Strengths and Weaknesses of Emergency Departments and Urgent Care

By Sondra Forsyth

Yelp reviews reveal that emergency departments are viewed as being higher quality but lacking in service as compared to urgent care centers, which patients rate the opposite

That is the rinding of  a 2018 study from researchers in the Perelman School of Medicine at the University of Pennsylvania. The study results, published this month in the Annals of Emergency Medicine, provide a unique opportunity for researchers and clinicians to learn from online reviews, which provide a raw narrative from consumers.

“Today’s world is very digital, and it’s very common for consumers to rate a restaurant, hotel or service online, a practice that is spilling over into health care,” said the study’s lead author, Anish Agarwal, MD, a National Clinician Scholars fellow and Emergency Medicine physician at Penn Medicine. “As an emergency department physician, patients often tell me that the internet is the first place they go for information about medical conditions and to research providers. Health systems and clinicians can learn a lot about the communities they treat and how people experience the services they provide by looking to online ratings and reviews.”

ONLINE REVIEWS ARE BECOMING COMMON FOR HEALTHCARE FACILITIES

In this new study, researchers, with the help of an automated system, analyzed high (five-star) and low (one-star) Yelp reviews for both emergency departments and urgent care centers, two venues that patients can select from when in need of acute care.

Researchers identified key themes in the five-star reviews of emergency departments, including bedside manner, treatment of family members, and access to care on nights and weekends. Urgent care centers were unique in receiving five-star reviews more often for factors including ease of refilling prescriptions and being positively recommended by others.

On the other side, emergency departments received negative remarks for speed of care, while urgent care centers received one-star reviews as a result of poor reception experiences and patients lacking confidence in the care received.

“We are seeing more and more that patients are sharing their experiences online, and they’re looking to social media platforms and online communities to help inform their decision-making,” said Kevin B. Mahoney, executive vice president and chief administrative officer of the University of Pennsylvania Health System. “Within these review and rating websites lies a trove of decision-making data that we can and should be culling through to help inform how care is delivered, and what matters most to our patients in emergency situations.”

URGENT CARE CENTERS HAVE PROLIFERATED WIDELY

Urgent care centers have proliferated widely across the country in the past 15 years. Between 2007 and 2016, visits increased by more than 1,700 percent. But while emergency departments have established surveys for patients and their families to report their experiences, there is not a clear equivalent for gathering direct feedback from patients who visit urgent care centers.

The study’s senior author, Raina Merchant, MD, director of the Penn Medicine Center for Digital Health and an associate professor in Emergency Medicine, believes Yelp reviews could fill a knowledge gap.

“Online reviews provide a rapid way of taking the pulse of how this acute care market is emerging and what consumers look for in these settings” said Merchant. “These platforms can also help us identify new focus areas, in an effort to provide better, more efficient care to patients based on their expressed needs.”

The researchers analyzed more than 100,000 Yelp reviews, posted between 2005 and 2017–in the midst of the urgent care boom–tied to 1,566 emergency departments and 5,601 from urgent care centers. During the study period, an average of one new review for an emergency department or an urgent care center appeared every hour of every day.

The reviews fell largely on one end of the spectrum or the other: five stars or one star. Roughly 47 percent of emergency department and 30 percent of urgent care center reviews fell in the one-star category. The disproportionate amount of negative reviews for acute care facilities, compared to other entities reviewed online, like hotels or restaurants, could be a result of what is at stake for the consumer.

“If a restaurant provides you with a quick meal exactly as advertised, they meet your expectations,” Merchant said. “With healthcare, things are different. People are often critically ill, the outcomes are uncertain, and the wait can be long–which are all things that sometimes can’t be controlled.”

The research team found that each type of facility received similar five-star reviews for comfort, cleanliness of facilities, pediatric care, and professionalism. One-star reviews for poor phone experiences, long wait times, billing difficulties, and pain management were tied to both emergency departments and urgent care centers.

Moving forward, the researchers hope to find more nontraditional sources to provide clues about patient experiences and use them to enhance care quality.

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Other Penn Medicine authors of the study include Amy Lanza, Elissa Klinger, David Asch, Nick Fausti, and Christopher Tufts.