Intravenous tissue plasminogen activator (tPA) is a mainstay of therapy in acute ischemic stroke but transient neurologic changes related to reperfusion have not been well described. One of the ...authors (ISN) experienced a cardioembolic stroke due to apical hypertrophic cardiomyopathy with a left ventricular apical aneurysm. He received tPA and we describe his unusual cognitive symptoms during the infusion. The patient's presenting neurologic deficit improved with tPA, suggesting reperfusion. His subsequent restlessness, disorientation, and déjà vu lasted about 10 minutes and resolved spontaneously. Imaging studies confirmed an ischemic infarction in the left posterior cerebral artery (PCA) distribution. Cardiac events, including arrhythmias related to coronary reperfusion after myocardial infarction, are well described. Neurologic events due to reperfusion have not been previously described in patients with stroke. We describe a case of transient neurologic symptoms during revascularization of an embolic stroke.
Patient satisfaction surveys are an increasingly important part of health care, influencing the practice of physicians. Press Ganey has developed tools to assess physician and department performance ...that are used by 50 percent of hospitals in the United States and over 10,000 health care organizations. The authors sought to evaluate the factors that influence patient satisfaction in plastic surgery patients both locally and nationally.
A 24-item Press Ganey survey was distributed to patients of 686 participating plastic surgeons nationwide, including those at the authors' home institution. The responses from January to December of 2016 were analyzed retrospectively with Pearson correlation coefficients. The items "likelihood to recommend provider" and "likelihood to recommend practice" were correlated to all other items of the survey, as these items have been shown to be surrogates for overall satisfaction.
There were 411 survey responses from patients in the Northwell Health System and 36,836 responses from patients nationally. Items that were not well correlated (r < 0.5) with "likelihood to recommend practice" or "provider" were items such as wait time and courtesy of registration staff. The items that were best correlated (r > 0.8) with "likelihood to recommend practice" or "provider" were the patient's confidence in the care provider and the provider's concern for questions. All correlations were statistically significant (p < 0.001).
In an evolving patient centric culture, the patient's confidence and trust of the provider is more important than perception of the provider's office environment to maintaining patient loyalty and market share.
Quality and patient experience are important dimensions of care delivery. The extent to which they are related in the adult outpatient setting is unknown. This brief study utilized data from a large ...integrated health system over a 1-year period in 2015 and measured the degree of correlation between physicians' patient experience scores and 8 standardized quality metrics. These quality measures were paired into similar groups to create 4 composite measures: outcome, screening, vaccination, and adherence. Measures of outcome ( r = 0.20, P = .06), vaccination ( r = 0.12, P = .26), and adherence ( r = -0.04, P = .75) were not significantly correlated with patient experience; screening ( r = 0.29, P = .006) was minimally correlated with patient experience. Overall, this study found minimal correlation between measures of patient experience and clinical quality in the outpatient setting. Measurement of both of these domains is essential to understanding patterns of care.
Improving Quality in Healthcare: Start With the Patient DuPree, Erin; Anderson, Rebecca; Nash, Ira S.
The Mount Sinai journal of medicine,
November/December 2011, 2011 Nov-Dec, 2011-11-00, 20111101, Volume:
78, Issue:
6
Journal Article
In the aftermath of Hurricane Sandy the North Shore LIJ Health System (NS-LIJ HS) organized and launched its first mobile health unit (MHU) operation to some of New York’s hardest hit communities ...including Queens County and Long Island, NY. This document describes the initiation, operational strategies, outcomes and challenges of the NS-LIJ HS community relief effort using a MHU. The operation was divided into four phases: (1) community needs assessment, (2) MHU preparation, (3) staff recruitment and (4) program evaluation and feedback. From November 16th through March 21st, 2013 the Health System launched the MHU over 64 days serving 1,160 individuals with an age range of 3 months to 91 years. Vaccination requests were the most commonly encountered issue, and the most common complaint was upper respiratory illness. The MHU is an effective resource for delivering healthcare to displaced individuals in the aftermath of natural disaster. Future directions include the provision of psychosocial services, evaluating strategies for timely retreat of the unit and methods for effective transitions of care.
Patient Safety: Issues and Advances DuPree, Erin; Nash, Ira S.
The Mount Sinai journal of medicine,
November/December 2011, 2011 Nov-Dec, 2011-11-00, 20111101, Volume:
78, Issue:
6
Journal Article
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