Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Patient satisfaction data as a quality indicator: a tale of two emergency departments.
Patient satisfaction is a commonly measured indicator of quality emergency care. However, the existing empirical literature on emergency department (ED) patient satisfaction provides little guidance on how to analyze, interpret, and use data obtained in the clinical setting. Using two EDs as examples, the authors describe practical strategies designed to identify priority areas for potential improvement. ⋯ A combination of applying explicit acceptability criteria to descriptive statistics and using correlation coefficients with overall satisfaction can help to maximize the usefulness of patient satisfaction data by uncovering priority areas. These priority areas were broken down into maintenance and remediation indicators and were found to vary considerably depending on the hospital in question. Such strategies can help to refine performance improvement efforts by targeting those domains with the greatest impact on overall satisfaction.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Rapid two-stage emergency department intervention for seniors: impact on continuity of care.
A two-stage intervention comprising screening and a brief standardized nursing assessment and referral, for emergency department (ED) patients aged 65 years and over, reduced the rate of functional decline four months after the visit, without increasing societal costs. In this study, the authors investigated the effects of the intervention on the process of care at, and during the month after, the ED visit. ⋯ The beneficial outcomes of the intervention appear to result primarily from the early provision of home care rather than early contact with the primary physician.
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Multicenter Study
A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department.
To evaluate the predictive ability of a simple six-item triage risk screening tool (TRST) to identify elder emergency department (ED) patients at risk for ED revisits, hospitalization, or nursing home (NH) placement within 30 and 120 days following ED discharge. ⋯ Older ED patients with two or more risk factors on a simple triage screening tool were found to be at significantly increased risk for subsequent ED use, hospitalization, and nursing home admission.
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Multicenter Study
Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department.
Plasma B-type natriuretic peptide (BNP) can reliably identify acute congestive heart failure (CHF) in patients presenting to the emergency department (ED) with acute dyspnea. Heart failure, asthma, and chronic obstructive pulmonary disease (COPD) are syndromes where dyspnea and wheezing are overlapping signs, and hence, these syndromes are often difficult to differentiate. ⋯ The yield of adding routine BNP testing in patients with a history of asthma or COPD in picking up newly diagnosed CHF is approximately 20%. This group of patients presents a substantial therapeutic opportunity for the initiation and chronic administration of ACEI and BB therapy, as well as other CHF management strategies.
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Multicenter Study
Injury mortality following the loss of air medical support for rural interhospital transport.
This study evaluated variation in mortality among interfacility transfers three years before and after discontinuation of a rotor-wing transport service. ⋯ Injury mortality increased with loss of air transport for interfacility transfer in a rural area.