INTRODUCTION

The emergency department (ED) is a unique healthcare environment, bridging outpatient and inpatient care. Previous work has reported gender differences in diagnosis and treatment in ED settings.1 However, little is known about gender differences in patient experience in the ED, though such differences are reported in other settings. Among patients discharged from acute care hospitals, women reported worse experiences than men on nine out of ten measures;2 in a study of Medicare Advantage enrollees, women reported better experiences than men on measures involving interactions with administrative staff and timely access to care, but worse experiences than men on getting needed care.3

Potential gender differences in ED patient experiences would run counter to recent calls for health equity. Such differences are also important given evidence that better patient experience is associated with better outcomes and better adherence to treatment recommendations.4 We used data from a nationwide study of ED patients to examine gender differences in patient-reported experiences with ED care.

METHODS

We analyzed survey data from a nationwide administration of the Emergency Department Patient Experience of Care Discharged to Community survey (which became the ED CAHPS® Survey in March 2020) for ED patients discharged home between January and March 2016. Details regarding the survey instrument, study design, sampling, and item scoring are available elsewhere.5,6 Our analytic sample included 3122 eligible survey respondents from 50 hospitals. Gender was characterized as male vs. female and obtained from hospital administrative data. We analyzed eight patient experience measures scored to reflect the percentage of respondents who selected the most positive response option.6

We first compared respondent characteristics by gender. Next, we examined ED patient experience by gender using multivariate linear regression models predicting patient experience scores from gender; models were adjusted for mode of survey administration and respondent characteristics known to be associated with patients’ survey responses (see Table 2).6 Lastly, we added interactions to investigate whether gender differences in patient experience varied by age or the urgency of the condition (captured by patient-reported reason for ED visit and patient-reported importance of getting timely care).

RESULTS

Compared to men, women were younger, less likely to have arrived by ambulance, less often in excellent mental health, and more often had a usual source of care (Table 1). Women reported significantly worse experiences than men for five measures (Table 2): getting timely care (67.0% of women selected the “top-box” (most positive) response vs. 71.4% of men, p<0.001); whether doctors and nurses provided sufficient information about test results (68.2% women vs. 72.6% men, p<0.05); whether someone asked at discharge if they would be able to get follow-up care if needed (77.3% women vs. 81.4% men, p<0.05); and whether they got care within 30 minutes of getting to the emergency room (77.9% women vs. 81.0% men, p<0.05). Men did not report significantly worse experiences than women on any measures. These differences did not vary by urgency of condition or age.

Table 1 Respondent Characteristics By Gender
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Table 2 Emergency Department Patient Experience of Care Top-Box Scores by Gender
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DISCUSSION

To our knowledge, this is the first study to examine gender differences in ED experiences among patients with diverse medical conditions. These medium-to-large gender differences are larger and less positive for women compared with gender differences observed in inpatient settings 2 and gender differences identified for measures of “getting needed care” among Medicare beneficiaries.3

ED encounters are brief and sometimes chaotic, with health care providers the patient may have not met before and may not see again. Thus, interpersonal dynamics during ED encounters are fundamentally different than in other care settings, making it critical to be mindful of systematic differences in providers’ communications and decision-making. Training to increase awareness of implicit biases and differences in communication styles can support providers’ ability to communicate effectively with both men and women in ED settings.

Although men and women do not differ in their overall ratings of ED care, there are important and meaningful gender differences in reported experiences, particularly with respect to communication between patients and providers and ED staff responsiveness that should be addressed. Increased focus on women’s experience of care in the ED has the potential to improve ED care for all patients. Gender disparities in health care damage patient-physician relationships, and ultimately patient outcomes. Increased health equity is essential to high-value patient-centered care.