Can you be satisfied with a longer wait? #WILTW

This is the 180th #WILTW

The standard for defining emergency care ‘performance‘ in the UK is the four hour target. It is really important this is not confused with average wait to be seen. The target is the time taken for a decision to made on your disposition, essentially either admission and discharge, and this action carried out i.e in x % of the time patients should be admitted or discharged within 4 hours where x has been between 90-95% at various points.

A debate in the BMJ sums up excellently the pros and cons of this measurement. It is no secret that my hospital’s Emergency Department 4 hour target performance has been consistently at the lower end of the national average for some time. It was therefore pleasing to see this week that recently released figures from August showed our Friends and Family test (FTT) rating, the proportion of patients visiting your service who would recommend it to their friends and family, was the highest of 17 similar sized services.

Certainly the FFT is not an exact science and it has a great number of detractors. For example there probably is a relationship between response rate and overall recommendation as the FTT is collected via a form handed out to patients as they leave. If your response rate is abnormally high or low compared to others, does this say something about the quality of your care in itself? The responses are also aggregated for the whole department but larger departments are made up of different areas: majors, injuries, children etc. which may vary between each other and potentially aren’t comparable. For example is a parent answering on behalf of a child the same type of experiential response as an middle aged person answering for themselves?

However you would expect longer times to a definitive disposition to generally relate to a poorer experience so I think locally our staff should be proud of their efforts. Dependant on your point of view this does raise an interesting, or challenging, question. How does satisfaction and experience relate to performance and how should we interpret their interplay?

A blog from CanadiEM this week highlighted some surprising research showing concentrating on patient satisfaction resulted in increased hospital admissions, increased drug and total healthcare expenditures and increased mortality. The explanation is that evidence based medicine often clashes with expectation (the patient doesn’t need antibiotics but wants them) and when the clinician favours ensuring satisfaction above best practice the outcome is not ideal for anyone.

This demonstrates that quality is not uni-dimensional and that we still have a long way to go to creating a suite of measures that describe the care provided in a way that is meaningful and valid for all.

What have you learnt this week? #WILTW

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