Tension in the Emergency Department? The Impact of Flow Stage Times on Managing Patient‐Reported Experiences and Financial Productivity

2020 ◽  
Author(s):  
Jeffery S. Smith ◽  
Jeff Shockley ◽  
Sidney Anderson ◽  
Xiaojin (Jim) Liu
Keyword(s):  
Emergency Department ◽  
Patient Reported ◽  
The Impact ◽  
Flow Stage

scholarly journals The Impact of an Emergency Department Front-End Redesign on Patient-Reported Satisfaction Survey Results

2017 ◽  
Vol 18 (6) ◽  
pp. 1068-1074 ◽  
Author(s):  
Michael Repplinger ◽  
Shashank Ravi ◽  
Andrew Lee ◽  
James Svenson ◽  
Brian Sharp ◽  
...  
Keyword(s):  
Emergency Department ◽  
Satisfaction Survey ◽  
Front End ◽  
Patient Reported ◽  
Survey Results ◽  
The Impact

Phase III non-randomized controlled trial of PROMPT-Care, an eHealth intervention utilizing patient reported outcomes in routine clinical care: Impact on emergency department presentations.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6510-6510 ◽  
Author(s):  
Afaf Girgis ◽  
Ivana Durcinoska ◽  
Anthony Arnold ◽  
Nasreen Kaadan ◽  
Andrew Alexis Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Patient Reported Outcomes ◽  
Controlled Trial ◽  
Phase Iii ◽  
Control Group ◽  
Diverse Population ◽  
Patient Reported ◽  
The Impact

6510 Background: The significant impact of routine assessment and clinical utilization of patient-reported outcomes (PRO) on patient and survival outcomes and reduced emergency department (ED) presentations has been demonstrated in specific patient populations (e.g. advanced cancer). This controlled trial evaluated the impact of an eHealth system, PROMPT-Care, on ED presentations in a diverse population of cancer patients from four oncology treatments centers. Methods: All adult patients receiving cancer care (including adjuvant therapy and follow-up) were eligible, excepting those with a diagnosis of a hematological malignancy, insufficient English literacy or no internet access outside of the clinic. Intervention (PROMPT-Care) patients completed monthly online assessments comprising 61 items of distress, common symptoms and unmet needs, with PRO results electronically transferred into the electronic medical record (EMR). In “real-time”, the care team accessed patients’ PRO summary reports to guide their care, an email alert notified nurses of ongoing unresolved issues between visits, and patients received links to support self-management. Control group patients (n = 2,288) comprised the general cancer patient population receiving usual care at the participating cancer therapy centers. Multivariable negative binomial regression was used to compare between-group differences. Results: From April 2016 to March 2018, 345 eligible patients (mean age 62, 58% female, 27% stage IV) participated and were sent at least four assessments within the first six months on trial. On average, control patients had 30 ED presentations and PROMPT-Care patients had 21 ED presentations per 10,000 patient days. After adjusting for age, sex and stage of disease, PROMPT-Care patients had 26% (95% CI 0.2%, 57%) fewer ED presentations compared to the control group (p = 0.0483). Conclusions: The PROMPT-Care intervention resulted in significantly fewer ED presentations in a broad population of cancer patients, including those currently undergoing cancer treatment or are in follow-up, and patients with a wide range of tumor types. The results support its utility as an improved model for ongoing supportive care for a diverse population, with potential healthcare cost savings. Clinical trial information: ACTRN12616000615482.

scholarly journals LO77: Predictors of adverse self-reported 10-day outcomes in emergency department patients with acute ureteral colic

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S34-S34
Author(s):  
G. Innes ◽  
L. Cuthbertson ◽  
F. Scheuermeyer ◽  
J.E. Andruchow ◽  
H. Boyda ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Health Status ◽  
Patient Experience ◽  
Pain Severity ◽  
Composite Measure ◽  
Patient Reported ◽  
Ureteral Colic ◽  
The Impact

