Emergency Department Overcrowding Lowers Patient Satisfaction Scores

Orthopaedic trauma patients' experiences with emergency department care and follow-up through Virtual Fracture Care review: a qualitative study

OBJECTIVES

This study aimed to identify factors influencing orthopaedic trauma patients' experiences and satisfaction with emergency department (ED) care and follow-up through Virtual Fracture Care (VFC) review workflow.

DESIGN

This study employed an explorative, descriptive, qualitative design using individual, semistructured interviews.

SETTING

An urban level 2 trauma centre and teaching hospital in Amsterdam, the Netherlands.

PARTICIPANTS

Eligible patients were Dutch-speaking or English-speaking orthopaedic trauma patients, aged 18 years or above, who visited the hospital's ED between June and September 2022, and were treated through VFC review workflow. Exclusion criteria were: reason for follow-up other than injury, eye/motor/verbal score <15 at ED admission, follow-up treatment in another hospital, treatment initiated in another hospital, acute hospital admission (<24 hours). Twenty-three patients were invited for participation, of whom 15 participated and were interviewed.

RESULTS

Several influential factors contributed to seven generic themes: (1) waiting times, (2) information provision, (3) healthcare professional communication, (4) care expectations, (5) care coordination, (6) care environment and (7) patient condition. Overall, participants were satisfied with received care. Interpersonal skills of healthcare professionals, and timing and content of provided information were specifically valued. Additionally, patients stated that their needs in the ED differed from those after ED discharge, and appreciated the way the VFC review workflow addressed this. Points of improvement included more active involvement of patients in the care process and prevention of inconsistent instructions by different healthcare professionals.

CONCLUSIONS

Patient experiences with ED care and VFC review follow-up are influenced by factors categorised into seven themes. The VFC review workflow effectively addresses these factors, leading to positive feedback. Recommendations for healthcare professionals include anticipating evolving post-ED information needs, engaging patients early to provide clarity about the care process, involving them in treatment decisions and expanding information provision across the entire care pathway.

Overcrowding analysis in emergency department through indexes: a single center study

Introduction

Overcrowding in the Emergency Department (ED) is one of the major issues that must be addressed in order to improve the services provided in emergency circumstances and to optimize their quality. As a result, in order to help the patients and professionals engaged, hospital organizations must implement remedial and preventative measures. Overcrowding has a number of consequences, including inadequate treatment and longer hospital stays; as a result, mortality and the average duration of stay in critical care units both rise. In the literature, a number of indicators have been used to measure ED congestion. EDWIN, NEDOCS and READI scales are considered the most efficient ones, each of which is based on different parameters regarding the patient management in the ED.

Methods

In this work, EDWIN Index and NEDOCS Index have been calculated every hour for a month period from February 9th to March 9th, 2020 and for a month period from March 10th to April 9th, 2020. The choice of the period is related to the date of the establishment of the lockdown in Italy due to the spread of Coronavirus; in fact on 9 March 2020 the Italian government issued the first decree regarding the urgent provisions in relation to the COVID-19 emergency. Besides, the Pearson correlation coefficient has been used to evaluate how much the EDWIN and NEDOCS indexes are linearly dependent.

Results

EDWIN index follows a trend consistent with the situation of the first lockdown period in Italy, defined by extreme limitations imposed by Covid-19 pandemic. The 8:00–20:00 time frame was the most congested, with peak values between 8:00 and 12:00. on the contrary, in NEDOCS index doesn’t show a trend similar to the EDWIN one, resulting less reliable. The Pearson correlation coefficient between the two scales is 0,317.

Conclusion

In this study, the EDWIN Index and the NEDOCS Index were compared and correlated in order to assess their efficacy, applying them to the case study of the Emergency Department of “San Giovanni di Dio e Ruggi d’Aragona” University Hospital during the Covid-19 pandemic. The EDWIN scale turned out to be the most realistic model in relation to the actual crowding of the ED subject of our study. Besides, the two scales didn’t show a significant correlation value.

