Patient satisfaction and food illness

This podcast starts with improving patient satisfaction and press Ganey scores. Our case is one about a foodborne illness. Remember if you have a interesting case, email me: Robert @APPEMREADY.COM. I hope you enjoy this podcast. Check back frequently for new episodes.

Transcript

SPEAKER_00 0:13

Welcome to APPEM Ready, the podcast focused on career insight, system insight, and real-world case discussions designed to build your clinical confidence. Whether you're new to emergency medicine or looking to sharpen your edge, you're in the right place. This podcast is intended for advanced practice providers, students, studying medicine, or providers interested in emergency medicine. It is not intended to be medical advice for the general public. It does not replace your own clinical knowledge and decisions. If you have interesting cases, email me and I will talk about and break it down on the podcast. Email me Robert at apemready.com. Let's get started.

SPEAKER_01 0:53

Today I'm going to talk about something that is frustrating but is important. Improving patient satisfaction and press gaining scores. I'll be the first to admit I sigh when this subject gets brought up at our meetings. But let's be honest, in emergency medicine, patient satisfaction can feel like a moving target. We deal with high acuity, long wait times, limited resources, and patients who don't want to be there in the first place. Yet those same patients are asked to evaluate their experience, often through tools like Press Ganey, and those scores matter. They affect reimbursement, reputation, and increasingly how we're judged as clinicians. So the question becomes, how do we improve patient satisfaction in a system that isn't built for comfort? The answer isn't working faster, it's working smarter in how we connect. Set the framework early. The first sixty seconds matter the most. Patient satisfaction is largely determined in the first minute. Patients don't want just care, they want orientation. When you walk into the room, don't just introduce yourself. Set expectations. Try something like this. Hi, I'm Rob, one of the emergency medicine providers. I know weights can be frustrating. Here's what I'm focused on for you today. That one sentence does three things, acknowledges their frustration, builds trust, and shows you're in control. If you don't define the experience, the patient will, and it's usually not in your favor. Sit down. Even if it's for 20 seconds, multiple studies have shown that when providers sit, patients perceive the visit is longer and more attentive, even when it's not. You don't need to be there for 10 minutes, you need presence. In a chaotic ER setting, this signals I'm not rushing you, you matter right now. Studies have shown that when you sit down, the patient perceives you being in the room 50% longer than you actually are. It's small behavior changes that can disproportionately impact. Narrate your thinking. This is where emergency clinicians can separate themselves. Patients aren't reassured by what you know, they're reassured by what you explain. Instead of saying your labs are fine, you say I was concerned about your heart and lungs. We ran tests to look for those problems. Those tests came back reassuring. Now you've demonstrated thoroughness, reduced anxiety, and built credibility. This aligns directly with structured clinical thinking. When patients understand your pathway, they trust your decision. Acknowledge your time. Don't ignore it. You can't control wait times, but you can control how patients experience them. Silence around delays creates frustration. Acknowledgement reduces it. Simple phrases like I know it's been a long wait, thank you for your patience. Here's what we're waiting on next. Patients tolerate delays much better when they understand the process. Close the loop before you leave. One of the biggest drivers of poor scores is uncertainty at discharge. Before you leave the room, ask What questions do you still have? Not do you have any questions? That subtle shift invites engagement instead of dismissal. Then finish with clarity what we found, what we ruled out, what happens next, when to come back. Confusion equals dissatisfaction. Clarity equals confidence. Use the last impression rule. Patients don't remember everything, but they remember how it ends. Even if the visit was delayed, uncomfortable or stressful, a strong closing can reshape the entire perception. Try something like I'm glad you came in today. You did the right thing getting this checked out. That reinforces validation, safety, and partnership. Protect the human moment. Here's the truth. Press Ganey scores aren't really about medicine. They're about connections under stress. In emergency medicine we often default to efficiency over empathy. But it doesn't take more time to be