COMPARISON SHOPPING: REPORT LOOKS AT EMERGENCY ROOM SERVICES IN SOUTHEAST MISSOURI

A state report says hospitals in Southeast Missouri got the lowest patient satisfaction scores in the state for emergency services.

Local hospital administrators say they've already taken steps to address many of the report's findings, and disputed some of the data.

The 1997 Buyer's Guide, issued by the Missouri Department of Health's Center for Health Information Management and Epidemiology, compares services, policies, staffing and patient satisfaction available in emergency departments at the region's hospitals.

The patient satisfaction scores were based on random surveys of patients who visited the hospitals' emergency departments, said Garland Land, center director.

Participating hospitals turned over lists of all the patients who visited their emergency departments and 300 of those patients from each hospital were surveyed.

The report lists 17 hospitals from Bonne Terre to the Bootheel, including St. Francis Medical Center and Southeast Missouri Hospital in Cape Girardeau.

Both Cape Girardeau hospitals earned average scores for patient satisfaction and for meeting overall time standards for patients waiting to see physicians.

Reducing that waiting time "has been something that our emergency services department has really focused on," Southeast administrator Jim Wente.

He said, "While we still have patients that feel they're waiting too long, and sometimes they do, I think we've made some major strides in reducing that time."

Marilyn Curtis, assistant vice president of ancillary services at St. Francis, said the number of people surveyed "is a very, very small sampling size. In fact, it would be statistically invalid."

St. Francis expects nearly 26,000 visits annually to its emergency room/urgent care department. Of the 300 patients surveyed for the Buyer's Guide, 174 returned their surveys, she said.

But patient satisfaction is "very important" in all areas of the hospital, and the hospital monitors patient response carefully, Curtis said.

"We're actually mailing out a patient satisfaction survey to every fifth patient who comes into our ER, because we want this to be random," she said.

Overall, she said, the hospital has received a 97 percent approval rating on its surveys.

Since the Buyer's Guide information was taken, Curtis said, St. Francis has added a full-time pediatrician to its emergency services department and a board-certified pediatric nurse-practitioner.

St. Francis received low-marks for having full- and part-time pediatricians in the ER in the Buyer's Guide.

By the time the guides are published, the information in them "is almost two years old," Curtis said.

Southeast earned average marks for all the criteria under patient satisfaction, including respect for patient preferences, information and education, emotional support, access and coordination of care and continuity of care.

St. Francis scored low for information and education and continuity of care, and average marks for the other three criteria.

Lucy Lee Hospital in Poplar Bluff didn't participate in the patient satisfaction survey and didn't report its patient waiting times.

Kim Call, senior manager of planning and development at Lucy Lee, said Tenet HealthSystems, the hospital's parent company, conducts its own patient satisfaction surveys.

Call said it was unclear why Lucy Lee's waiting times weren't included in the study, and added the hospital conducts "ongoing ER time studies" for emergency, non-emergency and urgent care patients.

The region scoring the highest for overall patient satisfaction was central Missouri, according to Land's office.

Hospitals in the Kansas City metro area, including Jackson, Clay and Platte counties, earned the highest overall marks individually for patient satisfaction.

The two Cape Girardeau hospitals both scored high marks for having specially trained medical staff, including physicians and RNs, board-certified physicians, pediatric capabilities and triage and transfer policies.

Southeast received an average score and St. Francis earned a high score for support services, such as having an ICU, a 24-hour pharmacy and an operating room ready around-the-clock.

Southeast is listed in the report as not having an OR available 24 hours a day, but Wente disputed the fact.

"That's not true," Wente said, adding surgical teams are on call 24 hours a day.

"We can be in there in 20 minutes. Do we have a staff in there sleeping 24 hours a day? No, because that's not cost-effective," he said. "We can rock and roll pretty quick once the decision's made that it's necessary."

Southeast scored high and St. Francis average for quality improvement activities, which include having a quality improvement program in place, a follow-up policy and the number of quality indicators monitored.

St. Francis received a low score for its follow-up policy, which covers such things as whether a staff member is assigned to contact a patient after he/she is discharged if the patient does not have a personal physician.

Land said consumers have to decide for themselves which criteria are most important when choosing a hospital.

Previous Buyer's Guide editions have concentrated on specific types of care or procedures and have compared costs as well as quality of service.

It is not practical to comparison shop for emergency medical care based on price, Land said.

And because of the wide variety of services that might be needed in an emergency room -- from treating a sinus infection to stitching up a cut to major surgery after a trauma injury -- it's difficult to set cost guidelines.