A Not-so-fun look at Opioids and Press Ganey
Lack of Association Between Press Ganey Emergency Department Patient Satisfaction Scores and Emergency Department Administration of Analgesic Medications. Schwartz T, Tai M, Babu K, Mercahnt R. The Annals of Emergency Medicine, 2014; 64; 469-481.
The Bottom Line
This article attempted to assess for the association between Press Ganey scores and two things: amount of total analgesics given in the ER and, more importantly, the amount of opioids given in the ER. What they found was no association between these factors and Press Ganey scores after controlling for confounders. One must begrudgingly trudge through horrific tables and poorly worded paragraphs to see how they drew these conclusions.
In the end, this is a poorly organized, over powered study full of data mining that does eventually conclude no association between narcotics and Pres Ganey scores.
Physicians in many EDs across the country feel pressure of some kind to maintain or improve their Press Ganey scores. Some have a direct connection between Press Ganey and compensation or job security. The elements that lead to higher Press Ganey scores is poorly understood.
There is no argument that ED physicians will at times feel pressure from patients to prescribe narcotics. As greater focus is paid to patient satisfaction, there is the concern that withholding/ not prescribing narcotics to patients could led to poorer Press Ganey scores and actually threaten job security for some ED providers. The other side of that coin is that providers will be more apt to prescribe narcotics in the hope of maintaining their scores
What They Did
Paper analyzed the Press Ganey scores for 4,700 patients out of Brown’s Level I trauma center and community hospital. Review was of charts of the fiscal years 2010-2011. **Of note, Press Ganey does not release its response rates, considering that proprietary information. This makes it difficult, in some ways, to comment or generalizability or response biases. The researches then did a chart review, classing medications given as analgesics, opioid analgesics, or other. Now comes the data and terrible tables.
The first assessment was to see who was more apt to get pain meds. Those who go pain meds were more likely to be female, younger, Black/non-Hispainc or white/Hispanic, uninsured, at the Level I trauma center, arrive late a time, and have a longer length of stay. Similar results were seen for narcotic recipients. Next they analized the relationship between Press Ganey score and pain medications receipt. It was found that patients who got pain meds/narcotics gave lower scores in 6 of 8 sections. They scored higher in Treatment of Family/Friends and Tests. This seems to make no sense and comes back to the very high power in the study.
They next went on to see what variables were associated with lower scores. They found the following to be associated with lower scores: receipt of pain medications, receipt of opioids, higher units of opioids given, younger, trauma center, female, and longer stay. After accounting for the above confounders, the association between lower scores and pain medications was no longer seen.
They therefore concluded no association between receipt of pain medication and Press Ganey
This paper was a headache to read, but the conclusion was possibly of some value. We are not sure what the key components of a Press Ganey score are. It appears that the administration of pain medications, including narcotics, does not seem to be correlated with higher or lower Press Ganey scores.