Emergency Department Patient Experiences with Care (EDPEC): What You Need to Know

Tracking of how patients feel about care provided by emergency departments isn’t here yet, but it’s coming. Providers and facilities should already be familiar with the Hospital Quality Initiative, the annual national, standardized, public reported survey of patients’ perspectives on hospital care. The Centers for Medicare and Medicaid Services (CMS) are working on similar surveys — known as Emergency Department Patient Experiences with Care (EDPEC) — to specifically monitor a number of parameters regarding the quality of emergency care delivery. Here’s the latest from CMS on the development process, and what hospitals and providers can expect.

A little history

In 2012, CMS launched the development of the EDPEC surveys to measure the experiences of patients 18 and older with emergency department care. The survey respondents will include patients admitted to the hospital following their emergency department visit and those visiting the emergency department who are discharged to the community. The surveys were developed according to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) principles.

CMS stresses that it understands that the emergency department (ED) is a unique environment within the health care system, bridging the worlds of outpatient and inpatient care. In particular, the emergency department is a pivotal arena for the provision of acute care services, handling 28% percent of all acute care visits in the U.S., half of all such visits by Medicaid and State Children’s Health Insurance Program (SCHIP) beneficiaries, and nearly two-thirds of such visits among the uninsured. In addition, the emergency department is the portal of entry for nearly half of all hospital admissions. And that’s why CMS is placing its focus on communication structures over the course of the process of developing the EDPEC surveys.

Where we are now

CMS has distributed three test versions of the survey — two versions for patients administered to the hospital, and one for patients discharged to the community — as part of a pilot to determine feasibility and effectiveness. Patients who received care at fully hospital-based EDs are eligible for the surveys, which ask patients about their experiences with arriving at the ED, during ED care, and after being admitting to the hospital or discharged from the ED. Critically, CMS says, “The surveys will provide patient experience data that enables comparison of EDs across the nation and promotes effective communication and coordination.”

Examples of questions include:

• During this hospital stay, how often did doctors listen carefully to you?
• During this hospital stay, how often did doctors explain things in a way you could understand?
• Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
• Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?
• During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?
• During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?
• 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?
• During this emergency room visit, did the doctors or nurses ask about all of the medicines you were taking?
• During this emergency room visit, did doctors and nurses give you as much information as you wanted about the results of blood tests, x-rays or any other tests?

What to expect

Although the EDPEC Survey currently is under development and, therefore, no decisions regarding national implementation have yet been made, the implication is clear: CMS is continuing the push to codify improved communication among providers, and between providers and patients. Before the administration protocol comes to pass, it’s worth taking a look at how your institution supports these communication channels.

Using certified medical scribes frees physicians and other clinicians to fully examine and discuss symptoms, test results and more with patients, resulting in full engagement. For patients to feel truly cared for, it’s important that physicians “maintain eye contact, hold conversations and make personal connections with patients,” which can be difficult at best when a physician is alternating between patient and computer. These actions aren’t just good for the patient — quality face time with patients lets doctors make accurate diagnoses and order more appropriate tests, ensuring they’re providing the right level of care. As a result, physician job satisfaction is enhanced, while patients feel confident their best interests are driving the conversation.

In addition, scribes can act as links between patient and physician or physician and billing personnel to coordinate medical care with medical documentation in real-time. They help physicians communicate more efficiently among providers and departments (e.g. laboratory and radiology, other specialists), helping to coordinate planning and maintain the flow of tasks. Additionally, the work scribes contribute is a crucial link between acute and non-acute settings, as thorough documentation can help EDs quickly develop the written information discharged patients will need to take home with them.