Use of emergency departments by elder patients: a five-year follow-up study

OBJECTIVE: To compare the use of emergency medical care by elders in the United States in 1995 with that previously described for 1990. METHODS: A computerized billing database of 88 EDs in 21 states was retrospectively reviewed for 1995, comparing elder and nonelder patients, estimating national use of emergency medical services by elders, and comparing the 1995 data with previously published results for 1990. RESULTS: From 1990 to 1995, the number of ED visits in the United States increased from 92 million to 100 million. The number of visits made by patients aged 65 years or older increased from 13,639,400 (15%) to 15,666,300 (15.7%), but this increase did not reach statistical significance (p = 0.17). The admission rate for elder ED patients increased from 32% to 46% over the five-year interval (p<0.01). This represents more than 7 million hospital admissions for elder patients in 1995. The rate of intensive care unit (ICU) admission for elders decreased from 7% to 6% over the five-year interval (p = 0.56), compared with 1.3% for nonelder patients for both years. Thirty percent of elder ED patients arrived by ambulance in 1990, compared with 33% in 1995 (p = 0.02). Based on 1995 data, elders comprised 39% of patients arriving by ambulance [odds ratio (OR) 4.75, 95% confidence interval (CI) = 4.71 to 4.79], 43% of all admissions (OR 6.59, 95% CI = 6.54 to 6.64), and 47% of ICU admissions (OR 5.00, 95% CI = 4.91 to 5.09). The comparable ORs in 1990 were 4.4, 5.6, and 5.5, respectively. CONCLUSIONS: From 1990 to 1995, the overall number of ED visits increased. The rate of increase was somewhat greater for elder patients. The use of ambulance services also disproportionately grew among elder patients, as did the rate of hospital admission. The overall rate of ICU admission was stable, but actually fell modestly for elder patients. Of these changes, only the increase in the rate of hospital admission for elders reached statistical significance.     

Predicting student satisfaction in baccalaureate nursing programs: testing a causal model

The purpose of this study was to test a causal model for predicting the overall satisfaction of senior students with their baccalaureate nursing programs. The proposed model was primarily a sociological impact model based upon Tinto's (1975) student integration theory for predicting student departure, and Pascarella's (1985) causal model for predicting student outcomes. To test the model, a sample of 195 senior female students from five baccalaureate nursing programs in the southwestern United States was selected for step-wise regression studies and path analysis. Testing the causal model, the students' integration into the academic and social systems of their nursing programs directly explained 42% of the variance for predicting overall satisfaction. The best predictors of overall satisfaction were the students' 1) academic development, 2) satisfaction with facilities and services, 3) satisfaction with the faculty, and 4) social interaction with peers.     

Job satisfaction study of two small unorganized plants.

"The purpose of this study was to test the validity of the tear ballot on the premise that the higher the job satisfaction scores, the lower will be the job-related interpersonal communicative contacts between labor and management members. The number of job-problem sessions for a period of one year was thus utilized as the validation criterion based upon the hypothesis that the job-satisfied and happy worker has less job-related interview sessions than does the job-dissatisfied or unhappy worker; i.e., the frequence of such sessions should be inversely related with job satisfaction. Combining the data from both plants, [N's were 22 and 14] a Pearsonian coefficient of correlation of—.76 was found between job satisfaction scores and the number of job-related interview sessions." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emergency physician and patient confidentiality: a review

Confidentiality is a promise rooted in tradition, law, and medical ethics. Emergency physicians treat a variety of patients to whom confidentiality is of vital importance: employees, celebrities, victims of violence or disaster, minors, students, criminals, drug abusers, and patients with STDs. EDs should develop methods of ensuring confidentiality for all patients. Although confidentiality is an important principle that should be respected and guarded, it is not absolute. Various laws mandate disclosure of certain patient information; in addition, an overriding moral duty may occasionally require a breach of confidentiality. As Beauchamp and Childress noted, "the therapeutic role may sometimes have to yield to one's role as citizen and as protector of the interests of others." In general, however, circumstances requiring a breach of confidentiality are rare.     

