Factors influencing patients' experience of communication with the medical team of the emergency department

Patients' Experience with Received Healthcare in Internal Medicine and Surgery Wards of Slovenian Hospitals-A Cross-Sectional Survey

Aim

The aim of the study was to explore the experiences of patients with delivered healthcare in selected Slovenian hospitals.

Methods

A cross-sectional study was employed. A total of 1,748 patients participated. A shortened version of the Consumer Assessment of Healthcare Providers and Systems survey was used. Permission to conduct the study was obtained from the Slovenian Medical Ethics Committee. Data were collected between February and March 2020. Univariate, bivariate and multivariate analyses were conducted.

Results

The average hospital rating was 8.86 (SD=1.47; p<0.001) out of 10. The hospital would be definitely recommended to others by 1,290 (75.7%) respondents. The regression model "patients' experience with care" was explained in 18%, mostly by "patients' general health status" (-0.267), "provision of written and oral information about symptoms or health problems post discharge" (-0.200), and "talking to patients about care post discharge" (-0.175). The model "hospital rate" was explained in 30.4% by "patients' experience with care" (0.576), "new medication was explained" (-0.242) and "patient age" (0.132).

Conclusion

The hospital rates are good and mostly explained by patient experience. The results revealed that tasks connected to comprehensive preparation of patients for healthcare treatment including communication, health education and appropriate discharge are only partially fulfilled. Improvements and holistic data capture are needed to make the measurement of patient experience a greater contribution to the improvement and efficiency of hospital care.

Revision and Application of the Simplified Chinese Version of the Critical Care Family Needs Inventory in the Emergency Department

INTRODUCTION

The family members of patients are an important part of a patient's social support system. The needs of the family members of patients are critical factors that medical staff need to consider when formulating treatment plans. This study aimed to culturally adjust the traditional Chinese version of the Critical Care Family Needs Inventory in the Emergency Department to the simplified Chinese version for use with families in the emergency department of mainland China, test its reliability and validity, understand the needs and factors influencing scores, and to provide a reference for promoting patient and family-centered care.

METHODS

A cross-sectional survey was conducted to collect data from family members of a tertiary hospital in northeast China. This study consisted of 2 phases. Phase Ⅰ: 258 questionnaires were collected in the scale revision phase for the assessment of construct validity using exploratory factor analysis. In addition, internal consistency reliability and content validity were used to evaluate the psychometric characteristics. Phase Ⅱ: 297 family members were recruited in the cross-sectional survey phase. The data were collected through the simplified Chinese version of Critical Care Family Needs Inventory in the Emergency Department and analyzed with SPSS 26.0 Statistics software.

RESULTS

In the scale revision phase of the study, the content validity index was 0.92, and the total Cronbach's alpha coefficient was 0.87. In the cross-sectional survey phase, the mean score of family members' needs was 109.2 ± 9.8 (95%CI 108.1, 110.4). Age (P = .019), residential address (P = .001), income (P = .004), and triage category (P = .001) are independent factors influencing total scores.

DISCUSSION

Our findings suggested that the Simplified Chinese version of Critical Care Family Needs Inventory in the Emergency Department is a valid and reliable scale for use within mainland China. The needs of family members are at a high level. Hence, emergency nurses need to acquire more knowledge about family needs to better consider and address their needs.

Instruments evaluating the duration and pace of clinical encounters: A scoping review

OBJECTIVE

Hurried encounters in clinical settings contribute to dissatisfaction among both patients and clinicians and may indicate and contribute to low-quality care. We sought to identify patient- or clinician-reported instruments concerning this experience of time in clinical encounters.

METHODS

We searched multiple databases from inception through July 2023. Working in duplicate without restrictions by language or clinical context, we identified published instruments or single items measuring perceptions of time adequacy in clinical encounters. We characterized these by time domain (perceived duration or pace of the encounter), responder (patient or clinician), and reference (experience of care in general or of a particular encounter).

