95 An Analysis of Patient Complaints at a Community Teaching Hospital’s Emergency Department and Its Correlation to Litigation

Abstract

The purpose of this study is to analyze emergency department (ED) complaints received at a community teaching hospital, create benchmarks with complaint rates and to correlate this with litigation. A prospective study analyzed logged patient complaints forwarded to the ED Medical Director between 2014 and 2018. Our community teaching ED has an approximate annual volume of 50,000 visits with ED attending and mid-level provider coverage. Our ED satisfaction scores place us in the 85th percentile in our peer group and 65th percentile nationally. Qualitative evaluation was performed based on a systematic taxonomy and the following data was extracted: patient’s provider, reason of complaint, origin of complaint, patient date of service, the date case opened, and the date the case closed. The complaints were totaled by year and categorized, correlating to the context of complaints, mode of case opening, and time frame for resolution. ED litigation was reviewed over the same five-year interval and correlated to the complaint log. The most common reason for a complaint was based on clinical care concerns, followed by billing issues, and then by patient satisfaction issues. Satisfaction concerns were received the earliest at 19.7 days, clinical concerns occurred in 38 days and finally billing at 160 days. Most complaints were resolved within 19.5 days after the case was opened. Cases that took more than 90 days to open from the date of service were most likely associated to billing. Most complaints originated from the Patient Satisfaction and Billing Departments. We have found that our facility had an annual complaint rate ranging from 24.2 to 33.3 per 10,000 visits during the observation period, with an overall rate of 29.1 per 10,000 visits. The hospital had nine total lawsuits attributed to the ED over the five-year period, for a rate of 9 per 251,012 or 0.36 lawsuits per 10,000 patient visits. The rate of a complaint associated with a lawsuit was 2 per 731 or 27.4 lawsuits per 10,000 complaints when extrapolated. Only one suit would assign attribution to the ED provider; all others were related to supporting services. The complaint incidence in our ED is low at 29.1 per 10,000 visits and remained constant over the five-year observation period. Only two complaints out of the 731 complaints led to litigation for a rate of 27.4 lawsuits per 10,000 complaints. This rate was substantially higher in magnitude than the general rate of 0.36 per 10,000. Moreover, most cases that ended up in litigation did not have an associated complaint filed in advance of the claim. Clinical complaints of quality of care, billing, and satisfaction were the most common. Satisfaction and quality of care complaints tend to come in earlier, while billing complaints are more likely to come in later and take longer to be resolved.