Devon Hill Associates provides healthcare mystery shopping services

With the final ED – CAHPS survey (The Emergency Department Consumer Assessment of Healthcare Providers and Systems) expected to become mandatory sometime in late 2015 or early 2016, now is the time for hospitals to make sure they have sufficient, in-depth, feedback about patients’ perceptions of their experiences in their emergency department. The survey from CMS will assess information about the patient experience during arrival in the Emergency Department, during care, and after being admitted to an inpatient unit or discharged from the ED.

More specifically, the final surveys will ask questions about how quickly patients receive initial care, the perceived quality and timeliness of communication with nurses and doctors, wait times, medication and pain handling, interpreter services and discharge instructions — plus the overall rating of care and likelihood to recommend the hospital to others. The Centers for Medicare & Medicaid Services (CMS) is still testing the draft surveys.

Similar to HCAHPS on the inpatient side, CMS’s goal in developing the Emergency Department version of CAHPS is to better understand the ED experience from the patient’s perspective, allow for objective comparisons of the care that patients receive, and improve the quality of Emergency Department visits across the country. Likewise, a portion of Emergency Department reimbursement is expected to eventually be tied to the hospital’s ED-CAHPS scores.

The ED Experience and the Patient’s Overall Perception of Hospital Care

Understanding a patient’s perception of his care and treatment in the Emergency Department is not only important for its own sake. Research suggests that first impressions and perceptions of care in the ED often carry over into the inpatient stay – impacting a hospital’s HCAHPS scores. And since approximately 50% of inpatient admissions come through the Emergency Department, when a patient has a poor perception of care in the ED, it may be difficult to completely recover from it during the inpatient stay. (Check out my blog, “A Different View: When Doctors Become Patients.”)

What Can Hospitals Do To Get Ready For ED-CAHPS?

The first thing hospitals should do is make sure that all staff is aware of and prepared for ED-CAHPS. If the Emergency Department is the front door to the hospital; if it sets the stage for the overall perception of care — then focusing on what needs to be done to improve or enhance the ED experience is hugely important. Interestingly, a survey conducted by the Studer Group reported that less than 50 percent of contacted hospitals said that they were aware of and/or actively preparing for ED-CAHPS. The most common reason given was lack of certainty about the final requirements.

Although the ED-CAHPS surveys have not been finalized, the various proposed questions are available online and can be used to analyze past and current ED metrics and to shape an action plan. In addition, there’s a wealth of useful information online describing how hospitals have streamlined processes, improved flow, cut waiting times, improved communication and enhanced the patient’s perception that staff cared about them.

Another preparation strategy is Mystery Shopping. Mystery shopping can provide management and staff with eye-opening insight into patients’ perceptions of their ED care – including wait times, communication, courtesy, friendliness, pain management, discharge instructions and patient safety. Mystery shopping feedback can include details about the “who, what, when, where and why” of the experience. One of the most significant values of mystery shopping is that it digs underneath and beyond the information that traditional satisfaction surveys provide.

If you’d like more information about Mystery Shopping, and how Devon Hill’s Secret Patient Service can help you and your hospital target areas needing improvement before ED–CAHPS scores become public, contact Devon Hill Associates at 858-456-7800 or visit our website at