Regulatory Relationships of Demographic, Clinical Characteristics and Quality of Care for Heart Failure Patients in Southern China

Background Quality of care for Chinese patients with heart failure was substandard. It is of utmost value to ascertain the characteristics related to quality of care to narrow the gap. Methods Data from 2,064 heart failure patients between 1 January 2012 and 31 December 2015 at a hospital in Fujian Province were analyzed. Bayesian Network was used to assess the regulatory relationships between demographic, clinical characteristics and compliance with quality indicators. Results The compliance with quality indicators ranged from 42.5% to 90.2%. The compliance with recommended doses for medications all reached or was close to 100% except indapamide. In Bayesian network, residence place, hypertension, troponin, B-type natriuretic peptide, heart rate, lung disease, number of emergency treatment, ejection fraction directly regulated the compliance and gender, age, medical payment method, myocardiopathy, coronary heart disease, arrhythmia had indirectly effect. The lower compliance was found in patients under emergency treatment, patients with abnormal testing indicators, patients without specific comorbidities and patients with NRCMS or self-paying. Patients with lung disease and those who lived in urban area had longer length of stay. Conclusions The compliance with medication indicators for heart failure were suboptimal, but recommended doses were prescribed in patients who received medications. A series of strategies should be developed to improve the quality of care, such as expanding the scope and depth of knowledge of guidelines and clinical pathway, integrating the reminder and quality assessment model into hospital medical record information system, paying more attention to vulnerable population and improving the medical security system.

Interruption of Initial Patient Assessment in the Emergency Department and its Effect on Patient Perception of Care Quality

ABSTRACT Background Triage is a critical first step in appropriately caring for patients in the emergency department. Patients’ assumptions of the care they will receive can be established in triage. Interruptions to this process can disrupt patient flow, cause errors and lead to patient dissatisfaction. The purpose of this study was to determine how the frequency and duration of interruptions during triage are associated with errors, patient satisfaction, and patient’s perception of the care they received. Methods Prospective, observational, cohort study conducted in the emergency department of a Level 1 trauma center. Interruptions were measured using time-and-motion observations of triage interviews performed by nurses and physicians. Patients were surveyed immediately after triage interviews were complete. Results Surveys were completed for 178 observations. 62.9% of the observations were interrupted between 1 and 5 times. While interruptions did not significantly influence patient satisfaction directly, interruptions positively influenced triage duration, which was negatively associated with patient satisfaction. Increased errors were associated with increasing frequency of triage interruptions. Triage interruptions were not associated with either patient satisfaction or perceived caregiver competence. Overall, the majority (76.6%) of patients were satisfied with their care; patient satisfaction was associated with the perceived competency of caregivers but was not associated with errors. Conclusion Interruptions are associated with increased errors and delays in patient care. Although increased triage duration adversely affected patient satisfaction, patients’ perceptions were not influenced by interruptions. While patient satisfaction is essential, the lack of association between patient satisfaction and errors suggests that using patient satisfaction as a measure of care quality may omit important safety information.

Effect of a Waiting Room Communication Strategy on Imaging Rates and Awareness of Public Health Messages for Low Back Pain

Background Few studies have investigated the effects of waiting room communication strategies on healthcare behavior. We aimed to determine the effect of a waiting room communication strategy, designed to raise awareness of potential harms of unnecessary imaging, on lumbar imaging rates in the Emergency Department (ED). Methods We conducted a controlled experimental study with BABA or ‘replicated time series’ design. Design included a 6-week run-in time. Following this there were alternating one-week intervention and control periods. The intervention group received a communication strategy describing the potential harms of unnecessary imaging for low back pain, shown on the same 55” screen as the standard messaging. The communication strategy was designed by a creative innovation agency and included five digital posters and a patient leaflet. The control group received standard messaging for the waiting room at the time, shown on a 55” LCD screen, and the patient leaflet. The primary outcome was the number and proportion of people presenting to ED with low back pain who received at least one lumbar imaging test, measured using routinely collected ED data. Secondary patient-reported outcomes (patient satisfaction, awarenesss of campaign messages) were collected from a sample of people presenting for any condition who responded to a text message-based survey. Results For the imaging outcome, 337 people presenting to ED with low back pain were included over a 4-month period (intervention n= 99; control n= 238). All had available data on lumbar imaging. Use of lumbar imaging was 25% in those exposed to the communication strategy (95% CI= 18% to 35%) compared with 29% in those exposed to the standard waiting room messaging (95% CI= 23% to 35%) (OR= 0.83; 95% CI= 0.49 to 1.41). For the patient-reported outcomes, 349 patients presenting to ED for any condition responded to the survey (intervention n=170; control n=179; response rate =33%). There was uncertain evidence that the intervention increased awareness of the communication strategy leaflet (OR= 2.00, 95% CI= 0.90 to 4.47). Other measures did not suggest between-group differences in patient satisfaction or awareness of the campaign messages. Conclusion A communication strategy displayed in the emergency department waiting room may slightly reduce the proportion of patients with low back pain who receive lumbar imaging; though there is uncertainty due to imprecision. The campaign did not appear to increase awareness of campaign messages or affect patient satisfaction in a sample of patients presenting to the ED for any reason. Larger studies should investigate whether simple, low-cost waiting room communication strategies can raise awareness of unnecessary healthcare and influence healthcare quality. Trial registration : ACTRN12620000300976, 05/03/2020