scholarly journals LO92: Improving patient communication in an emergency department's rapid assessment zone

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S41
Author(s):  
A. Taher ◽  
F. Webster Magcalas ◽  
V. Woolner ◽  
S. Casey ◽  
D. Davies ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Low Cost ◽  
Statistical Significance ◽  
Rapid Assessment ◽  
Communication Tool ◽  
Patient Anxiety ◽  
Waiting Room ◽  
Statistical Process ◽  
Patient Focus Group ◽  
Stakeholder Input

Background: Emergency Department (ED) communication between patients and clinicians is fraught with challenges. A local survey of 65 ED patients revealed low patient satisfaction with ED communication and resultant patient anxiety. Aim Statement: To increase patient satisfaction with ED communication and to decrease patient anxiety related to lack of ED visit information (primary aims), and to decrease clinician-perceived patient interruptions (secondary aim), each by one point on a 5-point Likert scale over a six-month period. Measures & Design: We performed wide stakeholder engagement, surveyed patients and clinicians, and conducted a patient focus group. An inductive analysis followed by a yield-feasibility-effort grid led to three interventions, introduced through sequential and additive Plan-Do-Study-Act (PDSA) cycles. PDSA 1: clinician communication tool (Acknowledge-Empathize-Inform [AEI] tool), based on survey themes and a literature review, and introduced through a multi-modal education approach. PDSA 2: patient information pamphlets developed with stakeholder input. PDSA 3: new waiting room TV screen with various informational ED-specific videos. Measures were conducted through anonymous surveys: Primary aims towards the end of the patient ED stay, and the secondary aim at the end of the clinician shift. We used Statistical Process Control (SPC) charts with usual special cause variation rules. Two-tailed Mann-Whitney tests were used to assess for statistical significance between means (significance: p < 0.05). Evaluation/Results: Over five months, 232 patient and 104 clinician surveys were collected. Wait times, ED processes, timing of typical steps, and directions were reported as the most important communication gaps, they and were included in the interventions. Patient satisfaction improved from 3.28 (5 being best, all means; n = 65) to 4.15 (n = 59, p < 0.0001). Patient anxiety improved from 2.96 (1 being best; n = 65) to 2.31 (n = 59, p < 0.01). Clinician-perceived interruptions went from 4.33 (1 being best; n = 30) to 4.18 (n = 11, p = 0.98). SPC charts using Likert scales did not show special cause variation. Discussion/Impact: A sequential, additive approach undertaken with pragmatic and low-cost interventions based on both clinician and patient input led to increased patient satisfaction with communication and decreased patient anxiety due to lack of ED visit information after PDSA cycles. These approaches could easily be replicated in other EDs to improve the patient experience.

Quality improvement initiative for improved patient communication in an ED rapid assessment zone

2020 ◽  
pp. emermed-2019-209124
Author(s):  
Ahmed Taher ◽  
Federico Webster Magcalas ◽  
Victoria Woolner ◽  
Stephen Casey ◽  
Debra Davies ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Statistical Significance ◽  
Likert Scale ◽  
Secondary Outcome ◽  
Patient Anxiety ◽  
Improve Patient Satisfaction ◽  
Scale Point ◽  
Clinician Communication ◽  
Improve Patient