Introduction: Our objective is to investigate predictors of adverse patient reported outcomes during the 10 days after an index emergency department (ED) encounter for ureteral colic. Methods: This prospective two-city patient experience survey enrolled ED patients with confirmed 2-10 mm ureteric stones. Researchers telephoned consenting patients 10 days post-ED visit and assessed quality of life (QoL) using survey items from the VR-12 Health Outcome Survey. We used five survey items and three other variables to derive a composite measure of patient adverse experience (AE). The association between patient characteristics, symptoms and perceptions of care with outcome was determined using multiple logistic regression. Results: Of 224 patients studied (68% male, mean age 52 years) 154 (68.8%) indicated that one or more of the following AEs occurred during their 10day followup interval: 103 (46%) reported that the impact of pain on their life was >4/10; 87 (39%) described poor or fair health status; 83 (37%) required >7days for return of normal function; 66 (27.7%) had >2 severe pain episodes per day; 62 (27.7%) required ED revisit or hospitalization; 47 (21%) found usual activities were limited most or all the time; 45 (20%) required >2 opioid doses/day; and 24 (10.7%) lost >7 work days. A composite measure derived from 3 survey items (days to normal, pain impact, health status) captured 92% of patients with adverse experiences. On multivariable logistic regression modeling, the strongest predictors of adverse (composite) outcome were male sex (adjusted OR=0.44; CI, 0.22-0.85), (excellent) quality of physician answers (OR=0.40; CI,0.2-0.77), proximal or mid-ureteric stone (OR=1.9; CI, 1.1-3.5), arrival pain severity (OR=1.18 per unit increase; CI,1.01-1.4), and perceived physician skill (OR=0.81; CI, 0.65-1.0). Patient age, stone size, pain duration, nausea, discharge pain and perceived ED care quality were not independent predictors of 10-day adverse patient experience in multivariate models. Conclusion: Patient sex, quality of physician communication, patient sex, arrival pain severity, and proximal stone location are highly associated with 10-day patient reported AE.

scholarly journals Patient Experience: Living with Cystinuria During the COVID-19 Pandemic

2020 ◽  
Vol 3 (3) ◽  
pp. e7-e12
Author(s):  
Ramandeep Chalokia ◽  
Francesca Kum ◽  
Niamh Foran ◽  
Kay Thomas ◽  
Matthew Bultitude
Keyword(s):  
Emergency Department ◽  
Online Survey ◽  
Future Health ◽  
Work From Home ◽  
The United Kingdom ◽  
Stone Formers ◽  
Patient Reported ◽  
Future Care ◽  
Cystine Stone ◽  
The Impact

Background and ObjectivesCystinuria is a rare genetic cause of recurrent urolithiasis and requires multimodal treatment, and stringent follow up. We wanted to evaluate the fears and concerns of patients with cystinuria during the COVID-19 pandemic. Materials and MethodsAn online survey using Google Forms was emailed to 165 patients with cystinuria who are maintained on a prospective database and had previously consented for email correspondence. ResultsFifty-five responses were received following a single invitation, 23 were men and 32 women with a median age of 43 (range: 18-72) years. Thirty-nine (70.9%) out of 55 were isolating during the COVID-19 pandemic although only 7(12.7%) were given specific advice to shield officially. Six (10.9%) reported having COVID or COVID like symptoms, but none reported having a positive test. Only 9 (16.4%) had been able to work as usual. In comparison, 20 (36.4%) were able to work from home. Ten out of 19 patients (52.6%) on chelating medication described difficulty in access to their medicine, either due to a shortage at the pharmacy or prescription access. Reassuringly 34 (61.8%) patients described no issues with access to any of their cystinuria medications.Twenty-two patients (40%) reported experiencing pain or passing a stone during the COVID-19 pandemic, while 30 (54.5%) reported no problems. Of patients who felt it applicable, 16/31 (51.6%) were worried about attending the Emergency Department during this time. Of patients who had scheduled hospital appointments during this time, 26/44 (59.1%) had experienced cancellations. The majority of the respondents (37 (67.3%)) did not state any difference in the ability to stay hydrated during the lockdown.Twenty-eight (50.9%) were more anxious about their overall health during the pandemic, and 20 (36.4%) had expressed more concern about their kidney stones. ConclusionThis personal fully patient-reported snapshot of the impact of the COVID-19 pandemic on a population of cystine stone formers in the United Kingdom has highlighted additional challenges for patients with a rare disease. The lockdown measures enforced have had a varying effect on patients’ ability to work as normal, access medications, health anxieties, in addition to cancellations of the planned hospital appointments and Emergency Department attendance, which will impact on their future health and pose evolving challenges in delivery of their future care.

Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database

2020 ◽  
Vol 32 (4) ◽  
pp. 523-532 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Mohamad Bydon ◽  
John Knightly ◽  
Mohammed Ali Alvi ◽  
Anshit Goyal ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Acute Care ◽  
Body Mass ◽  
Care Facility ◽  
Older Age ◽  
Quality Outcomes ◽  
Acute Care Facility ◽  
Factors Associated ◽  
Patient Reported ◽  
The Impact

OBJECTIVEDischarge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility.RESULTSOf the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42–62.12] vs 46 [IQR 34.4–58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308–0.708] vs 0.597 [IQR 0.358–0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3–5] vs 2 days [IQR 1–3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79–22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31–3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96–9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1–1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4–10.9, p < 0.001).CONCLUSIONSIn this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

The Impact of COVID-19 on Emergency Department Attendance in a Vulnerable Population - The What, and the Why

2020 ◽  
Author(s):  
Rebecca L. Jessup ◽  
Cassandra Bramston ◽  
Alison Beauchamp ◽  
Anthony Gust ◽  
Natali Cvetanovska ◽  
...  
Keyword(s):  
Emergency Department ◽  
Vulnerable Population ◽  
Emergency Department Attendance ◽  
The Impact

Optimizing electronic capture of patient-reported outcome measures in oncology clinical trials: lessons learned from a qualitative study

2020 ◽  
Vol 9 (17) ◽  
pp. 1195-1204
Author(s):  
Florence D Mowlem ◽  
Brad Sanderson ◽  
Jill V Platko ◽  
Bill Byrom
Keyword(s):  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Lessons Learned ◽  
Structured Interviews ◽  
Patient Reported ◽  
Oncology Clinical Trials ◽  
Anticancer Treatment ◽  
Fit For Purpose ◽  
The Impact ◽  
Electronic Implementation

Aim: To understand the impact of anticancer treatment on oncology patients’ ability to use electronic solutions for completing patient-reported outcomes (ePRO). Materials & methods: Semi-structured interviews were conducted with seven individuals who had experienced a cancer diagnosis and treatment. Results: Participants reported that the following would impact the ability to interact with an ePRO solution: peripheral neuropathy of the hands (4/7), fatigue and/or concentration and memory issues (6/7), where they are in a treatment cycle (5/7). Approaches to improve usability included: larger, well-spaced buttons to deal with finger numbness, the ability to pause a survey and complete at a later point and presenting the recall period with every question to reduce reliance on memory. Conclusion: Symptoms associated with cancers and anticancer treatments can impact the use of technologies. The recommendations for optimizing the electronic implementation of patient-reported outcome instruments in this population provides the potential to improve data quality in oncology trials and places patient needs at the forefront to ensure ‘fit-for-purpose’ solutions.

scholarly journals The Impact of a Concierge Medicine Model on Door to Doctor Time and Patient Flow in an Urban Emergency Department

2020 ◽  
Vol Volume 12 ◽  
pp. 13-18
Author(s):  
Asher L Mandel ◽  
Thomas Bove ◽  
Amisha D Parekh ◽  
Paris Datillo ◽  
Joseph Bove Jr ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
The Impact ◽  
Urban Emergency Department
Sign in / Sign up

Export Citation Format

Share Document