from the ED to a community-based setting
• Admitted Stand Alone: 29 questions regarding ED experience, plus 18 questions regarding the respondent's characteristics, for those patients who were admitted to the hospital from the ED
• Admitted HCAHPS Add-on: 10 questions regarding ED experience that should be inserted into a full Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) instrument (using the most recently available version of the instrument) immediately preceding the “About You” section that includes questions regarding the respondent's characteristics. This instrument is also for use with those patients who were admitted to the hospital from the ED.

The 18 questions regarding the respondent's characteristics in the Discharged to Community and Admitted Stand Alone instruments include

• eight demographic and general health status questions that are typically included in CAHPS surveys
• seven additional questions focused primarily on disabilities and functional status that are legally mandated by Section 4302 of the Affordable Care Act
• three questions related to proxy assistance with completing the survey.

These instruments yielded four composite measures, which are measures composed of responses to multiple survey questions:

• Getting Timely Care
• Communication with Patients About Their Medicines
• How Well Emergency Room Doctors and Nurses Communicate with Patients
• Communication with Patients Prior to Their Release.

In addition, they yielded ten measures that are each comprised of a single survey question:

• “Using any number from 0 to 10, where 0 is not at all important and 10 is extremely important, when you first arrived at the emergency room, how important was it for you to get care right away?”
• “During this emergency room visit, did the doctors and nurses do everything they could to help you with your pain?”
• “During this emergency room visit, when you needed an interpreter did you get one?”
• “Using any number from 0 to 10, where 0 is the worst care possible and 10 is the best care possible, what number would you use to rate your care during this emergency room visit?”
• “Would you recommend this emergency room to your friends and family?”
• “During this emergency room visit, did doctors and nurses give you as much information as you wanted about the results of these tests?” (discharged patients only)
• “Before you left the emergency room, did a doctor or nurse tell you what the new medicines were for?” (discharged patients only)
• “Before you left the emergency room, did someone ask you if you would be able to get this follow-up care?” (discharged patients only)
• “Once you found out you would have to stay in the hospital, were you kept informed about how long it would be before you went to another part of the hospital?” (admitted patients only)
• “Before you left the emergency room, did you understand why you needed to stay in the hospital?” (admitted patients only)

These instruments are based on the results of our field test, should not be considered final instruments that are endorsed by CMS, and were not ready for use at the time this study was released. As of September 2014, CMS plans to conduct additional testing on these instruments.

The research described in this article was conducted in RAND Health, a division of the RAND Corporation.