This clinical review article examines the patient satisfaction literature for the past 20 years. This literature is summarized for qualitative themes and general trends. Intended for the practicing clinician, these themes are then applied to the emergency department (ED) milieu. According to the Agency for Healthcare Research and Quality, the ED is the point of entry for more than half of all patients admitted to the hospital in the United States. Indeed, the ED is the "front door" to the hospital. According to Press Ganey, satisfaction with ED care is at an all-time low. A review of the literature revealed 5 major elements of the ED experience that correlate with patient satisfaction: timeliness of care, empathy, technical competence, information dispensation, and pain management. The literature supporting these 5 elements is summarized and applications to the ED setting are suggested. Other minor correlates with patient satisfaction are also presented.
"Thus, evaluation and management of acute pain is a fundamental element in the ED and acute care medicine. Good pain management is one of the major elements that correlate with patients’ satisfaction in the ED . "
[Show abstract][Hide abstract] ABSTRACT: Parecoxib sodium is the first parenteral COX-2 inhibitor used for pain management licensed for postoperative pain. However, no study has assessed the usage of parecoxib for acute traumatic pain in the emergency department (ED). The objective of this study was to investigate a potential alternative analgesic agent in the ED by determining the mean reduction of pain score between acute traumatic pain patients who were administered with intravenous (IV) parecoxib sodium versus IV morphine sulfate. The onset of perceptible analgesic effect and side effects were also evaluated.
A randomized, double-blinded study comparing IV parecoxib 40 mg versus IV morphine at 0.10 mg/kg was conducted in adult patients presented with acute traumatic pain with numeric rating scale (NRS) of 6 or more within 6 hours of injury. Patients were randomized using a computer-generated randomization plan. Drug preparation and dispensing were performed by a pharmacist. Periodic assessment of blood pressure, pulse rate, oxygen saturation, and NRS were taken at 0, 5, 15, and 30 minute intervals after the administration of the study drug. The primary outcome was the reduction of NRS. Side effect and drug evaluation was conducted within 30 minutes of drug administration.
There was no statistically significant difference in the reduction of mean NRS between patients in the IV parecoxib group or IV morphine group (P = 0.095). The mean NRS for patients treated with IV morphine were 7.1 at 0 minutes, 4.5 at 5 minutes, 3.1 at 15 minutes, and 2.0 at 30 minutes. Whereas mean NRS for patients who received IV parecoxib were 7.8 at 0 minutes, 5.7 at 5 minutes, 4.7 at 15 minutes, and 3.9 at 30 minutes. The onset of perceptible analgesic effects could be seen as early as 5 minutes. Dizziness was experienced in 42.9% of patients who received IV morphine compared to none in the parecoxib group.
There was non-significant trend toward superiority of IV morphine over IV parecoxib. Looking at its effectiveness and the lack of opioid-related side-effects, the usage of IV parecoxib sodium may be extended further to a variety of cases in the ED.
International Journal of Emergency Medicine 01/2014; 7(1):2. DOI:10.1186/1865-1380-7-2
"There are various reasons why it may be profitable for a hospital to perform surveys on patient satisfaction . Several studies have found that satisfied patients suffer less pain [4, 5]; they require fewer (secondary) operations and more rarely have complications [4, 5]. Moreover, satisfied patients exhibit better compliance [4–6]. "
[Show abstract][Hide abstract] ABSTRACT: Introduction. In this era of high-tech medicine, it is becoming increasingly important to assess patient satisfaction. There are several methods to do so, but these differ greatly in terms of cost, time, and labour and external validity. The aim of this study is to describe and compare the structure and implementation of different methods to assess the satisfaction of patients in an emergency department. Methods. The structure and implementation of the different methods to assess patient satisfaction were evaluated on the basis of a 90-minute standardised interview. Results. We identified a total of six different methods in six different hospitals. The average number of patients assessed was 5012, with a range from 230 (M5) to 20 000 patients (M2). In four methods (M1, M3, M5, and M6), the questionnaire was composed by a specialised external institute. In two methods, the questionnaire was created by the hospital itself (M2, M4).The median response rate was 58.4% (range 9–97.8%). With a reminder, the response rate increased by 60% (M3).
Conclusion. The ideal method to assess patient satisfaction in the emergency department setting is to use a patient-based, in-emergency department-based assessment of patient satisfaction, planned and guided by expert personnel.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE OF REVIEW: To report on recent advances in quality initiatives in emergency departments (EDs), with a special focus on applicability to pediatric EDs (PED) RECENT FINDINGS: Although healthcare quality improvement has made great strides in the last couple of decades, quality improvement efforts in pediatrics have lagged behind. Over the last decade, as quality initiatives have matured in adult hospitals, there has been a downstream effect on general EDs, as system-wide clinical guidelines are usually initiated through the ED--such efforts are being reported in the literature. There is significant overlap in quality improvement efforts in adult and pediatric EDs. In this article, we review the recent relevant articles, with particular emphasis on pediatrics where appropriate. SUMMARY: There is an opportunity in pediatric emergency medicine to reduce practice variability, decrease cost and improve efficiency of care. There is an urgent need to report the successes and failures of these initiatives, so we can develop benchmarks and optimize services provided in the PED.
Current opinion in pediatrics 06/2010; 22(3):262-7. DOI:10.1097/MOP.0b013e3283396fe1 · 2.53 Impact Factor
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