IntroductionPatient–clinician communication in the Emergency Department (ED) faces challenges of time and interruptions, resulting in negative effects on patient satisfaction with communication and failure to relieve anxiety. Our aim was to improve patient satisfaction with communication and to decrease related patient anxiety.MethodsA multistage quality improvement (QI) initiative was conducted in the ED of Toronto General Hospital, a quaternary care centre in Ontario, Canada, from January to May 2018. We engaged stakeholders widely including clinicians, allied health and patients. We developed a 5-point Likert scale survey to measure patient and clinician rating of their communication experience, along with open-ended questions, and a patient focus group. Inductive analyses yielded interventions that were introduced through three Plan-Do-Study-Act (PDSA) cycles: (1) a clinician communication tool called Acknowledge-Empathize-Inform; (2) patient information pamphlets; and (3) a multimedia solution displaying patient-directed material. Our primary outcome was to improve patient satisfaction with communication and decrease anxiety by at least one Likert scale point over 6 months. Our secondary outcome was clinician-perceived interruptions by patients. We used statistical process control (SPC) charts to identify special cause variation and two-tailed Mann-Whitney U tests to compare means (statistical significance p<0.05).ResultsA total of 232 patients and 104 clinicians were surveyed over baseline and three PDSA cycles. Communication about wait times, ED process, timing of next steps and directions to patient areas were the most frequently identified gaps, which informed our interventions. Measurements at baseline and during PDSA 3 showed: patient satisfaction increased from 3.28 (5 being best; n=65) to 4.15 (n=59, p<0.0001). Patient anxiety decreased from 2.96 (1 being best; n=65) to 2.31 (n=59, p<0.001). Clinician-perceived interruptions by patients changed from 4.33 (5 being highest; n=30) to 4.18 (n=11, p=0.98) and did not meet significance. SPC charts showed special cause variation temporally associated with our interventions.ConclusionsOur pragmatic low-cost QI initiative led to statistically significant improvement in patient satisfaction with communication and decreased patient anxiety while narrowly missing our a priori improvement aim of one full Likert scale point.

Text Messaging as a Mental Health Treatment Intervention: A Corpus-Based Study

2019 ◽  
Author(s):  
Megan Partch ◽  
Cass Dykeman
Keyword(s):  
Mental Health ◽  
Mental Health Treatment ◽  
Text Messaging ◽  
Low Cost ◽  
Statistical Significance ◽  
Text Message ◽  
Treatment Session ◽  
Text Messages ◽  
Health Treatment ◽  
Emotional Tone

Mental health treatment providers seek high-impact and low-cost means of engaging clients in care. As such, text messaging is becoming more frequently utilized as a means of communication between provider and client. Research demonstrates that text message interventions increase treatment session attendance, decrease symptomology, and improve overall functioning. However, research is lacking related to the linguistic make up of provider communications. Text messages were collected from previously published articles related to the treatment of mental health disorders. A corpus of 39 mental health treatment text message interventions was composed totaling 286 words. Using Linguistic Inquiry and Word Count (LIWC) software, messages were analyzed for prevalence of terminology thought to enhance client engagement. Clout, demonstrating the writer’s confidence and expertise, and positive Emotional Tone were found to be at a high level within the corpus. Results demonstrated statistical significance for five linguistic variables. When compared with national blog norms derived from Twitter, Clout, Emotional Tone, and use of Biological terminology were found to be at higher rates than expected. Authenticity and Informal terminology were found at significantly lesser rates.

Statistical Tests of Type I Error

2021 ◽  
pp. 90-120
Author(s):  
Charles Auerbach
Keyword(s):  
Control Charts ◽  
Sampling Error ◽  
Statistical Tests ◽  
Statistical Significance ◽  
Data Sets ◽  
Chi Square ◽  
Statistical Process ◽  
Incorrect Decision ◽  
Type 1 Error ◽  
Statistical Process Control Charts

This chapter covers tests of statistical significance that can be used to compare data across phases. These are used to determine whether observed outcomes are likely the result of an intervention or, more likely, the result of sampling error or chance. The purpose of a statistical test is to determine how likely it is that the analyst is making an incorrect decision by rejecting the null hypothesis, that there is no difference between compared phases, and accepting the alternative one, that true differences exist. A number of tests of significance are presented in this chapter: statistical process control charts (SPCs), proportion/frequency, chi-square, the conservative dual criteria (CDC), robust conservative dual criteria (RCDC), the t test, and analysis of variance (ANOVA). How and when to use each of these are also discussed, and examples are provided to illustrate each. The method for transforming autocorrelated data and merging data sets is discussed further in the context of utilizing transformed data sets to test of Type 1 error.

Analyzing Group Data

2021 ◽  
pp. 121-142
Author(s):  
Charles Auerbach
Keyword(s):  
Control Charts ◽  
Type I Error ◽  
Statistical Significance ◽  
Data Sets ◽  
Type I ◽  
Chi Square ◽  
Statistical Process ◽  
Incorrect Decision ◽  
Group Data ◽  
Statistical Process Control Charts

This chapter covers tests of statistical significance that can be used to compare data across phases. These are used to determine whether observed outcomes are likely the result of an intervention or, more likely, the result of chance. The purpose of a statistical test is to determine how likely it is that the analyst is making an incorrect decision by rejecting the null hypothesis and accepting the alternative one. A number of tests of significance are presented in this chapter: statistical process control charts (SPCs), proportion/frequency, chi-square, the conservative dual criteria (CDC), robust conservative dual criteria (RCDC), the t test, and analysis of variance (ANOVA). How and when to use each of these are also discussed. The method for transforming autocorrelated data and merging data sets is discussed. Once new data sets are created using the Append() function, they can be tested for Type I error using the techniques discussed in the chapter.

