Emergency department (ED) crowding and patient boarding are associated with increased mortality and decreased patient satisfaction. This study uses a positive deviance methodology to identify ...strategies among high-performing, low-performing, and high-performance improving hospitals to reduce ED crowding.
In this mixed-methods comparative case study, we purposively selected and recruited hospitals that were within the top and bottom 5% of Centers for Medicare & Medicaid Services case-mix-adjusted ED length of stay and boarding times for admitted patients for 2012. We also recruited hospitals that showed the highest performance improvement in metrics between 2012 and 2013. Interviews were conducted with 60 key leaders (physicians, nurses, quality improvement specialists, and administrators).
We engaged 4 high-performing, 4 low-performing, and 4 high-performing improving hospitals, matched on hospital characteristics including geographic designation (urban versus rural), region, hospital occupancy, and ED volume. Across all hospitals, ED crowding was recognized as a hospitalwide issue. The strategies for addressing ED crowding varied widely. No specific interventions were associated with performance in length-of-stay metrics. The presence of 4 organizational domains was associated with hospital performance: executive leadership involvement, hospitalwide coordinated strategies, data-driven management, and performance accountability.
There are organizational characteristics associated with ED decreased length of stay. Specific interventions targeted to reduce ED crowding were more likely to be successfully executed at hospitals with these characteristics. These organizational domains represent identifiable and actionable changes that other hospitals may incorporate to build awareness of ED crowding.
Study objective Our primary aim is to identify patient and emergency department (ED) characteristics that are associated with patient satisfaction scores. Methods This retrospective study reviewed ...Press Ganey patient satisfaction surveys completed between December 2009 and May 2013 in a single academic ED for all patients aged 21 years and older. Patient and ED operational characteristics were included in the analysis. The outcomes were satisfaction scores for overall experience, likelihood to recommend, and wait time before consulting provider. A linear mixed-effects regression model was used while taking the clustering within patients and physicians into account. Results Two thousand eighty-three patients were included in the analysis, representing all responses to the survey. A total response rate could not be calculated because Press Ganey does not report the total number of surveys sent out. During this period, 119,244 patients were treated in the ED. The overall mean score was 7.7 (SD 2.7) for overall experience, 78.0 (SD 31.8) for likelihood to recommend, and 70.9 (SD 30.7) for wait time before consulting provider. For all 3 outcomes, white older patients with low door-to-room times had higher scores. Additionally, survey language and payer type were significantly associated with overall experience score, discharge length of stay and time of day by shift were significantly associated with wait time scores, and patients who arrive by ambulance were less likely to recommend the ED. Conclusion Both ED and patient characteristics were associated with satisfaction with care. EDs seeking to increase patient satisfaction scores may consider working on reducing door-to-room times.
BACKGROUNDEmergency departments (EDs) are seeing an increase in the importance of patient satisfaction scores, yet little is known about their association with patient and operational ...characteristics.
OBJECTIVESThis study aimed to identify patient and operational characteristics associated with patient satisfaction scores.
METHODSThis was a retrospective analysis of data from Press Ganey patient satisfaction surveys of pediatric patients (<18 years) and their families, discharged from the ED of a single, academic, pediatric ED from December 2009 to May 2013. A linear mixed-effects regression model was used to identify significant associations while taking the clustering within patients and physicians into account. Outcome variables included scores for overall experience (0–10), wait time to be seen by a provider (0–100), and likelihood to recommend (0–100). The ED characteristics considered included daily census, proportion of left without being seen, average length of stay (LOS), and total boarding hours, as well as time of day by shift, door-to-room time, and discharge LOS. Patient characteristics included pa tient age, sex, race, person completing survey, survey language, survey method (mailed or online), payer type, mode of arrival, distance to hospital, weekend or weekday visit, and difference of patient-reported LOS to actual LOS. Only statistically significant variables were included in the final model.
