440 - Improving Patient and Caregiver Experience at a Pediatric Emergency Department

Publication Number: 4431.440

Theodore E. Trigylidas, Children's National Hospital/The George Washington University School of Medicine and Health Sciences, Washington, MD, United States; Nichole L. McCollum, Children's National Health System, Washington, DC, United States; Lauren Waterhouse, Children's National Health System, Washington, DC, United States; Evelyn Logan, Children's National Health System, Washington, DC, United States; Mandisa McIver, Children's National Health System, Washington, DC, United States; Tanika Jones-Madden, Children's Hospital & Medical Center, Washington, DC, United States; Julia Volcjak, Childrens National Hospital, Washington, DC, United States; Sephora Morrison, Children's National Health System, Washington, DC, United States

Background: Enhancement of patient experience is linked to better health outcomes and reduced safety events. Patient comfort measures, effective staff communication, and implementation of post-discharge callback programs are linked to improved emergency department (ED) patient experience. The Press Ganey (PG) survey question "likelihood to recommend" has demonstrated to correlate best with overall patient experience and customer loyalty to a healthcare organization.

Objective: To improve patient and caregiver experience through a series of plan, do, study, act (PDSA) cycles.

Design/Methods: A quality improvement initiative was implemented at our freestanding pediatric hospital ED from November 2023 to June 2025. Baseline data were collected from April 2022 to October 2023. We included all patients aged 0 to 21 years that were discharged home from our ED and completed a post-discharge PG survey. Key drivers were identified at the outset of our study (Figure 1). Our outcome measure was the change in proportion of maximum score results on the "likelihood to recommend" PG survey question over time. Our interventions included the introduction of a discharge callback program (November 2023), patient experience ambassadors (May 2024), and standard behavior and communication training for all ED staff (August 2024). Statistical process control charts were used to monitor data over time.

Results: A total of 6135 patients met inclusion for analysis during our baseline period and 4390 patients during our intervention period. Forty-four percent of patients interacted with an experience ambassador and 62.9% received a post-discharge call prior to completing a PG survey. Thirty-eight percent of staff completed standard behavior and communication training. Mean proportion of maximum score results for "likelihood to recommend" improved from 42.4% (baseline) to 53.7% (intervention; Figure 2).

Conclusion(s): The introduction of interventions to enhance both patient comfort measures and patient-staff interactions was associated with improved ED patient experience.

Figure 1 - Driver Diagram. ED, emergency department


Figure 2 - Emergency Department Proportion of Maximum Score Results for Likelihood to Recommend - P' Laney Chart
UCL, upper confidence limit; LCL, lower confidence limit; CL, center line. CL represents the mean.