Quality development at an emergency unit--an intervention study based on consumer satisfaction

A study among the users of an emergency department was carried out to assess user satisfaction, based upon a questionnaire. The study was split into two periods, before and after a change in procedure in the emergency department, namely that a nurse was to give information about waiting time, make coordinations and fix an order of priority of patients (triage) in the waiting room. Fourteen hundred and twenty-six answers were received, 794 before and 632 after the change. The users questioned after this change of procedure felt that they had been better received, that they had waited for a shorter time and described a better general experience as compared to the users questioned before the change, these differences were significant. There were no difference between the two groups concerning opinions on information about diagnosis, treatment and outcome, whether there was enough time for examination, treatment and information, whether the staff were obliging or whether their expectations had been fulfilled. It is concluded that such changes in procedure in the emergency department are to be recommended.     

Consent to treatment by minors attending accident and emergency departments: guidelines

The absolute right to refuse medical treatment, even if the reasons are irrational, is confined to competent adults. Children under 16 years can give legal consent to treatment in the absence of consent from those with parental responsibility. Children under 18 years do not, however, have an absolute right to consent, or refuse to consent, to treatment. The views of children assume increasing importance with age and maturity. Accident and emergency medical and nursing staff may face difficult decisions when children, or those with parental responsibility, refuse to consent to medical treatment. This paper presents guidelines designed to guide the decision making process in immediately or potentially life threatening conditions and in non-life-threatening conditions.     

Evidence-based practice: is patient satisfaction evidence?

Patient satisfaction is a popular way of evaluating nursing practice, but there are doubts about its reliability and validity. This article describes a study which assessed the usefulness of one tool for measuring patient satisfaction--the Newcastle Satisfaction with Nursing Scale.     

A prospective study to assess the effect of ambulatory teaching on patient satisfaction

PURPOSE: To assess the effect of ambulatory teaching on patients' satisfaction. METHOD: In 1996, 103 adult patients presenting to the Walter Reed General Medicine Walk-in Clinic completed a patient-satisfaction questionnaire immediately following their visits, during which they were initially seen by a trainee (third-year medical student or intern) and then seen by a faculty preceptor. The questionnaire included five items from the validated Medical Outcomes Study (MOS)-9 questionnaire as well as two open-ended questions. Fourteen staff physicians, 13 students (49% of the visits), and 11 interns (51% of the visits) participated in the study. Satisfaction was analyzed by level of training, and the responses from the study patients were compared with the responses from 372 usual-care (i.e., non-teaching) patients from the same clinic, using the chi-squared test. RESULTS: The study patients were typically pleased with their encounters, rating their overall satisfaction as excellent (61%), very good (29%), or good (9%). Nearly two thirds of the patients rated their satisfaction with waiting time to be very good or excellent. Compared with the usual-care patients, the study patients reported equal or greater satisfaction for all five MOS-9 items. Ninety-five percent of the study patients said they would be willing to be seen by a trainee-staff team on future visits. There was no difference in patient satisfaction by trainee level. The study patients cited enhanced interaction (45%), enhanced education (34%), and improved care (26%) as benefits of trainee-involved care, and increased waiting time (18%) and worse care (5%) as drawbacks. CONCLUSION: The results of this study suggest that ambulatory teaching does not adversely affect patient satisfaction, regardless of trainee level, and that patients who have been seen by trainee-staff teams are willing to experience such encounters again.     

A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study

PURPOSE: To use a controlled, randomized design to assess the effect on patient satisfaction of an intensive psychosocial training program for residents. METHOD: Twenty-six first-year residents, in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine, were randomly assigned during 1991 and 1992 to a control group or a one-month intensive training program. Experiential teaching focused on many psychosocial skills required in primary care. A 29-item questionnaire administered before and after the residents' training evaluated their patients' satisfaction regarding patient disclosure, physician empathy, confidence in physician, general satisfaction, and comparison of the physician with other physicians. Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training. RESULTS: The patients of the trained residents expressed more confidence in their physicians (p = .01) and more general satisfaction (p = .02) than did the patients of controls. The effect of training on patient satisfaction with patient disclosure (p < .01) and physician empathy (p < .05) was greater for female than for male residents. CONCLUSION: The intensive psychosocial training program for residents improved their patients' satisfaction.     

