scholarly journals P072: Exploring definitions of “unnecessary care” in emergency medicine: a qualitative analysis of physician survey responses

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S102-S103
Author(s):  
L. Krebs ◽  
L. Gaudet ◽  
L.B. Chartier ◽  
B.R. Holroyd ◽  
S. Dowling ◽  
...  
Keyword(s):  
Qualitative Analysis ◽  
System Level ◽  
Free Text ◽  
Emergency Physicians ◽  
System Failures ◽  
Canadian Association ◽  
Urgent Patient ◽  
Definition Of ◽  
Evidenced Based ◽  
Survey Responses

Introduction: Recently, campaigns placing considerable emphasis on improving emergency department (ED) care by reducing unnecessary tests, treatments, and/or procedures have been initiated. This study explored how Canadian emergency physicians (EPs) conceptualize unnecessary care in the ED. Methods: An online 60-question survey was distributed to EP-members of the Canadian Association of Emergency Physicians (CAEP) with valid emails. The survey explored respondents awareness/support for initiatives to improve ED care (i.e., reduce unnecessary tests, treatments and/or procedures) and asked respondents to define “unnecessary care” in the ED. Thematic qualitative analysis was performed on these responses to identify key themes and sub-themes and explore variation among EPs definitions of unnecessary care. Results: A total of 324 surveys were completed (response rate: 18%); 300 provided free-text definitions of unnecessary care. Most commonly, unnecessary ED care was defined as: 1) performing tests, treatments, procedures, and/or consults that were not indicated or potentially harmful (n=169) and/or 2) care that should have been provided within a non-emergent context for a non-urgent patient (n=143). Emergency physicians highlighted the role of system-level factors and system failures that result in ED presentations as definitions of unnecessary care (n=69). They also noted a distinction between providing necessary care for a non-urgent patient and performing inappropriate/non-evidenced based care. Finally, a tension emerged in their description of frustration with patient expectations (n=17) and/or non-ED referrals (n=24) for specific tests, treatments, and/or procedures. These frustrations were juxtaposed by participants who asserted that “in a patient-centred care environment, no care is unnecessary” (Participant 50; n=12). Conclusion: Variation in the definition of unnecessary ED care is evident among EPs and illustrates that EPs’ conceptualization of unnecessary care is more nuanced than current campaigns addressing ED care improvements represent. This may contribute to a perceived lack of uptake or support for these initiatives. Further exploring EPs perceptions of these campaigns has the potential to improve EP engagement and influence the language utilized by these programs.

scholarly journals What are emergency-sensitive conditions? A survey of Canadian emergency physicians and nurses

CJEM ◽  
2015 ◽  
Vol 17 (2) ◽  
pp. 154-160 ◽  
Author(s):  
Simon Berthelot ◽  
Eddy S. Lang ◽  
Hude Quan ◽  
Henry T. Stelfox
Keyword(s):  
International Classification Of Diseases ◽  
Face Validity ◽  
Professional Status ◽  
Standardized Mortality Ratio ◽  
Free Text ◽  
Care Providers ◽  
Emergency Physicians ◽  
Emergency Nurses ◽  
Canadian Association ◽  
Sensitive Conditions

AbstractObjective: In a previous study, we assembled a multidisciplinary Canadian panel and identified 37 International Classification of Diseases-10-Canada Diagnosis Groups (DGs) for which emergency department (ED) management may potentially reduce mortality (emergency-sensitive conditions). Before using these 37 DGs to calculate a hospital standardized mortality ratio (HSMR) specific to emergency care, we aimed to test their face validity with ED care providers.Methods: We conducted a self-administered web survey among Canadian emergency physicians and nurses between November 22 and December 31, 2012. All members (N=2,507) of the Canadian Association of Emergency Physicians and the National Emergency Nurses Association were surveyed. They were asked to agree or disagree (binary response) with the panel classification for each of the 37 DG emergency-sensitive conditions identified and provide free text responses to identify missing entities.Results: A total of 719 ED providers (719 of 2,507, 29%) completed the survey, of whom 470 were physicians (470 of 1,407, 33%) and 232 were nurses (232 of 1,100, 21%). Information on professional status was not provided for 17 respondents. Of 37 DGs, 32 (e.g., A41 sepsis) were rated by more than 80% of respondents to be emergency-sensitive conditions. The remaining five DGs (e.g., E11 type 2 diabetes mellitus) were rated by 68.5 to 79.7% of the respondents to be emergency-sensitive conditions. Respondents suggested an additional 31 emergency-sensitive diagnoses.Conclusion: We identified 37 emergency-sensitive DGs that had high face validity with emergency physicians and nurses, which will enable the calculation of an ED-HSMR.