human. It takes more intention. Use eye contact. Use their name. Listen without interrupting for just a few seconds longer. These are low cost, high impact behaviors. Closing improves patient satisfaction. It isn't about changing the system overnight, it's about mastering small repeatable actions. Set expectations early, show presence, explain your thinking, acknowledge delays, and close with clarity. These are structured pathways, not just for clinical care, but for communication. And just like in medicine, when you followed a structured approach, you reduce risk and you improve outcomes, not just for patients, but for how they remember you. Now let's move on to a case discussion. I thought about a case I had the summer before COVID hit. Let's call it the business lunch that wasn't food poisoning. In emergency medicine, not every case walks in and announces what it is. Sometimes it tells a story that almost fits, but not quite. If you're not paying attention to that mismatch, you miss it. So let's get started with this case. I had this patient several years ago, a middle aged man who came in to the emergency department after a business lunch. He told me that about twenty minutes after he finished his meal, while sitting there talking business, his face suddenly became intensely red. He then developed a pounding headache. He became nauseated. He actually had to excuse himself to go to the restroom and vomited several times. By the time he got to me, he still felt awful. He was still flushed in the face, still had a pounding headache, and he was still nauseated. But no more vomiting, no more diarrhea, no abdominal cramping. And here's the detail that should make you pause. No one else at the table was sick. So now you're thinking is this food poisoning? Maybe. But something still doesn't fit. If the pitcher doesn't fit, you need to press further, because in emergency medicine, time course matters. Foodborne illnesses usually takes hours, sometimes days for symptoms to develop. Not twenty minutes. So I asked him a question that changed everything. What did you eat? And he said I ate fresh caught salmon. I eat it often. And that's when it clicks. Anyone out there know what it is? Go ahead. Shout it out. You know it. Come on. This wasn't food poisoning. This was scromboid poisoning, also known as histamine fish poisoning. Here's what's happening. When fish like tuna or mackerel or even salmon aren't stored properly, bacteria convert histidine in the fish to histamine. And here's the key. Cooking does not destroy it. So the patient isn't reacting to bacteria. He's just ingested a large histamine load. This looks like an allergic reaction, but it's not IgE mediated. It's toxin mediated physiology. It goes back to pattern recognition, and once you know the pattern, you start to see it clearly. Rapid onset, minutes to an hour, facial flushing, pounding headache, nausea, vomiting, sometimes palpitations, sometimes even a rash. Now here's the real decision point. Is this really scromboid or is this anaphylaxis? Because early on they can both look very similar. In emergency medicine, you don't get to miss anaphylaxis. So you ask, is there any airway involvement? Hypotension or bronchial spasms? If yes, you treat it like anaphylaxis with no hesitation. If not and the pattern fits, you're dealing with a histamine problem. The treatment is straightforward. H1 blockers like diphenhydramine, H two blockers like famatidine, fluids if needed, animetics if needed, maybe some Tylenol for his headache. And most of the time, these patients get better quickly. Symptoms usually resolve with treatment in thirty to forty minutes, and that was the case here. Once treated properly, his symptoms did improve it. But the real value of this case isn't the treatment, it's the thinking, because this is exactly why structured clinical pathways of thinking reduce risk and improve risk management. There are four keys in this case. Let's talk about them. Number one, time course is a diagnostic tool. Minutes versus hours should immediately shift your differential. two recognize the mismatch. When the story doesn't fit the typical pattern, don't force it. Pause and reassess. Number three, treat the physiology, not just the label. Histamine excess give antihistamines. Airway risk treat anaphylaxis. four in rare cases with respiratory symptoms, overnight emission with repeated antihistamines is warranted. So remember not every bad meal is an infection. Sometimes it's chemistry. Recognize the pattern, trust the timeline, build structured pathways of thinking so you can stay AP EM ready. Remember, email me your interesting cases to discuss on the podcast. You can contact me at Robert at APEMRady.com. I really appreciate you listening and come back soon for our next podcast. This is APP EM Ready, where better thinking means better outcomes.