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Rapid cycle testing drives improved communication and satisfaction using in-person survey
  1. Nicholas Anders Kuehnel1,
  2. Andrea K Morrison2,
  3. Catherine C Ferguson2
  1. 1Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  2. 2Pediatrics, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  1. Correspondence to Dr Nicholas Anders Kuehnel; nkuehnel{at}


Background Good communication with families improves safety and drives patient/family satisfaction. Rapid cycle improvement for the communication is difficult in our emergency department as current mailed surveys provide little and delayed data. We had two aims in this quality improvement study: (1) to increase proportion of families responding ‘always’ when asked if they received consistent communication from nurses and providers from 52% to 80% and (2) increase families reporting their visit as excellent, reflecting higher family satisfaction.

Methods Key drivers of the consistent communication were determined using the model for improvement. Interventions focused on interprovider communication and parental knowledge of communication processes. Eight Plan-Do-Study-Act ramps were conducted focusing on each of the key drivers, with 1–10 cycles per ramp. A five-question in-person survey was conducted at the time of disposition by the research assistants. Process and outcome measures were tracked on the statistical process control charts.

Results Mean percentage of families who reported always receiving consistent communication increased from 52% to 70% over 12 months. Additionally, families reporting their visit as ‘excellent’ increased from 62.5% to 75%. Using in-person surveys,weekly responses increased from 3 to 22.

Conclusions Iterative processes to improve interprovider communication and inform families about their care led to improvement in families’ perceived communication consistency. Improved communication can lead to higher family satisfaction, most affecting those previously feeling neutral about their visit. In-person surveys can inform the real-time improvement efforts.

  • emergency department
  • patient satisfaction
  • communication
  • paediatrics
  • quality improvement

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  • Contributors NAK assisted in conceptualising and designing the study, data analyses and interpretation, drafted the manuscript, and approved the final manuscript as submitted. AKM and CCF assisted in conceptualising and designing the study, reviewed the data analysis and interpretation, reviewed and revised the manuscript, and approved the final manuscript as submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This project was reviewed by the Medical College of Wisconsin’s Institutional Review Board. It was deemed a QI study, thus exempt and not human subject research. No other financial or ethical conflicts of interest were noted.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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