Keep ’em Happy

Nice little post from EM Lit of Note on how to increase patient satisfaction scores. Hint, has nothing to do with quality medical care.

Patient Satisfaction: It’s Door-to-Room Times (Duh)

As customer satisfaction becomes rapidly enshrined as our reimbursement overlord, we are all eager to improve our satisfaction scores.  And, by scores, I mean: Press Ganey.

So, as with all studies attempting to describe patient satisfaction, we unfortunately depend on the validity of the proprietary Press Ganey measurement instrument.  This limitation acknowledged, these authors at Oregon Health and Science University have conducted a single-center study, retrospectively linking survey results with patient characteristics, and statistically evaluating associations using a linear mixed-effects model.  They report three survey elements:  overall experience, wait time before provider, and likelihood to recommend.

Which patients were most pleased with their experience?  Old, white people who didn’t have to wait very long.  Every additional decade in age increased satisfaction, every hour wait decreased satisfaction, and there was a smattering of other mixed effects based on payor source, ethnicity, and perceived length of stay.  What’s interesting about these results – despite the threats to validity and limitations inherent to a retrospective study – is how much the satisfaction outcomes depend upon non-modifiable factors.  You can actually purchase patient experience consulting from Press Ganey, and they’ll come teach you and your nurses a handful of repackaged common-sense tricks – but I’m happy to save your department the money:  door-to-room times.

Or change your client mix.

Done.

“Associations Between Patient and Emergency Department Operational Characteristics and Patient Satisfaction Scores in an Adult Population”
http://www.ncbi.nlm.nih.gov/pubmed/25182541

Golden Hour

Below is the LITFL summary of another look at the importance of early ABx administration in septic patients. Septic and especially severely septic patients should be taken to room 9, obtain blood cultures promptly, and initiate antibiotics as early as possible.

 

Ferrer R et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 2014; 42: 1749-55. PMID: 24717459

  • This retrospective analysis of prospective surviving sepsis data of patients admitted to the ICU with severe sepsis found that delays in antibiotic administration resulted in a concomitant increase in hospital mortality. Though the results are compelling with a linear relationship between time to administration and hospital mortality discovered it is key to interpret this study with caution as the data are uncontrolled for the antibiotic administration to time metric primarily studied by this paper. Multiple potential confounders exist that might account for the observed relationship that should be studied prospectively. In the meantime it makes reasonable sense to administer antibiotics as soon as possible after the actual discovery of real sepsis.  
  • Recommended by: William Paolo

FOAMed

Nice little post from Lauren Westafer, who just finished medical school and is fairly well known amongst FOAMers (FOAMeders?). Reminds us to be tentative about accepting everything we read on the internet.

She apparently gave a SMACC talk which is a pretty big deal. I was linked to her post on the Life in the Fast Lane weekly review, which I consider pretty much the best roundup of FOAMed on the web.

AvR

Hey guys a long but important post from Steve Smith on AvR ST elevation in setting of ACS, STEMI.

His main point in posting is to emphasize the point that STE in AvR is concerning for Left Main Disease, but NOT SPECIFICALLY Left Main OCCLUSION.

This highlights a consistent theme on Smith’s blog which is our role in differentiating the patients who HAVE ACUTE OCCLUSION, ie STEMI or STEMI equivalent. These patients need emergent cath where others might be best treated medically prior to pulling the trigger for cath lab.

 

Acute Cardiogenic Pulmonary Edema

Here is nice summary post by FOAMed guru Anand Swaminathan with evidence-based discussion of the role (or lack thereof) for diuretics in acute pulmonary edema. Trust me it works. See also the first Emcrit podcast on the topic.

Bottom line: minimal role for diuretics in the pulmonary edema patient in extremis. This is not the mildly fluid overloaded patient with normal respiratory status, they can use a little diuresis once BUN/Cr are determined.

Post-Publication Peer Review

For those who have not been introduced to this concept, here is a blog post from Dr Radecki who writes the EM Lit of Note.

Because blog posts are not “peer-reviewed” before they are posted, the quality of a given post could be low. But depending on how many people read the post, the discussion can be lively and constructive.

This is in contrast to formal journal publication, where the peer review is PRE-publication, and discussion may be minimal. We will see a comment or two in an issue a month or two later, sometimes an official comment in the same issue. But the volume and even quality of responses possible with blogs, twitter, etc may surpass that of the official, slow process in the journals.

Scientific American had a nice article about this PPPR concept. As FOAMed and social media continues to expand in medicine, and in other fields, I think we will see more respect for this type of peer-review.

Journal Club May 2014

Journal Club is this coming Thursday, May 22.

Where:
Kashmir Indian Restaurant (Patio!) (Beer + wine!) (I absolutely love this place.)
1285 Bardstown Road
(loads of parking across the street in the Mid City Mall)

When:
7 PM

Email or text me if you will be there.

Attached articles:
1. Hypnosis in the ED
2. Wound management myths
3. Is it actually a spider bite?

2-Wound_Myths-EMCCR

1-Hypnosis_in_the_ED-JEM

3-Is_it_a_Spider_bite-JEM