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Here is a nice summary of what we have learned about ED crowding over the past 10 years. There exists quite a bit in the literature for those interested enough to read further. Of course at UL we don’t know much about ED crowding.
Nice little post from EM Lit of Note on how to increase patient satisfaction scores. Hint, has nothing to do with quality medical care.
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
A frightening article about contract management groups and ED / Hospital staffing.
Public health is associated with the least interesting courses of medical school (epidemiology and biostatistics). It has been linked to ED frequent flyers and psych hold patients (social and behavioral health). One might say it’s an integral part of vague clinical decision rules and flip-flopping society guidelines and Press-Ganey scores.
It’s also something us ED docs do every day, whether we want to or not. There’s no reason why we shouldn’t try to understand it and do it better.
Kiran and I have been developing a website dedicated to public health for ED personnel. It’s a FOAMed site. Our plan is to get it tied in with sites like EMCrit, ALiEM, LITFL, and the like. It’s still a very young project, but there’s a couple articles posted for you to glance at.
If anyone is interested in population health, there’s a ton of uncharted territory and we’d welcome the collaboration. Just let us know how you want to be involved. Also, tell your friends.
Hey Guys,
Thought I’d post this as I feel it was a mistake on my part, though fortunately no harm came from it.
50 year old guy this past Saturday (which was a ridiculous shift full of drunks and unhelmeted mopeds and motorcyclists with some very sick people) who was an unhelmeted moped rider going reportedly 60mph and wrecked while drinking alcohol and somehow managed not to make their way to Rm 9.
BP: 125/73. HR: 86. RR: 18. O2 saturation: 91% on room air. Temp: 97.6 F (oral)
A&Ox3, c/o shortness of breath and diffuse chest tenderness. Not really any obvious bad looking signs of trauma and had been log-rolled prior to my eval (triaged about 1hr 45min before I saw him).
I saw him, in no respiratory distress, maybe some expiratory wheezing on my exam, but with breath sounds on both sides and no crepitus that I could feel to his anterior chest. I finish my eval and just order a MAN scan based on his Hx and due to his drinking alcohol (EtOh 292)
Patient is taken to CT at 23:05 (about 2 hrs after I ordered them) and the nurse grabs me after the scan and tells me I need to look at his chest CT (only his C-spine images were up at the time which showed me all kinds of SubQ emphysema).
Just a lesson learned; when it’s super busy like that shift was is when we need to be the most cautious and really think critically about the things we need to do, and not be in a hurry when we’re putting orders in.
The guy is doing well so far (and not intubated) and in THIS case no harm was done, I put a chest tube in without difficulty. But I really should have gotten a CXR to start.
His injuries included Bilateral 1st-6th Rib Fx’s, Pulmonary Contusions, Mediastinal Hematoma, Manubrium Fx, C7 Fx, T4, T7 Fx.
Interesting article by a retired academic physician / “business executive.”