Epidemiology and biostatistics

2019 ◽  
pp. 52-67
Author(s):  
Nizam Damani
Keyword(s):  
Cohort Studies ◽  
Confidence Intervals ◽  
Prevalence Rate ◽  
Statistical Significance ◽  
Case Control ◽  
Statistical Process ◽  
Practical Advice ◽  
Advantages And Disadvantages ◽  
Basic Concepts ◽  
Healthcare Associated

This section includes a chapter on basic epidemiology and biostatistics as applied to healthcare-associated infections (HAIs). The epidemiology section summarizes various types of studies and outlines the advantages and disadvantages of case–control and cohort studies. It describes the incidence and prevalence rate and how to calculate the most common HAIs. Practical advice is also given on how to avoid bias and confounders. The chapter describes basic concepts in biostatistics and tests of statistical significance used in investigating an outbreak. It also provides guidance on how to calculate the sensitivity and specificity of the test and describes how to interpret confidence intervals and statistical process charts.

Patient Satisfaction Regarding Health Education and Practice Environment Using the PPAESS Survey

2016 ◽  
Vol 6 (1) ◽  
pp. 57-64
Author(s):  
Paul Jordan Washburn
Keyword(s):  
Patient Satisfaction ◽  
Practice Environment ◽  
Contributing Factors ◽  
Individual Group ◽  
Health Investment ◽  
Waiting Room ◽  
Care Environment ◽  
Survey Tool ◽  
Patient Health ◽  
High Internal Consistency

The waiting room and the examination rooms are the two central locations patients spend time in a primary care environment. Patient health outcomes and satisfaction are significant contributing factors for reimbursement The Patient Practice And Education Satisfaction Survey (PPAESS) tool has high internal consistency (a = 0.92) with subcategories of practice (a = 0.88) and education (a = 0.86). When comparing between arms of the study utilizing the PPAESS tool, a marginally significant, total survey Kruskall-Wallace was observed (p = 0.071). Inter-arm comparisons of the practice subcategory control vs. health investment worker were significant (p = 0.034). The PPAESS survey tool is a highly consistent and reliable tool for patient satisfaction regarding practice environment and education. A health investment worker in a practice waiting room environment was noted to increase patient satisfaction. The PPAESS tool allows health practices to further optimize practice space, patient time, individual/group education and is highly effective for assessment of patient satisfaction.

scholarly journals The Effect of Bedside Presentations in the Emergency Department on Patient Satisfaction

2011 ◽  
Vol 3 (4) ◽  
pp. 481-486 ◽  
Author(s):  
Craig I. Schranz ◽  
Robert J. Sobehart ◽  
Kiva Fallgatter ◽  
Robert H. Riffenburgh ◽  
Michael J. Matteucci
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Resident Education ◽  
Statistical Significance ◽  
Future Research ◽  
First Year ◽  
Convenience Sample ◽  
Visual Analog Scales ◽  
Significant Difference ◽  
The Difference

Abstract Background Due to increasing time constraints, the use of bedside presentations in resident education has declined. We examined whether patient satisfaction in the emergency department is affected when first-year residents present at the bedside with attendings. Methods We performed an observational, prospective, nonblinded study in the emergency department of a military teaching hospital. We alternately assigned first-year residents to present a convenience sample of 248 patients to the attending physician at the patient's bedside or away from the patient. We measured patient satisfaction by using the Patient Satisfaction Questionaire-18 (PSQ-18), a validated survey instrument that utilizes a Likert scale, and additional nonvalidated survey questions involving Likert and visual analog scales. Results While the median PSQ-18 score of 74 (95% confidence interval [CI], 72–76) was higher for patient satisfaction when residents made bedside presentations than that for standard presentations, 72 (95% CI, 70–74), the difference did not reach statistical significance (P  =  .33). Conclusion There was no significant difference in overall patient satisfaction between residents' bedside presentations and presentations to attendings away from the patient. Although not significant, the differences noted in PSQ-18 subscales of communication, general satisfaction, and interpersonal manner warrant further investigation. Patients did not appear to be uncomfortable with having their care discussed and with having subsequent resident education at the bedside. Future research on patient satisfaction after implementation of standardized bedside teaching techniques may help further elucidate this relationship.

