CME: Examining Patient Desires for ED Function

CME: Examining Patient Desires for ED Function
Author Information (click to view)

Jeffrey Druck, MD, and Paul Leccese

Druck,-Jeffrey
Jeffrey Druck, MD
Associate Professor of Emergency Medicine
Director, Integrated Clinician’s Course
University of Colorado School of Medicine
Associate Residency Director, Residency Program in Emergency Medicine
Denver Health Medical Center

Jeffrey Druck, MD, has indicated to Physician’s Weekly that he has or has had no financial interests to report. Paul Leccese has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Leccese,-Paul
Paul Leccese
MD Candidate, Class of 2016
University of Colorado School of Medicine

Paul Leccese has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  1. Explain the findings of a study that aimed to determine baseline knowledge of emergency department (ED) and hospital processes among ED patients.
  2. Discuss the implications of these findings.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwJan2.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Jeffrey Druck, MD
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Paul Leccese
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
 AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Jeffrey Druck, MD, and Paul Leccese (click to view)

Jeffrey Druck, MD, and Paul Leccese

Druck,-Jeffrey
Jeffrey Druck, MD
Associate Professor of Emergency Medicine
Director, Integrated Clinician’s Course
University of Colorado School of Medicine
Associate Residency Director, Residency Program in Emergency Medicine
Denver Health Medical Center

Jeffrey Druck, MD, has indicated to Physician’s Weekly that he has or has had no financial interests to report. Paul Leccese has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Leccese,-Paul
Paul Leccese
MD Candidate, Class of 2016
University of Colorado School of Medicine

Paul Leccese has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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Average ED wait times in the United States vary considerably, but some locations have particularly long wait times. This time spent in the waiting room often frustrates patients and their families as other ED visitors receive care while those who are waiting are given few, if any, updates. Some research has explored educating patients while they wait to be seen by ED personnel, and this appears to be a potentially valuable tool. “Some studies suggest that providing education in the ED waiting room is of interest to patients,” says Jeffrey Druck, MD.

In a study published in the Western Journal of Emergency Medicine, Dr. Druck, Paul Leccese, and colleagues aimed to determine baseline knowledge of ED and hospital processes among ED patients. “One of our goals was to establish types of information that waiting room patients wanted, including expected wait times, causes of delays, and the triage process,” explains Leccese. “We also wanted to see how they would like this information to be delivered.” In addition, the study asked participants what they expected regarding wait times for labs, imaging studies, and admission. The authors also assessed links between racial groups and their desire for information as well as whether or not patients wanted educational health materials.

New Data

For the study, a 32-question survey was administered to patients and showed that 55% of the 544 respondents indicated that they had a primary care physician (PCP). Of these patients, about 53% reported calling a PCP before they came to the ED. About 72% of participants wanted to know about delays, but just 25% wanted to know others’ wait times. “While patients wanted regular updates,” Dr. Druck says, “it didn’t matter if they received these updates from physicians or other ED personnel.”

Nearly 69% of patients reported knowing why some patients were seen sooner than others despite arriving later. “We observed a significant difference in the percentage of respondents saying it was fair to see some patients before others between the group that did not claim to know why this happens and groups that claimed to know why this happens and provided a valid explanation as to why,” says Leccese (Table).

Results also showed that 41% of respondents wanted information on how the ED functions, 60% of whom wanted handouts and 43% wanted a video. Information on updates and common medical emergencies was significantly more important to respondents than materials on common illnesses, finding a PCP, or ED function. The median estimated time for medical workups ranged from 35 minutes for radiographs, to 60 minutes for lab results, CTs, specialist consults, and admissions.

Only about 69% of respondents claimed to know the definition of what constituted a teaching hospital, and approximately 87% of this group knew they were currently in a teaching hospital. “When asked to identify aspects that differentiate teaching hospitals from other hospitals, the responses varied considerably,” Dr. Druck says (Figure). In a subgroup analysis between racial groups, minority groups had significantly less knowledge of the definitions of triage and teaching hospitals, but wanted significantly more information on ED function. These differences did not appear to be related to language barriers and could represent variations in cultural beliefs regarding the value of ED visits or disparities in healthcare literacy.

Important Implications

“To reduce barriers between waiting room patients and ED providers, it’s important to understand what patients wish to know as they wait and how to best describe ED workflow to patients,” Leccese says. Many strategies have been used to reduce the time and improve the experience of waiting room patients, but the problem is multifactorial. Many patients leave the ED without being seen because their wait times are too long. “Our study provides a better understanding of factors that need to be addressed to improve experiences in the waiting room and ensure that patients don’t leave because of long wait times,” adds Dr. Druck.

The study suggests that there are possible high-impact targets for interventions in patient education and ED throughput that may improve patient satisfaction, according to Dr. Druck. “These interventions could include providing educational materials about hospital and ED function and severe health conditions,” he says. “We should also strive to provide regular updates when there are foreseeable delays.” This can increase transparency as patients gain an understanding of what is happening during their visit and how much time they can reasonably expect it to take. This may also have the potential to reduce the stress and frustration of waiting.

Readings & Resources (click to view)

Seibert T, Veazey K, Leccese P, Druck J. What do patients want? Survey of patient desires for education in an urban university hospital. West J Emerg Med. 2014;15:764-769. Available at: http://westjem.com/original-research/patients-want-survey-patient-desires-education-urban-university-hospital.html.

Horwitz LI, Green J, Bradley EH. US emergency department performance on wait time and length of visit. Ann Emerg Med. 2010;55:133-141.

Delgado MK, Ginde AA, Pallin DJ, et al. Multicenter study of preferences for health education in the emergency department population. Acad Emerg Med. 2010;6:652-658.

Ibanez G, Guerin L, Simon N. Which improvements could prevent the departure of the left-without-being-seen patients? Emerg Med J. 2011;28:945-947.

McCarthy ML, Zeger SL, Ding R, et al. Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Ann Emerg Med. 2009;54:492-503.

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