Postal survey methodology to assess patient satisfaction in a suburban emergency medical services system: an observational study

BACKGROUND Patient satisfaction is of growing importance to providers of emergency medical services (EMS). Prior reports of patient satisfaction have frequently used resource-intensive telephone follow-up to assess satisfaction. We determine the feasibility of using a single mailing, anonymous postal survey methodology for collecting patient satisfaction data from a suburban EMS system. METHODS Patients transported between January 2001 and December 2004 were mailed a brief satisfaction questionnaire. The questionnaire was printed on a pre-addressed, postage paid postcard and consisted of five questions that used a five-point Likert scale to assess satisfaction with EMS personnel and services provided. Three open-ended questions assessed concerns, the most important service provided, and methods for improving service. Survey response rate was the primary outcome of interest. The Chi-square test was used to compare rates between years. RESULTS The survey required about 6 man hours and cost about $70 per month. Overall response rate was 32.0% (857/2764; 95CI 30.3% - 33.9%). During the first year, response rate was 42.6% (95CI 38.5% - 46.8%), but was significantly lower in subsequent years (29.0% in year 2, 30.8% in year 3, and 27.6% in year 4, p < 0.05). There were 847/851 respondents (99.5%) who were satisfied or very satisfied with their EMS experience. Three patients felt the service was adequate and one was very unsatisfied. Open-ended questions suggested that interpersonal communications were the single most important contributor to patient satisfaction. Patients also reported that response times and technical aspects of care were important to them. CONCLUSION Postal surveys for assessing patient satisfaction following EMS transport can achieve comparable response rates to similar surveys in other health care settings. Response rates did not decline after the second year of patient surveys, suggesting some stability after the initial year. Interpersonal communication was determined to be the single most important contributor to patient satisfaction.