Assessment of Patient Satisfaction With Inpatient Services Provided at an Acute Care Facility: A Quality Improvement Project

Hospitals across the United States use patient satisfaction surveys to assess the quality of inpatient and outpatient services provided to patients when they interact with the healthcare system. Results from this survey are used as input to identify weaknesses in the system with the intention of providing appropriate intervention. Here, we report the results of the quality improvement project completed in an acute healthcare facility. Patient satisfaction was evaluated based on indices established by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Responses from 400 patients admitted into the hospital between July 2022 and June 2023 were obtained using a pre-designed questionnaire prepared by HCAHPS on behalf of Prime Healthcare Services. Indices of assessment include doctor-patient interaction, nurse-patient interaction, hospital responsiveness to patient needs, hospital environment, communication about medicine, discharge information, transition of care, overall assessment, and willingness to recommend. The best hospital performance was seen in the dissemination of discharge information, while the worst performance was noted in the transition of care and communication about medicine. Appropriate recommendations were made to improve on these weak areas.

Subacute Appendicular Abscess Masquerading as Neoplasia Causing Large Bowel Obstruction

Acute appendicitis is the most common reason for emergency abdominal surgery worldwide. Nonacute appendicitis variants include recurrent, subacute, and chronic appendicitis. Although these are not considered surgical emergencies, they are frequently overlooked, resulting in complications such as perforation or abscess formation. The presentation of nonacute forms is rare in the modern era because of sophisticated diagnostic modalities and treatment measures. We discuss a rare case of subacute appendicular abscess simulating a neoplasm with large bowel obstruction.

Thrombosis, Septic Emboli, and Multiple Abscesses Triggered by Klebsiella pneumoniae: A Case Report and Review of Literature

Urinary tract infection and pneumonia are common diseases caused by Klebsiella pneumoniae. In rare circumstances, Klebsiella pneumoniae has been associated with abscess formation, thrombosis, septic emboli, and infective endocarditis. We report a 58-year-old woman with a past medical history of uncontrolled diabetes who presented with abdominal pain along with swelling in the left third finger and left calf. Further work-up revealed bilateral renal vein thrombosis, inferior vena cava thrombosis, septic emboli, and perirenal abscess. All cultures were positive for Klebsiella pneumoniae. This patient was aggressively managed with abscess drainage, intravenous antibiotics, and anticoagulation. Diverse thrombotic pathologies associated with Klebsiella pneumoniae pathogen as documented in literature were also discussed.

Devastating Effects of Combined DKA and Acute Pancreatitis in Select Patients: Two Cases

Most cases of acute pancreatitis are routinely managed in the hospital without complications. However, management could become very complicated when patients present with a combination of acute pancreatitis and diabetic ketoacidosis (DKA). In fact, triad of acute pancreatitis, DKA, and hypertriglyceridemia in patients could result into systemic complications which may lead to fatal consequences. We report 2 cases in which patients presented with acute pancreatitis and DKA. Clinical course was complicated for both cases. While one of the patients expired, the other patient could not be extubated. This combination must be avoided at all costs because the clinical outcome for affected patients is difficult to predict.

Thromboembolism Triggered by a Combination of Electronic Cigarettes and Oral Contraceptives: A Case Report and Review of Literature

Genetic predisposition, oral contraceptive (OCP) use, tobacco smoking, cancers, and trauma are well-known triggers for hypercoagulability and thromboembolism. Multiple reports have been published on the health risk of combining OCP and traditional cigarettes smoking in the context of thromboembolism. However, limited information is available on the health consequences of combining OCP use with electronic cigarettes. Here, we report a case of a young female patient with a past medical history of ovarian cysts and electronic cigarettes use who came into the hospital with a complaint of "recurrent seizures" and tachycardia. This patient was subsequently diagnosed with bilateral pulmonary emboli, subacute cerebrovascular accident (CVA), and possible patent foramen ovale. Therapeutic Lovenox was initiated. Reasons to educate young females on the risks of combining OCP and electronic cigarettes use were explained.