# Decoding Emergency Department Dissatisfaction: Factors Associated with Patient Complaints

## TL;DR

Long waits and frequent visits increase chances of complaints in emergency departments, while imaging and admissions reduce them.

## Contribution

Identifies specific operational factors linked to patient complaints in emergency departments using a matched-cohort study.

## Key findings

- ED length of stay ≥ 12 hours increases complaint risk by 3.12 times.
- Diagnostic imaging and hospital admission reduce complaint odds.
- High-volume ED periods are associated with fewer complaints.

## Abstract

Patient experience has important implications for hospitals and patient care including its ties to reputation, reimbursement, and clinical outcomes. Despite its importance, little is known about how operational factors in the emergency department (ED) impact formal complaints. In this study we aimed to identify encounter-level operational characteristics associated with the risk of formal patient complaints.

We conducted a retrospective matched-cohort study of ED encounters between October 2023–December 2024 at three EDs affiliated with a large academic health system. Each complaint case was matched to three non-complaint cases (3:1 matching) based on age, sex, race/ethnicity, acuity score, and chief complaint. We used logistic regression to assess the associations between operational factors and the likelihood of submitting a formal complaint. A Bonferroni correction was applied for multiple comparisons with statistical significance set at P < .005.

Of 246,983 ED visits, 476 (0.19%) formal complaints were submitted. These were matched with 1,428 non-complaint cases. Baseline characteristics, which included age, sex, race/ethnicity, primary insurance, and chief complaint, did not differ, by design, between groups. Analysis revealed that ED length of stay ≥ 12 hours (odds ratio OR 3.12; 95% CI, 2.34–4.18) and an average of more than one ED visit per month (2.00; 1.45–2.73) were significantly associated with increased odds of filing a complaint. In contrast, any imaging performed during the visit (0.43; 0.35–0.54), hospital admission (0.72; 0.57–0.90), and presenting to the ED during a high-volume time (0.47; 0.33–0.67) were significantly associated with decreased odds of filing a complaint.

Length of stay > 12 hours and frequent ED visits were associated with a significantly increased complaint risk. Any form of diagnostic imaging, admission to the hospital, and presenting to the ED during a high-volume period were associated with fewer complaints. These findings offer ED and hospital leadership insights on the patient experience and highlight that improving capacity constraints for all patients can have downstream benefits for those who submit formal complaints.