RESULTS

Of the 96 instruments found, none focused exclusively on perception of time adequacy in clinical encounters. Nonetheless, these instruments contained 107 time-related items. Of these, 81 items (77 %) measured the perception of the encounter duration, assessing whether there was adequate consultation time overall or for specific tasks (e.g., listening to the patient, exploring psychosocial issues, formulating the care plan). Another 19 (18 %) assessed encounter pace, and 7 (7 %) assessed both duration and pace. Pace items captured actions perceived as rushed or hurried or the perception that patients and clinicians felt pressed for time or rushed. Patients were the respondents for 76 (71 %) and clinicians for 24 (22 %) items. Most patient-reported items (48 of 76) referred to the patient's general care experience.

CONCLUSION

There are existing items to capture patient and clinician perceptions of the duration and/or pace of clinical encounters. Further work should ascertain their ability to identify hurried consultations and to detect the effect of interventions to foster unhurried encounters.

PRACTICE IMPLICATIONS

The available items assessing patient and clinician perceptions of duration and pace can illuminate the experience of time adequacy in clinical encounters as a target for quality improvement interventions. These items may capture unintended consequences on perceived time for care of interventions to improve healthcare access and efficiency.

Determinants of Doctor-Patient Communication in Terms of Patient Rights During the COVID-19 Pandemic

BACKGROUND

Today, the public does not want to be just a passive consumer of health services. Patients often expect to be informed and involved in decisions about their health. With better doctor-patient communication, patients are more likely to follow treatment recommendations.

MATERIAL AND METHODS

The study was conducted using a face-to-face survey method on a group of 203 adult, independent patients from 2021 to 2022 at a medical facility, i.e., a rehabilitation clinic.

OBJECTIVE

The purpose of this study was to assess the determinants of doctor-patient communication in terms of patient rights. One of patients' rights is the right to information about their health condition and treatment methods and the right to ask questions when the doctor does not provide details about the treatment or diagnosis or when it is not understandable. Doctors providing information to the patient and the opportunity for the patient to ask questions are key elements in the process of making informed decisions regarding further medical treatment. Therefore, patients were divided into two groups: active (+) and passive in communication (-) with doctors.

RESULTS

Patients who were active in communication (33%) wanted to ask questions or had the opportunity to ask the doctor questions, and thus, they were able to take an active part in the discussion with the doctor. In contrast, patients who were passive in communication (67%) did not want to ask questions or did not have the opportunity to ask the doctor questions, and therefore, their active participation in the discussion and thus their right to ask questions may have been limited. The authors' survey shows that respondents with active communication were significantly more likely than patients with passive communication (almost 100% vs. 86%) to obtain information about their condition (p = 0.002), diagnostic methods (p = 0.003), therapeutic methods (p = 0.00007), treatment results, and prognosis (p = 0.0008). Moreover, almost all respondents with active communication as opposed to respondents with passive communication (95% vs. 52%) rated communication with doctors highest (on a scale from 0 to 5), including credible and professional approach to patients (p < 0.0001), providing information in clear and simple language (p < 0.0001), answering questions asked by patients (p < 0.0001), openness and kindness (p < 0.0001), maintaining professional confidentiality (p < 0.0001), or emotional support (p < 0.0001).

CONCLUSIONS

Hence, the primary key element of the medical consultation is appropriate amount and content of information given to the patient, providing explanations and answering questions. Also importantly, according to the results, active communication between patients and doctors was significantly influenced by female gender, higher education, and a positive evaluation of communication with doctors.

Validation of a checklist to facilitate serious illness conversations in adult emergency in China: a single-centre pilot study

BACKGROUND

Advances in emergency and critical care have improved outcomes, but gaps in communication and decision-making persist, especially in the emergency department (ED), prompting the development of a checklist to aid in serious illness conversations (SIC) in China.

METHODS

This was a single-centre prospective interventional study on the quality improvement of SIC for life-sustaining treatment (LST). The study recruited patients consecutively for both its observational baseline and interventional stages until its conclusion. Eligible participants were adults over 18 years old admitted to the Emergency Intensive Care Unit (EICU) of a tertiary teaching hospital, possessing full decisional capacity or having a legal proxy. Exclusions were made for pregnant women, patients deceased upon arrival, those who refused participation, and individuals with incomplete data for analysis. First, a two-round Delphi process was organized to identify major elements and generate a standard process through a checklist. Subsequently, the efficacy of SIC in adult patients admitted to the EICU was compared using the Decisional Conflict Scale (DCS) score before (baseline group) and after (intervention group) implementing the checklist.