RESULTSA total of 810 pediatric surveys were included for analysis. The overall mean (SD) was 8.7 (2.0) for overall experience, 84.0 (23.5) for waiting time to be seen by a provider, and 90.1 (22.2) for likelihood to recommend. The score for overall experience was highly correlated with likelihood to recommend (r = 0.90) and less strongly correlated with score for waiting time (r = 0.58). In the final models, increased door-to-room time was associated with a significant decrease in scores for all 3 outcome variables. In addition, a difference between perceived and actual LOS (>2 hours) was significantly associated with lower scores in overall experience and likelihood to recommend, whereas surveys completed online had higher scores for waiting time to see a provider compared with mailed.
CONCLUSIONSEmergency departments looking to increase satisfaction scores should focus efforts on decreasing door-to-room times.
A research program to discover solubilizing prodrugs of the HCV NS5A inhibitor pibrentasvir (PIB) identified phosphomethyl analog 2 and trimethyl-lock (TML) prodrug 9. The prodrug moiety is attached ...to a benzimidazole nitrogen atom via an oxymethyl linkage to allow for rapid and complete release of the drug for absorption following phosphate removal by intestinal alkaline phosphatase. These prodrugs have good hydrolytic stability properties and improved solubility compared to PIB, both in aqueous buffer (pH 7) and FESSIF (pH 5). TML prodrug 9 provided superior in vivo performance, delivering high plasma concentrations of PIB in PK studies conducted in mice, dogs, and monkeys. The improved dissolution properties of these phosphate prodrugs provide them the potential to simplify drug dosage forms for PIB-containing HCV therapy.
We investigated if increasing the colonoscopy screening interval from 10 to 15 years would increase provider preferences for colonoscopy as a screening test. We further examined whether having ...colonoscopy performed at a 15-year interval by an endoscopist with a high adenoma detection rate would influence preferences.
Colonoscopy is recommended every 10 years in average risk individuals without polyps for colorectal cancer (CRC) screening. The use of a 15-year interval offers substantial protection, increases cost-effectiveness, and might make colonoscopy more attractive to patients and health care providers who order CRC screening tests.
An anonymous online survey of health care providers across a health care system that serves a single US state and encompasses both academic and community physicians was conducted. Physicians and nurse practitioners in family medicine, obstetrics-gynecology, and internal medicine were included. Providers were asked to indicate their preference for CRC screening tests as a proportion of tests they prescribe among 5 common screening tools. Responses were compared for current colonoscopy screening intervals and if the screening intervals are increased to 15 years.
One hundred and twelve (34%) responded of 326 providers. Colonoscopy was the most frequently ordered test for CRC screening. Increasing screening interval from 10 to 15 years increased the choice of colonoscopy from 75.2% to 78.6% ( P =0.003).
Expanding colonoscopy screening interval to 15 years could produce an increase in physicians and nurse practitioners choice of using colonoscopy for CRC screening, but the clinical impact appears minor. Additional surveys of patients and providers are needed.
Tertiary referral centers have created inpatient units to meet the needs of specific patient populations but sometimes are forced to place patients on other units that, although having the basic ...necessary skillsets for treating the patient, are not focused on that diagnosis area. The objective of this study was to look at outcomes of patients admitted to these different inpatient settings.
Retrospective review of patient data from a single tertiary academic medical center from August 1, 2014, to June 30, 2015, comparing patients admitted to primary versus secondary inpatient services. Patients admitted to the inpatient children's hospital, psychiatric hospital, labor and delivery unit, or subacute transitional care unit were excluded.
Demographics of patients in the primary versus secondary units were compared to look for systematic differences between the 2 patient populations. To control for confounding variables, a gamma regression analysis was conducted for length of stay (LOS) and total cost, whereas a logistic regression was conducted for mortality.
Admitting to the primary unit resulted in 5.5% lower observed LOS, controlling for other patient variables, but it came at a 17.8% higher total cost of care provided compared with secondary units. Mortality was also found to be lower on primary units (odds ratio, 0.864) but did not cross the threshold of statistical significance (P = .101).
Patients admitted to the primary unit had a lower LOS with higher costs of care. There was a trend toward improved mortality, although it was not statistically significant.
PDF