Spiral CT: applications in the emergency patient

The influence of vasopressin (AVP) on recall of information in a passive avoidance situation after bilateral 6-OHDA lesions to the central amygdala was tested. AVP given 15 min before the retention testing at the icv dose of 1 microgram significantly prolonged avoidance latencies both in lesioned and in sham-operated rats in comparison with the respective icv saline injected animals. Insignificant increase of spontaneous locomotor activity in rats lesioned to the central amygdala was unlikely to interfere with the cognitive effect of AVP. These results suggest that dopaminergic projection to the central amygdala is not responsible for the facilitatory effect of AVP on retrieval process in a passive avoidance situation.     

Impact of The Patient's Charter on A&E departments. 2: The emergency nurse practitioner

This article is the second of a two-part study based upon the results of a national survey of senior nurses in accident and emergency (A&E) departments. It explores the development of the nurse practitioner role in A&E. In particular, the extent to which this expanded role has become a means by which patients with minor injuries can be 'fast-tracked', to the possible detriment of more holistic goals for care delivery.     

Peripherally inserted central venous catheters: factors affecting patient satisfaction

OBJECTIVE: We studied factors that affect satisfaction of patients who have undergone placement of peripherally inserted central venous catheters (PICCs) by interventional radiologists and patients' willingness to undergo placement of future PICCs. SUBJECTS AND METHODS: This longitudinal prospective consecutive cohort study included 85 patients referred for PICC placement. A record was made of catheter type, time taken for placement, patient age, and possible complications. Follow-up was obtained by telephone interview to determine the effect of site of placement in the arm, residence time of catheter, additional complications, and interference with activities of daily living on patient willingness to undergo future PICC placement at the same site. Logistic regression analysis was used to determine factors statistically predictive of patient willingness to undergo placement of future PICCs. RESULTS: Patients having PICCs placed above the elbow were more often satisfied (55 of 61 respondents) with catheter location than patients having placements at the elbow (three of 17 respondents). Patient willingness to undergo future PICC placement was strongly related to catheter location (p < .0001) and interference with activities of daily living (p < .0001). Catheter type, residence time, time taken for the placement, age, and complications were not associated with patient willingness to undergo future PICC placement. CONCLUSION: PICC placement above the elbow is more acceptable to patients than placement at the elbow. PICC placement above the elbow and patients' perception of less interference by the PICC with activities of daily living are positively related to patient willingness to undergo future PICC placement.     

Telephone triage of cardiac emergency calls by dispatchers: a prospective study of 1386 emergency calls

OBJECTIVES: To evaluate the handling of potential cardiac emergency calls by dispatchers, to determine their final diagnosis and urgency, and to determine the value of the main complaint in predicting urgency and the ability of the dispatchers to recognise non-urgent conditions. DESIGN: Prospective data collection and recording of main complaint of emergency calls placed via the 06-11 alarm telephone number with follow up to hospital when the patients were transported and the general practitioner when they were not. SETTING: Dispatch centres of the emergency medical services in Amsterdam (urban area) and Enschede (rural area). PATIENTS: 1386 consecutive adult subjects of emergency calls placed by citizens about chest problems or unconsciousness not caused by injury. MAIN OUTCOME MEASURES: Frequency of characteristics of the calls, outcome in diagnosis, and assessment of urgency. RESULTS: 69 (5%) patients were dead when the ambulance arrived. Diagnosis was established in 1071 patients (77%). The disorders most often reported were cardiac, with acute ischaemia in 15% of all subjects. In 28% of cases and for each presenting complaint no organic explanation was found. Overall 39% of all emergency calls were urgent; the urgency rate was lowest for calls for people with abdominal discomfort. Dispatchers correctly identified 90% of the non-urgent calls, but 55% of the calls that they identified as urgent proved to be non-urgent. CONCLUSION: Currently, direct dialling for an ambulance without the intervention of a general practitioner imposes a high work load on emergency systems and hospitals because triage by dispatchers is not sufficiently accurate. It may be possible to increase the accuracy of triage by developing and testing decision algorithms.