Revised February 2023, June 2016 with current title
Originally approved September 2010 titled "Patient Satisfaction Surveys"
The American College of Emergency Physicians (ACEP) recognizes that patient experience of care surveys that are methodologically and statistically sound can be reflective of the patient’s perception of their health care experience, and that patient outcomes can be related to perceived patient experience of care.
However, neither institutions nor survey vendors have established widespread standardization of survey tools, populations, or methodologies. Inclusion and exclusion criteria have not been consistently applied, resulting in inconsistent survey results. Hospitals and survey vendors may sample or receive responses from a small percentage of the patients seen in the emergency department (ED) potentially leading to results with poor validity. Importantly, acutely ill or injured patients who are admitted to the hospital are typically excluded, the very patients to whom emergency physicians appropriately devote disproportionate amounts of time and attention. Moreover, factors leading to poor patient experience scores, including wait times, are often related to factors extrinsic to ED operations and outside of the control of the staff working in the ED.
Consumer Assessment of Healthcare Providers & Systems (CAHPS) was a program introduced by the Centers for Medicare & Medicaid Services (CMS) in the mid-2000s as part of the overall shift of healthcare from a fee-for-service to a pay-for-performance model. The program was designed to assess the experiences of adult ED patients who were subsequently discharged home. An early version of a care quality survey for EDs, based on outpatient tools, was initially conceived as ED PEC (Patient Experience of Care); however, despite a prolonged trial of ED PEC and its offspring instrument, labeled ED CAHPS, CMS has still not validated nor issued standard ED surveys.
ACEP holds that patient experience of care survey tools should be:
Due to the difficulty in refining whether patient experience of care scores are the result of physician performance or due to demands and restrictions on the current health care system, implicit bias, or other factors out of the control of the physician, patient experience of care metrics should not be used in isolation for purposes such as credentialing, contract renewal, or incentive bonus programs. Instead, they should be viewed as one data point among many when assessing perception of ED care.
Using patient experience of care scores for credentialing, contract renewal, or incentive bonus programs could have potential negative impacts on quality patient care including safe prescribing of controlled substances, use of antibiotics, and utilization of imaging. Patient experience surveys are best utilized in a collaborative fashion between physicians and healthcare organizations to assess the patient experience of care in the ED.
ACEP believes that: