Health care provider complaints to the emergency department: a preliminary report on a novel quality improvement instrument

Study objectives: Patient complaints to the emergency department (ED) are an important component in assessing patient satisfaction and quality of care and have been studied from a number of perspectives. However, no study has addressed complaints made to the ED by health care providers (HCPs) (physicians, nurses, and hospital administrators). Given their training, experience, and expertise, HCPs are uniquely positioned to provide detailed follow-up, present pointed inquiry, and give informed opinions about care in the ED. We present 1 yearʹs data from a system initiated to capture HCP complaints to the ED, respond systematically, and integrate these into our quality management program. Methods: Complaints to our metropolitan, academic ED from HCPs during 1 calendar year were reviewed. Receipt of an HCP complaint to the ED generated a “care concern” alert, forwarded to the involved emergency physician, who responded within 7 days. All complaints were routed through 2 quality managers who reviewed them, assigned 1 of 8 categories to the primary complaint, and evaluated the need for formal peer review. Descriptive data are presented. Results: Of 185 complaints to the ED, 53 (29%) were from HCPs, representing 1 per 1,000 visits, or 3.3 for 1,000 admissions. Of these, 31 (58%) related to medical care in the ED: 8 (15%) to diagnostic workup, 9 (16%) to ED management, and 14 (26%) to consultations; 11 (21%) related to miscommunication; 7 (13%) related to disposition: 4 (8%) to admitting service, 2 (4%) inappropriate discharge, and 1 (2%) to inappropriate transfer; and 4 (8%) related to infraction of a hospital policy. Overall, 10 (19%) cases, on formal review, led to staff reeducation or clarification of policy, and 2 cases resulted in new ED operational policy. Conclusion: HCP complaints highlight an aspect of customer care in the ED that is sometimes overlooked: that which we provide to other services within the hospital. Compared to patient complaints, those from HCPs primarily relate to patient care issues, many of which raise significant concerns requiring intervention. This underused source of patient care information presents a wealth of opportunity for quality improvement and customer service in the ED.