American journal of medical quality : the official journal of the American College of Medical Quality
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The objective of this study was to demonstrate the impact of a single ICD-9 (International Statistical Classification of Diseases and Related Health Problems, Version 9) code on the observed-to-expected mortality ratios for acute care hospitals, calculated using administrative data. The study was a retrospective analysis of mortality data and prospective measurement of the impact of a change in coding on expected mortality rates. ⋯ The main result was that both retrospective and prospective applications of this single ICD-9 code significantly reduced observed-to-expected mortality ratios. Both regulators and hospitals need to be aware of the impact of the quality of coding on publicly reported quality and patient safety data.
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The objective of this article was to explore new intake models for processing patients into the emergency department (ED) and disseminate these new ideas. In the fall of 2008, the Board of Directors of the Emergency Department Benchmarking Alliance (EDBA) identified intake as an area of focus and asked its members to submit new intake strategies alternative to traditional triage. All EDBA members were invited to participate via an e-mail survey. ⋯ These submissions were collated into a document that outlines some of the new models. Collaborative methodology promoted the diffusion of innovation in this organization. The results of the project are presented here as an original article that outlines some of the new and mostly unpublished work occurring to improve the intake process into the ED.
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To characterize safety culture in emergency medical services (EMS), the authors modified a validated safety culture instrument, the Safety Attitudes Questionnaire (SAQ). The pilot instrument was administered to 3 EMS agencies in a large metropolitan area. The authors characterized safety culture across 6 domains: safety climate, teamwork climate, perceptions of management, job satisfaction, working conditions, and stress recognition. ⋯ The results confirm feasibility with a high response rate, acceptable internal consistency, and model fit validity. However, some agencies voiced concerns about respondent burden and the wording and face validity of several EMS-SAQ items. Variation in safety culture scores across EMS agencies within a single geographic area, as well as variation across respondent characteristics, warrants further investigation.
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This clinical review article examines the patient satisfaction literature for the past 20 years. This literature is summarized for qualitative themes and general trends. Intended for the practicing clinician, these themes are then applied to the emergency department (ED) milieu. ⋯ A review of the literature revealed 5 major elements of the ED experience that correlate with patient satisfaction: timeliness of care, empathy, technical competence, information dispensation, and pain management. The literature supporting these 5 elements is summarized and applications to the ED setting are suggested. Other minor correlates with patient satisfaction are also presented.