Women's unmet needs in early labour: Qualitative analysis of free-text survey responses in the M@NGO trial of caseload midwifery

Midwifery ◽  
2020 ◽  
Vol 88 ◽  
pp. 102751
Author(s):  
Jyai Allen ◽  
Bec Jenkinson ◽  
Sally K. Tracy ◽  
Donna L. Hartz ◽  
Mark Tracy ◽  
...  
Keyword(s):  
Qualitative Analysis ◽  
Unmet Needs ◽  
Free Text ◽  
Early Labour ◽  
Caseload Midwifery ◽  
Survey Responses

SELF ASSESSMENT TO KNOW UNDERSTANDING MATHEMATIC CONCEPT

2018 ◽  
Vol 3 (1) ◽  
pp. 14-21
Author(s):  
Deni Iriyadi
Keyword(s):  
Qualitative Study ◽  
Qualitative Analysis ◽  
Resolution Limit ◽  
Self Assessment ◽  
Limit Concept ◽  
Research Instrument ◽  
Definition Of ◽  
The Right

This research is a qualitative study aimed to determine the students' understanding of the concept of matter limit. The subjects were students of class XI IPA 1 SMA Negeri 1 Watampone. The concept includes the definition of the limit. Data obtained using a research instrument in the form of self-assessment and then proceed with the interview subjects were selected based on the results of self-assessment has been done before. Analysis using qualitative analysis of students' understanding of the concept of the limit concept. The results of this study indicate that students' understanding of concepts some of which are not / do not understand especially regarding definitions limit. In addition students are also wrong about the resolution limit. Students who understand the concept of limit dinyakatakan them restate concepts, including examples and classify the sample to non-completion of function and limit the right results.

Minority Presidents in a Coalitional World

2018 ◽  
Author(s):  
Paul Chaisty ◽  
Nic Cheeseman ◽  
Timothy J. Power
Keyword(s):  
Coalition Formation ◽  
Cost Minimization ◽  
Analytical Framework ◽  
System Level ◽  
Current State ◽  
Key Concepts ◽  
Definition Of

This chapter summarizes the main parameters of coalitional presidentialism and the key concepts, definitions, explanatory frameworks, indicators, and propositions. It summarizes our understanding of coalitional presidentialism; the distinction between coalition formation and maintenance; the definition of coalitions; the multidimensional understanding of coalition management (the ‘presidential toolbox’); and an analytical framework that emphasizes the motivation of presidents to achieve cost minimization under constraints determined by system-level, coalition-level, and conjunctural factors. It also summarizes our main empirical findings: (1) the characteristics of presidential tools, (2) the substantive patterns of their deployment, (3) the factors that shape the costs of using these tools, (4) the actual (observed) costs of using them, and (5) the potential for imperfect substitutability of these tools. Finally, it concludes with some reflections on the current state of the research on comparative presidentialism.

scholarly journals Patient Suggestions to Improve Emergency Physician Empathy and Communication

2021 ◽  
Vol 8 ◽  
pp. 237437352199698
Author(s):  
Sophia Aguirre ◽  
Kristen M Jogerst ◽  
Zachary Ginsberg ◽  
Sandeep Voleti ◽  
Puneet Bhullar ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Emergency Physician ◽  
Active Listening ◽  
Patient Relationship ◽  
Emergency Physicians ◽  
Future Improvement ◽  
Survey Responses ◽  
Physician Empathy

Emergency physician empathy and communication is increasingly important and influences patient satisfaction. This study investigated if there is a need for improvement in provider empathy and communication in our emergency department and what areas could be targeted for future improvement. Patients cared for by emergency physicians with the lowest satisfaction scores were surveyed within 1 week of discharge. Patients rated their emergency provider’s empathy and communication and provided feedback on the patient–provider interaction. Compared to survey responses nationally, our providers fell between the 10th and 25th percentiles for all questions, except question 5 (making a plan of action with [the patient]) which was between the 5th and 10th percentile. Areas most frequently cited for improvement were “wanting to know why” (N = 30), “time is short” (N = 15), and “listen to the patient” (N = 13). Survey percentiles and open-ended suggestions demonstrate a need for providers to give thorough explanations, spend more time with the patient, and demonstrate active listening. These themes can be used to strengthen the provider–patient relationship.

scholarly journals Advancing UK Regulatory Science Strategy in the Context of Global Regulation: a Stakeholder Survey

2021 ◽  
Author(s):  
Samantha Cruz Rivera ◽  
Barbara Torlinska ◽  
Eliot Marston ◽  
Alastair K. Denniston ◽  
Kathy Oliver ◽  
...  
Keyword(s):  
Pay For Performance ◽  
Regulatory Science ◽  
International Strategy ◽  
Free Text ◽  
The European Union ◽  
Accurate Definition ◽  
Definition Of ◽  
Healthcare Innovation ◽  
The Uk ◽  
Medium Enterprises

