TOPLINE:

In a large cross-sectional analysis of surveys of patient experience in emergency departments (EDs), responses to multiple survey items reflected a single underlying overall experience and showed similar associations with operational factors such as placement in a hallway bed and ED crowding.

METHODOLOGY:

• Researchers conducted a cross-sectional study of 58,623 unique National Research Corporation Health ED patient-experience surveys collected from 13 EDs between 2022 and 2023.
• Participants were predominantly women (55%) and White (76.3%); about 60% of them received laboratory and radiology studies, and 57.1% had an Emergency Severity Index score of 3.
• The survey consisted of three questions asked to all respondents and 10 questions asked to specific subsets. A binary "top-box" rating (4 on a 1-4 scale; 9-10 on a 0-10 scale) was used for each survey item, and not all respondents received every item.
• Researchers assessed the dimensionality of very positive survey responses using tetrachoric correlations and analyzed associations between individual survey items and clinical and operational predictors.

TAKEAWAY:

• Individual survey items showed high correlations with a single underlying patient-experience factor (correlation coefficient, 0.83-0.96).
• Clinical and operational variables, including pain scores, placement in a hallway bed, and ED crowding, showed consistent associations across survey items, regardless of the specific aspect of care being measured.
• Wait times demonstrated variable associations, with increases in the odds of top-box responses seen only for items related to nursing communication.

IN PRACTICE:

"Multi-item patient experience surveys may not provide substantially more information than brief 1-2 question patient experience surveys. Given response burden and survey fatigue, shorter surveys should be considered," the authors wrote.

SOURCE:

The study was led by Diane Kuhn, MD, PhD, Indiana University School of Medicine, Indianapolis. It was published online on November 17, 2025, in Annals of Emergency Medicine.

LIMITATIONS:

The study was limited to a single health survey, which may not have reflected nationwide practices. Focusing on top-box scores limited the broader analysis of patient experience data. Self-reported demographics may not have been consistently collected, and the results may have overrepresented higher-volume academic EDs rather than critical access locations. Language barriers were not included due to inconsistent data on interpreter use, and the low percentage of hallway bed patients may not have represented institutions with significant ED boarding issues.

DISCLOSURES:

This research was supported in part by a grant from the American Academy of Emergency Medicine (AAEM) Institute for Leadership, Education, & Advancement in the Development of Emergency Medicine, Inc. The authors reported that the views presented in the article are those of the authors and do not necessarily represent those of AAEM or its affiliates. Two authors reported being editors of Annals of Emergency Medicine.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.