scholarly journals Comparison of anti-plaque efficacy between a low and high cost dentifrice: A short term randomized double-blind trial

2014 ◽  
Vol 08 (03) ◽  
pp. 381-388 ◽  
Author(s):  
Rahul Ganavadiya ◽  
B. R. Chandra Shekar ◽  
Pankaj Goel ◽  
Sudheer G. Hongal ◽  
Manish Jain ◽  
...  
Keyword(s):  
Low Cost ◽  
Statistical Significance ◽  
T Test ◽  
Residential Home ◽  
Gingival Inflammation ◽  
Short Term ◽  
Post Intervention ◽  
Double Blind ◽  
Baseline Difference ◽  
Paired T Test

ABSTRACT Objective: The aim of this study was to compare the anti-plaque efficacy of a low and high cost commercially available tooth paste among 13-20 years old adolescents in a Residential Home, Bhopal, India. Materials and Methods: The study was randomized double-blind parallel clinical trial conducted in a Residential Home, Bhopal, India. A total of 65 patients with established dental plaque and gingivitis were randomly assigned to either low cost or high cost dentifrice group for 4 weeks. The plaque and gingival scores at baseline and post-intervention were assessed and compared. Statistical analysis was performed using paired t-test and the independent sample t-test. The statistical significance was fixed at 0.05. Results: Results indicated a significant reduction in plaque and gingival scores in both groups post-intervention compared with the baseline. Difference between the groups was not significant. No adverse events were reported and both the dentifrices were well-tolerated. Conclusion: Low cost dentifrice is equally effective to the high cost dentifrice in reducing plaque and gingival inflammation.

scholarly journals Predicting Soil Organic Carbon and Total Nitrogen at the Farm Scale Using Quantitative Color Sensor Measurements

Agronomy ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. 212 ◽  
Author(s):  
Roxanne Stiglitz ◽  
Elena Mikhailova ◽  
Julia Sharp ◽  
Christopher Post ◽  
Mark Schlautman ◽  
...  
Keyword(s):  
Organic Carbon ◽  
Soil Organic Carbon ◽  
Total Nitrogen ◽  
Low Cost ◽  
Rapid Assessment ◽  
Soil Health ◽  
Sensor Technology ◽  
P Value ◽  
Color Sensor ◽  
Farm Scale

Sensor technology can be a reliable and inexpensive means of gathering soils data for soil health assessment at the farm scale. This study demonstrates the use of color system readings from the Nix ProTM color sensor (Nix Sensor Ltd., Hamilton, ON, Canada) to predict soil organic carbon (SOC) as well as total nitrogen (TN) in variable, glacial till soils at the 147 ha Cornell University Willsboro Research Farm, located in Upstate New York, USA. Regression analysis was conducted using the natural log of SOC (lnSOC) and the natural log of TN (lnTN) as dependent variables, and sample depth and color data were used as predictors for 155 air dried soil samples. Analysis was conducted for combined samples, Alfisols, and Entisols as separate sample sets and separate models were developed using depth and color variables, and color variables only. Depth and L* were significant predictors of lnSOC and lnTN for all sample sets. The color variable b* was not a significant predictor of lnSOC for any soil sample set, but it was for lnTN for all sample sets. The lnSOC prediction model for Alfisols, which included depth, had the highest R2 value (0.81, p-value < 0.001). The lnSOC model for Entisols, which contained only color variables, had the lowest R2 (0.62, p-value < 0.001). The results suggest that the Nix ProTM color sensor is an effective tool for the rapid assessment of SOC and TN content for these soils. With the accuracy and low cost of this sensor technology, it will be possible to greatly increase the spatial and temporal density of SOC and TN estimates, which is critical for soil management.

Sign in / Sign up

Export Citation Format

Share Document