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A Day in the Life of a Patient: Why Can’t We Do Better?

A Day in the Life of a Patient: Why Can’t We Do Better?

Is there a patient who goes through a hospitalization who does not have stories to tell about the obstacles, errors, and indignities that they endured? I just wonder sometimes. A family relative was hospitalized this week with a stroke at a hospital a few hours from me—and his experience left me demoralized about medicine. Joe (not his real name) is an 82 year old grandfather, father, husband, and one of a kind. He has a scraggly beard and ponytail. He possesses an artistic spirit, but is punctual to a fault—always early, never late. He has an integrity that is rare these days, which led to a loyal following in business and life. And yes, he is devoted to his family. On Tuesday, he developed some difficulty with his balance. His wife of over 60 years was worried and brought him to the doctor.  That is when the issues began. Issue #1. His doctor fit him into her schedule and recognized the possibility of the early signs of stroke and sent him for an MR imaging study of his brain. And she also gave him an aspirin, which he promptly took. The problem is that the MR study revealed a small bleed in his brain—and the last thing you want to give someone bleeding in his brain is an aspirin because it can cause more bleeding. Issue #2. At one of the nation’s most reputable New England hospitals he was evaluated in the Emergency Department and admitted to the hospital. He is brought upstairs to the stroke ward fairly late and he is exhausted. Even later he is told that...
Enhancing Patient Satisfaction After ED Visits

Enhancing Patient Satisfaction After ED Visits

Efforts to improve the care experience for ED patients have the potential for wide-ranging benefits, including more effective continuity of care, reduced need for follow-up visits, and higher staff morale. Recent studies suggest that several types of interventions can be effective tools to enhance ED patient satisfaction. “In some analyses, telephone and email follow-up by healthcare providers has been shown to improve patient satisfaction rates,” says Pankaj B. Patel, MD. “The benefits of higher patient satisfaction range from better patient compliance with discharge instructions to higher staff morale. Contacting patients after they leave the ED may also improve transitions of care and help reduce unnecessary return visits to the ED.” Given that emergency care is often rushed, it has been hypothesized that ED patients may have even more to gain from timely post-visit contact with healthcare providers, especially among the elderly. “The potential for improving follow-up communication with elderly ED patients is particularly important because of their rising population,” Dr. Patel says. “It behooves EDs to identify opportunities that can help improve continuity of care and opportunities to increase patient satisfaction. In turn, there is also an opportunity to enhance patient outcomes for the long term.” In-Depth Analysis of Patient Satisfaction The direct effect of post-visit patient contact by ED physicians has not been studied extensively. Dr. Patel and David R. Vinson, MD, published an article in Annals of Emergency Medicine detailing results of their study that examined the impact of post-visit email or phone contact on patient satisfaction. “Prior to our investigation, our study team was contacting patients by email or by telephone shortly after their ED visit,”...

Improved Satisfaction After ED Visits

Patient satisfaction appears to be higher when emergency physicians contact them via email or phone briefly after a visit to the ED when compared with no contact. Researchers from Kaiser Permanente Medical Center found an average patient satisfaction rate of 79.4% among those who were not contacted, compared with a 87.7% rate for those who were contacted. Patient satisfaction scores were 89.3% for those contacted via email and 85.2% for those contacted via phone. Abstract: Annals of Emergency Medicine, February 27, 2013...
Shoulder Arthroplasty for Proximal Humeral Nonunions

Shoulder Arthroplasty for Proximal Humeral Nonunions

Shoulder fractures are common injuries among the elderly, but the management of these fractures can be challenging for physicians. Treatment options include nonoperative modalities, osteosynthesis, and arthroplasty, but patients can still suffer from substantial pain and functional impairment even after receiving these interventions. Nonunions have been frequently linked to bone loss, poor bone quality, and soft-tissue contractures. “In previous studies, surgeons have had difficulty achieving fracture union with internal fixation and bone-grafting treatments in patients with proximal humeral fracture nonunions,” explains Thomas R. Duquin, MD. “As an alternative, unconstrained shoulder arthroplasty has been advocated for treating these nonunions. Unfortunately, research has documented high rates of unsatisfactory results with arthroplasty, especially with regard to functional outcomes.” Study Results on Proximal Humeral Nonunions In the Journal of Bone and Joint Surgery, Dr. Duquin and colleagues recently had a study published that reviewed the results and complications of conventional anatomic shoulder arthroplasty for proximal humeral nonunions. The study also identified factors associated with success or failure. From 1976 to 2007, 67 patients who underwent unconstrained shoulder arthroplasty for proximal humeral nonunions were followed for more than 2 years. The study included 49 women and 18 men with an average age of 64 and a mean duration of 9 years follow-up. Fracture type was assessed according to the Neer rating classification. There were two-part fractures in 36 patients, three-part fractures in 16 patients, and four-part fractures in 15 patients. Hemiarthroplasty was performed in 54 individuals, and total shoulder arthroplasty was done in 13. According to findings, there were 33 excellent or satisfactory results based on a modified Neer rating classification (Figure 1). “For...
Patient Satisfaction Surveys Are Useless —Take #2

Patient Satisfaction Surveys Are Useless —Take #2

Patient satisfaction surveys are theoretically good things. After all, hospitals and doctors should know what their patients think about them. If a service is not performing well, the results of a patient satisfaction survey would be useful in helping us make improvements. This would be true if patient satisfaction could be measured in a meaningful way. In a previous blog, I explained some of the statistical problems with all patient satisfaction surveys. Here’s an example of the current state of the art and why these surveys are useless.                   A hospital posted the above graphic. As provided by a leading company, it shows the trend of patient satisfaction scores for the question “Were you informed about the causes of delays during your emergency department [ED] visit?” You can see that the scores fluctuate around the average score of the 79th percentile for the year, meaning that 21% of comparator hospitals fared better on this question. This ED receives more than 25,000 visits per year, or over 2000 visits per month. The number of responses to the survey questionnaires ranged from a low of 2 in June of that year to a high of 42 in October of the year before. This represents a range of 0.1% to 2.1% of all ED visits — far below what even a non-statistician would recognize as a reasonable sample. Despite efforts to improve scores for this question, no significant change has occurred. What does it all mean? If you look at the trend line, you will note that it mirrors what occurs in a feedback...
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