RESULTS

The study participants presented with the most common comorbidities, such as diabetes, myocardial infarction, cerebrovascular disease, moderate-to-severe renal disease, congestive heart failure, and chronic pulmonary disease. The median Charlson Index did not differ between the baseline and intervention cohorts. The median length of hospital stay was 11.0 days, and 82.9% of patients survived until hospital discharge. The total DCS score was lower in the intervention group than in the baseline group. Three subscales, including the informed, values clarity, and support subscales, demonstrated significant differences between the intervention and baseline groups. Fewer intervention group patients agreed with and changed their minds about cardiopulmonary resuscitation (CPR) compared to the baseline group.

CONCLUSION

The use of a SIC checklist in the EICU reduced the DCS score by increasing medical information disclosure, patient value awareness, and decision-making support.

Asking patients if they have any questions can help improve patient satisfaction with medical team communication in the emergency department

BACKGROUND

It is well known that patient satisfaction with medical communication in the emergency department (ED) improves patient experience. Investing in good communication practices is highly desirable in the emergency setting. In the literature, very few studies offer evidence of effective interventions to achieve this outcome. Aim of the study is to evaluate whether encouraging emergency physicians to ask if patients have questions at the end of the visit would improve patient satisfaction with medical communication.

METHODS

The physicians of two EDs in Lugano, Switzerland, were invited by various methods (mailing, newsletter, memo pens and posters, coloured bracelets etc.) to implement the new practice of asking patients if they had questions before the end of the visit. Patients discharged were consecutively enrolled. Participants completed the modified CAT-T questionnaire rating their satisfaction with medical communication from 1 (very poor) to 5 (excellent). Data such as age, means of arrival, seniority of the physician etc. were also collected. Statistical analysis was performed with Bayesian methodology. The results were compared with those of a similar study conducted one year earlier.

RESULTS

517 patients returned the questionnaire. Overall, patients' satisfaction with communication in the ED was very good and improved from the previous year (percentage of fully satisfied patients: 68% vs. 57%). The result is statistically significant (C: I: 51.8 - 61.3% vs. 63.9 - 71.8% p = 0.000). Younger patients (< 30 ye22ars old) were slightly less satisfied. Waiting time did not affect perception of communication.

CONCLUSION

This study implements a concrete way to improve patients' satisfaction with medical communication in the ED. The intervention targeted only one item of the CAT-T ("Encouraged me to ask questions") but it generated an overall perception of better communication from patients discharged from the ED. The study also confirms that there are some objective elements that can alter perception of quality of medical communication by patients (age, seniority of the physician), in agreement with the literature. In conclusion, focusing physicians' attention on asking patients whether they have questions before discharge helps improving overall patient satisfaction with medical communication in the ED. This may lead to changes in physicians' clinical practice.

Strategies to Measure and Improve Emergency Department Performance: A Review

Emergency Departments (EDs) globally face escalating challenges such as overcrowding, resource limitations, and increased patient demand. This study aims to identify and analyze strategies to enhance the structural performance of EDs, with a focus on reducing overcrowding, optimizing resource allocation, and improving patient outcomes. Through a comprehensive review of the literature and observational studies, the research highlights the effectiveness of various approaches, including triage optimization, dynamic staffing, technological integration, and strategic resource management. Key findings indicate that tailored strategies, such as implementing advanced triage protocols and leveraging telemedicine, can significantly reduce wait times and enhance patient throughput. Furthermore, evidence suggests that dynamic staffing models and the integration of cutting-edge diagnostic tools contribute to operational efficiency and improved quality of care. These strategies, when combined, offer a multifaceted solution to the complex challenges faced by EDs, promising better patient care and satisfaction. The study underscores the need for a comprehensive approach, incorporating both organizational and technological innovations, to address the evolving needs of emergency healthcare.