“Iceberg, right ahead!”
Quick… name that movie! If you said “The Titanic”, you’re right! To this day, when I see a picture of an iceberg, I can’t help but hear that voice from the movie with the British accent belting out that phrase. Silly memory, I know, but I thought of it this week when preparing to write a bit about the Unexpected Experience of the Emergency Department and also the upcoming ED CAHPS. Here’s why…
For years now we’ve known that the CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys such as HCAHPS (Hospital), CG CAHPS (Clinician and Group), and Home Health CAHPS were just the “tip of the iceberg” for the required patient experience surveys across the healthcare continuum, and that ED CAHPS, Outpatient Ambulatory Surgery CAHPS, and others were all coming up soon. For ED CAHPS, that “soon” is pretty much upon us! While there’s no crystal ball, best bets are that ED CAHPS will be required starting in 2017. Currently under development as the EDPEC (Emergency Department Patient Experiences with Care) survey, this tool will be most likely required in Emergency Departments across the country in the next year. 
Currently there are several versions of the survey being tested for final use with:
- Patients who are discharged from the ED
- Patients who are admitted for an inpatient stay and are eligible to receive the HCAHPS survey—they receive either:
- A survey specifically about their ED experience
- The traditional HCAHPS survey with some added ED items
Regardless of the version and discharge disposition, the survey is broken down into four sections relating to the patient’s journey, specifically:
- Going to the Emergency Room – focusing on timeliness of care and the arrival process
- During the Emergency Room Visit – focusing on timeliness of care, medication communication, and pain management
- People Who Took Care of You – focusing on how nurses and doctors communicated with the patient
- Leaving the Emergency Room – focusing on discharge instructions and follow up care, or transitions to the inpatient setting, whichever applies 
This is important to hospitals and health systems as many of their patients’ and families’ journeys begin in the Emergency Department. Most organizations know that the Emergency Department is the front door of their hospital. According to a study by Rand Corp., the ED now accounts for more than one-half of all hospital admissions. This is up from one-third of admissions in the early 1990s. 
In addition to being this front door and conduit of hospital admissions, the ED is really a hub connecting so many other organizations involved in the care of the patient. According to Rand, “EDs support primary care practices by performing complex diagnostic workups and handling overflow, after-hours, and weekend demand for care. Almost all of the physicians we interviewed—specialist and primary care alike—confirmed that office-based physicians increasingly rely on EDs to evaluate complex patients with potentially serious problems, rather than managing these patient themselves.”
This is especially true for the patients in the mental health community. I recently heard of a letter from a grateful patient who came into the ED with acute anxiety in a moment of crisis. She detailed how everyone helped her, from the security officer who gave her a warm blanket and put his hands on her shoulder and assured her that she was safe, to the staff that reassured her over and over again that she did the right thing in coming in. The care and respect and understanding from the team across the board stuck with her and her husband.
What impressed me about her story the most was the way that the team connected and coordinated with her care back into the community. The physician assistant who saw her explained the medication she received and how important it was to carefully take this drug. This patient remembered this when her primary care physician reiterated this to her as well at her follow up appointment. The social worker wanted to make sure she would follow up with a mental health professional and told her about some resources available. This supported her in a counseling appointment which she scheduled for the following week. For this woman, like for so many, the Emergency Department was the connecting and catalyst point for her care coordination.
There are so many reasons that the ED is important, to patients and families and also to hospitals and health systems. In the next part of this series, we will look at what’s most important to patients and families when they have their Unexpected Experience and come to the ED , as well as what departments, staff and physicians can do to help make it a better experience for their patients.
 CMS, Emergency Department Patient Experience with Care (EDPEC) Survey, https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/ed.html
 CMS, Emergency Department Patient Experience with Care (EDPEC) Survey, https://www.cms.gov/research-statistics-data-and-systems/research/cahps/edpec-survey.pdf
 “Research Report: The Evolving Role of Emergency Departments in the United States” (RAND Corporation, 2013), http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR280/RAND_RR280.pdf