Abstract Background The UK’s transition from the European Union creates both an urgent need and key opportunity for the UK and its global collaborators to consider new approaches to the regulation of emerging technologies, underpinned by regulatory science. This survey aimed to identify the most accurate definition of regulatory science, to define strategic areas of the regulation of healthcare innovation which can be informed through regulatory science and to explore the training and infrastructure needed to advance UK and international regulatory science. Methods A survey was distributed to UK healthcare professionals, academics, patients, health technology assessment agencies, ethicists and trade associations, as well as international regulators, pharmaceutical companies and small or medium enterprises which have expertise in regulatory science and in developing or applying regulation in healthcare. Subsequently, a descriptive quantitative analyses of survey results and directed thematic analysis of free-text comments were applied. Results Priority areas for UK regulatory science identified by 145 participants included the following: flexibility: the capability of regulations to adapt to novel products and target patient outcomes; co-development: collaboration across sectors, e.g. patients, manufacturers, regulators, and educators working together to develop appropriate training for novel product deployment; responsiveness: the preparation of frameworks which enable timely innovation required by emerging events; speed: the rate at which new products can reach the market; reimbursement: developing effective tools to track and evaluate outcomes for “pay for performance” products; and education and professional development. Conclusions The UK has a time-critical opportunity to establish its national and international strategy for regulatory science leadership by harnessing broader academic input, developing strategic cross-sector collaborations, incorporating patients’ experiences and perspectives, and investing in a skilled workforce.

Knowledge needs in the non-profit sector: an evidence-based model of organizational practices

2016 ◽  
Vol 20 (1) ◽  
pp. 23-48 ◽  
Author(s):  
Dinesh Rathi ◽  
Lisa M. Given ◽  
Eric Forcier
Keyword(s):  
Quantitative Data ◽  
Qualitative Data ◽  
Free Text ◽  
Evidence Based ◽  
Theory Approach ◽  
Organizational Practices ◽  
Content Type ◽  
Non Profit ◽  
Types Of Knowledge ◽  
Survey Responses

Purpose – This paper aims to present findings from a study of non-profit organizations (NPOs), including a model of knowledge needs that can be applied by practitioners and scholars to further develop the NPO sector. Design/methodology/approach – A survey was conducted with NPOs operating in Canada and Australia. An analysis of survey responses identified the different types of knowledge essential for each organization. Respondents identified the importance of three pre-determined themes (quantitative data) related to knowledge needs, as well as a fourth option, which was a free text box (qualitative data). The quantitative and qualitative data were analyzed using descriptive statistical analyses and a grounded theory approach, respectively. Findings – Analysis of the quantitative data indicates that NPOs ' needs are comparable in both countries. Analysis of qualitative data identified five major categories and multiple sub-categories representing the types of knowledge needs of NPOs. Major categories are knowledge about management and organizational practices, knowledge about resources, community knowledge, sectoral knowledge and situated knowledge. The paper discusses the results using semantic proximity and presents an emergent, evidence-based knowledge management (KM)-NPO model. Originality/value – The findings contribute to the growing body of literature in the KM domain, and in the understudied research domain related to the knowledge needs and experiences of NPOs. NPOs will find the identified categories and sub-categories useful to undertake KM initiatives within their individual organizations. The study is also unique, as it includes data from two countries, Canada and Australia.

scholarly journals Emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments

CJEM ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Lauren Lacroix ◽  
Lisa Thurgur ◽  
Aaron M. Orkin ◽  
Jeffrey J. Perry ◽  
Ian G. Stiell
Keyword(s):  
At Risk ◽  
Perceived Barriers ◽  
Face Validity ◽  
Opioid Overdose ◽  
Emergency Physicians ◽  
Web Based ◽  
Health Crisis ◽  
Canadian Association ◽  
National Public Health

AbstractObjectivesRates of opioid-related deaths have reached the level of national public health crisis in Canada. Community-based opioid overdose education and naloxone distribution (OEND) programs distribute naloxone to people at risk, and the emergency department (ED) may be an underutilized setting to deliver naloxone to these people. The goal of this study was to identify Canadian emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs.MethodsThis was an anonymous Web-based survey of members of the Canadian Association of Emergency Physicians. Survey questions were developed by the research team and piloted for face validity and clarity. Two reminder emails were sent to non-responders at 2-week intervals. Respondent demographics were collected, and Likert scales were used to assess attitudes and barriers to the prescription of naloxone from the ED.ResultsA total of 459 physicians responded. The majority of respondents were male (64%), worked in urban tertiary centres (58.3%), and lived in Ontario (50.6%). Overall, attitudes to OEND were strongly positive; 86% identified a willingness to prescribe naloxone from the ED. Perceived barriers included support for patient education (57%), access to follow-up (44%), and inadequate time (37%). In addition to people at risk of overdose, 77% of respondents identified that friends and family members may also benefit.ConclusionsCanadian emergency physicians are willing to distribute take-home naloxone, but thoughtful systems are required to facilitate opioid OEND implementation. These data will inform the development of these programs, with emphasis on multidisciplinary training and education.

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