Determinants of Patient Satisfaction with an Emergency Department Observation Unit

Introduction

Patient satisfaction is a measure of healthcare quality. The aim of this study was to determine the factors affecting patient satisfaction in an emergency department (ED) multipurpose observation unit (OU) and developing strategies that will improve patient satisfaction.

Methods

In this cross-sectional study adult patients who were observed in and discharged from an OU were recruited voluntarily to complete the questionnaire over a one-year period. The global indices of satisfaction – overall satisfaction with care and willingness to return to the same OU – served as the dependent variables and were assessed on a 5-point Likert scale.

Results

Three hundred patients completed the questionnaire. Their mean age was 46.8±19.8 years, and 187 (62.3%) were female. With the exception of the patient's income, none of the demographic variables was related to the patient's rating of overall satisfaction. Overall satisfaction was significantly related to the doctor's explanation, the nurse's attitude, teamwork, technical quality of care, cleanliness of the unit, and quality of hospital food. In addition, likelihood of the patient's willingness to return was related to the patient's income, quality of hospital food, and overall satisfaction.

Conclusions

Overall satisfaction in the OU is affected by the patient's perception of care rather than demographic variables, it is an important predictor for willingness to return. Improvement in patient communication skills, the process of care and environmental factors in the OU will enhance patient satisfaction and increase the likelihood of their willingness to return.

Computed tomographic pulmonary angiography in the assessment of severity of acute pulmonary embolism and right ventricular dysfunction

BACKGROUND

The distinction between severe pulmonary embolism (PE) and right heart dysfunction is important for predicting patient mortality.

PURPOSE

To identify the role of computed tomographic pulmonary angiography (CTPA) in the assessment of the severity of acute PE and right ventricular dysfunction.

MATERIAL AND METHODS

Eighty-five patients suspected of having PE, as diagnosed by CTPA and scintigraphy, were divided into three groups: hemodynamically unstable PE (HUPE) (n = 20), hemodynamically stable PE (HSPE) (n = 33), and no PE (n = 32). For each patient, obstruction scores, including short-axis diameters of the right ventricle (RV) and left ventricle (LV), main pulmonary artery, and superior vena cava (SVC), were measured. The RV/LV short-axis ratios were calculated. The shapes of the interventricular septum and the reflux of the contrast medium into the inferior vena cava (IVC) were evaluated. The mortality due to PE within a 1-month follow-up period was recorded.

RESULTS

The median CTPA obstruction score (HUPE 64%, HSPE 28%, P < 0.001), median RV/LV short-axis ratio (HUPE 1.4, HSPE 1.0, P < 0.01), median RV diameter (HUPE 55 mm, HSPE 42 mm, P < 0.001), median SVC diameter (HUPE 23 mm, HSPE 19 mm, P < 0.01), interventricular septum convex toward the LV (HUPE 70%, HSPE 18%, P < 0.001), and reflux of the contrast medium into the IVC (HUPE 65%, HSPE 33%, p < 0.05) were significantly different between the HUPE and HSPE groups. With ROC analysis, the CTPA obstruction score and RV/LV short-axis ratio threshold values for the HUPE patients were calculated to be 48% (95% sensitivity, 76% specificity) and 1.1 (85% sensitivity, 76% specificity), respectively. Three patients in the HUPE group died within the first 24 hours. Logistic regression methods revealed only the RV diameter as a significant predictor of death (odds ratio 1.24; 95% CI 1.04-1.48; P = 0.01).

CONCLUSION

This study found that the parameters useful for distinguishing HUPE and HSPE included CTPA obstruction score, RV and SVC diameters, RV/LV short-axis ratio, interventricular septum shape, and reflux into the IVC. RV dilatation may be a significant predictor for mortality.

Comparison of trimethoprim-sulfamethoxazole, cephadroxil and cefprozil as prophylaxis for recurrent urinary tract infections in children

The aim of this study was to compare the efficacy of prophylactic trimethoprim-sulfamethoxazole (TMP/SMZ), cefprozil and cephadroxil treatments in children who have recurrent urinary tract infection, but no urinary tract pathology. After acute urinary tract infections (UTIs) were treated, the patients were divided into 3 groups randomly and TMP/SMZ was given to 21 patients, cephadroxil was given to 25 patients and cefprozil was given to 34 patients for 3 months--one dose at night. All patients were followed for 6 months following prophylaxis. The frequency of symptomatic UTIs among groups during prophylaxis was not statistically different, however the number of symptomatic UTIs in the cephadroxil group was lower than the other groups. Asymptomatic bacteriuria episodes were detected in TMP/SMZ and cefprozil groups, whereas no asymptomatic bacteriuria episodes were seen in the cephadroxil group. The number of patients with symptomatic UTI during the follow-up period was not different between groups, however all the asymptomatic bacteriuria episodes were encountered in the cefprozil group. In conclusion, in this study cephadroxil was found to be slightly superior to TMP/SMZ and cefprozil in preventing asymptomatic bacteriuria episodes and symptomatic UTIs in children with recurrent UTI and normal urinary tract system.