LAUSR

BACKGROUND Trauma and Emergency Surgery patients are unique with regards to the sudden and unexpected nature of their hospitalization and this may adversely affect patient satisfaction but no large study exists examining this issue. The purpose of this study was to investigate the major factors that affect satisfaction scores in Trauma and Emergency Surgery patients. STUDY DESIGN HCAHPS survey data from patients discharged in 2018-2019 from facilities in a national hospital system were obtained. Patients were categorized as Trauma, Emergency Surgery or Direct Admit Surgery (Elective Surgery). Individual HCAHPS question scores were regressed on the score for "Overall Rating" to determine the primary, secondary, and tertiary satisfaction drivers. RESULTS There were 186,779 patients from 168 Hospitals. As expected, the primary determinant of patient satisfaction was nursing communication for all groups. However, Trauma and Emergency Surgery patients differed from Elective Surgery patients in that physician communication was the second most important factor in patient satisfaction accounting for 12.0% (Trauma) and 8.6% (Emergency Surgery) of the total variability in the Overall Rating beyond the variability explained by the primary driver. If physician communication received low ratings, it was unlikely that high scores in other metrics could compensate to bring the "Overall" score above the 50th percentile. CONCLUSIONS Acute Care Surgeons appear to play a uniquely significant role in support of HCAHPS scores. These data emphasize the importance of physician communication, particularly when a pre-hospital physician-patient relationship does not exist. Future research should explore specific mechanisms by which physicians effectively communicate with patients.