Emergency Nursing-Care Patient Satisfaction Scale (Enpss): Development and Validation of a Patient Satisfaction Scale with Emergency Room Nursing

This study aimed to develop and validate an emergency nursing-care patient satisfaction scale to measure patient satisfaction with emergency room (ER) nursing. Patient satisfaction scales for ER nursing have been validated without considering the perspectives of the healthcare system or cultural background of the country. Moreover, although nursing care is changing with COVID-19, no scale has been specifically designed to assess patient satisfaction with ER nursing. The study population included patients who visited five ERs in Japan (March to December 2021) (n = 135). The rating scales were provided to patients who visited the ER and gave consent, and the patients were asked to reply. In the process of validating the scale, exploratory and confirmatory factor analyses of the construct and criterion validity were conducted. The confirmatory factor analysis results showed a factorial structure consisting of four factors. The domain and summary scores demonstrated good-to-excellent internal reliability (Cronbach’s range = 0.81–0.89). This patient satisfaction scale was designed and validated from the perspective of the Japanese healthcare system and cultural backgrounds. This scale may be useful for developing assessments and interventions to improve patient satisfaction with ER nursing.

Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room-An interview study with registered nurses

Aim

To explore how registered nurses in the emergency room describe their work approach and prerequisites for meeting life‐threateningly ill patients' care needs from the perspective of a person‐centred fundamental care framework.

Design

A descriptive, qualitative interview study.

Method

Individual interviews were carried out with 14 registered nurses with experience of working in an emergency room in Sweden, during 2019. Data were analysed using thematic analysis, according to Braun and Clarke. The COREQ checklist was used for reporting the findings.

Results

Three themes were identified: Task‐oriented nursing care based on structured guidelines and checklists; Fundamental care not being promoted or prioritized in the emergency room; and The organization and responsibilities for providing person‐centred fundamental care are unclear. Results showed that registered nurses structure their work approach based on prevailing organizational prerequisites as well as personal ones. Meeting patients' fundamental care needs was not always prioritized; their physical needs were met to a greater extent than their relational and psychosocial needs. Registered nurses did not prioritize fundamental care when the organization did not.

Conclusion

From the registered nurses' perspective, they structured their work based on the prevailing conditions for meeting patients' fundamental care needs. The organizational structure does not clearly state that fundamental care should be performed in the emergency room, and the registered nurses' work approach there for meeting patients' fundamental care needs is not adapted to provide patients with person‐centred care.

Impact

To date, little is known about registered nurses' work approach and prerequisites in meeting life‐threateningly ill patients' fundamental care needs in the emergency room. Our findings indicate that the organizational structure is pivotal in supporting registered nurses to provide person‐centred fundamental care. The knowledge from this study can be used in emergency care settings to facilitate person‐centred fundamental care and thereby avoid fundamental care being missed.

Machine Learning and Precision Medicine in Emergency Medicine: The Basics

As machine learning (ML) and precision medicine become more readily available and used in practice, emergency physicians must understand the potential advantages and limitations of the technology. This narrative review focuses on the key components of machine learning, artificial intelligence, and precision medicine in emergency medicine (EM). Based on the content expertise, we identified articles from EM literature. The authors provided a narrative summary of each piece of literature. Next, the authors provided an introduction of the concepts of ML, artificial intelligence as an extension of ML, and precision medicine. This was followed by concrete examples of their applications in practice and research. Subsequently, we shared our thoughts on how to consume the existing research in these subjects and conduct high-quality research for academic emergency medicine. We foresee that the EM community will continue to adapt machine learning, artificial intelligence, and precision medicine in research and practice. We described several key components using our expertise.

What can COVID-19 teach us about patient satisfaction in the emergency department? A mixed-methods approach

OBJECTIVE

The current study explored improved patient satisfaction scores at a single emergency department (ED) during the early phase of the COVID-19 pandemic (March to May 2020).

METHODS

A mixed-methods design, integrating qualitative and quantitative data analyses, was employed to explore a total of 289 patient satisfaction survey ratings and 421 comments based on care that took place in the ED during the initial phase of the COVID-19 epidemic. This allowed for comparisons to a more typical time period in the ED along with the emergence of novel categories of influence.

RESULTS

The ED census was 31% lower during 2020 (COVID-19) than the previous year, and a significantly greater percentage of patients in 2020 indicated that they would "definitely recommend" the ED compared with 2019. Wait time was mentioned in >40% of dissatisfied patient comments in 2019 but <20% of dissatisfied patient comments in 2020. General negative comments were proportionately greater than general positive comments in 2019, whereas in 2020 the reverse pattern held. Other categories did not differ significantly across 2019 and 2020.

CONCLUSIONS

The general circumstances surrounding the early stages of the COVID-19 pandemic included a lower census in the ED and higher reported satisfaction among patients. A comparison of the content of patient comments revealed less concern about wait times and a more positive overall view toward receiving care during the first 3 months of the pandemic.