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Schullo-Feulner A, Krohn L, Knutson A. Reducing Medication Therapy Problems in the Transition from Hospital to Home: A Pre- & Post-Discharge Pharmacist Collaboration. PHARMACY 2019; 7:pharmacy7030086. [PMID: 31323941 PMCID: PMC6789784 DOI: 10.3390/pharmacy7030086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND With 30-day Medicare readmission rates reaching 20%, a heightened focus has been placed on improving the transition process from hospital to home. For many institutions, this charge has identified medication-use safety as an area where pharmacists are well-positioned to improve outcomes by reducing medication therapy problems (MTPs). METHODS This system-wide (425 bed community hospital plus 18 primary care clinics) prospective study recruited inpatient and ambulatory pharmacists to provide comprehensive medication management before and after hospital discharge. The results analyzed were the success rate and timing of the inpatient to ambulatory pharmacist handoff, as well as the number, type, and severity of MTPs resolved in both settings. RESULTS Of the 105 eligible patients who received a pharmacist evaluation before discharge, 61 (58%) received follow-up with an ambulatory pharmacist an average of 2.88 days after discharge (range 1-8 days). An average of 5 and 1.4 MTPs per patient were identified and resolved in the inpatient vs. ambulatory setting, respectively. Although average MTP severity ratings were higher in the inpatient setting, the highest severity rating was seen most frequently in the ambulatory setting. CONCLUSIONS In the transition from hospital to home, pharmacist evaluation in both the inpatient and ambulatory settings are necessary to resolve medication therapy problems.
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Affiliation(s)
- Anne Schullo-Feulner
- Park Nicollet Health Services, St. Louis Park, MN 55426, USA.
- Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA.
| | - Lisa Krohn
- Park Nicollet Health Services, St. Louis Park, MN 55426, USA
| | - Alison Knutson
- Park Nicollet Health Services, St. Louis Park, MN 55426, USA
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Chadwick W, Bassett H, Hendrickson S, Slonaker K, Perales S, Pantaleoni J, Srinivas N, Platchek T, Destino L. An Improvement Effort to Optimize Electronically Generated Hospital Discharge Instructions. Hosp Pediatr 2019; 9:523-529. [PMID: 31243058 DOI: 10.1542/hpeds.2018-0251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The purpose of hospital discharge instructions (HDIs) is to facilitate safe patient transitions home, but electronic health records can generate lengthy documents filled with irrelevant information. When our institution changed electronic health records, a cumbersome electronic discharge workflow produced low-value HDI and contributed to a spike in discharge delays. Our aim was to decrease these delays while improving family and provider satisfaction with HDI. METHODS We used quality improvement methodology to redesign the electronic discharge navigator and HDI to address the following issues: (1) difficulty preparing discharge instructions before time of discharge, (2) suboptimal formatting of HDI, (3) lack of standard templates and language within HDI, and (4) difficulties translating HDI into non-English languages. Discharge delays due to HDI were tracked before and after the launch of our new discharge workflow. Parents and providers evaluated HDI and the electronic discharge workflow, respectively, before and after our intervention. Providers audited HDI for content. RESULTS Discharge delays due to HDI errors decreased from a mean of 3.4 to 0.5 per month after our intervention. Parents' ratings of how understandable our HDIs were improved from 2.35 to 2.74 postintervention (P = .05). Pediatric resident agreement that the electronic discharge process was easy to use increased from 9% to 67% after the intervention (P < .001). CONCLUSIONS Through multidisciplinary collaboration we facilitated advance preparation of more standardized HDI and decreased related discharge delays from the acute care units at a large tertiary care hospital.
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Affiliation(s)
- Whitney Chadwick
- Divisions of Pediatric Hospital Medicine and
- Departments of Clinical Informatics and
- Performance Improvement, Stanford Children's Health, Palo Alto, California
| | | | - Sarah Hendrickson
- Massachusetts General Hospital for Children and Harvard Medical School, Harvard University, Boston, Massachusetts; and
| | - Kimberly Slonaker
- Department of Pediatrics, Kaiser Permanente Northern California, Santa Clara, California
| | | | | | - Nivedita Srinivas
- Divisions of Pediatric Hospital Medicine and
- Pediatric Infectious Disease, School of Medicine, and
| | - Terry Platchek
- Divisions of Pediatric Hospital Medicine and
- Performance Improvement, Stanford Children's Health, Palo Alto, California
- Clinical Excellence Research Center, Stanford University, Stanford, California
| | - Lauren Destino
- Divisions of Pediatric Hospital Medicine and
- Performance Improvement, Stanford Children's Health, Palo Alto, California
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Teaching the Interplay Between Social Determinants of Health (SDH) and Health Outcomes: the ETGAR Student-Delivered Service. J Gen Intern Med 2019; 34:1103-1104. [PMID: 30859512 PMCID: PMC6614209 DOI: 10.1007/s11606-019-04904-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stevens L, Fry M, Browne M, Barnes A. Fast track patients’ satisfaction, compliance and confidence with emergency department discharge planning. Australas Emerg Care 2019; 22:87-91. [DOI: 10.1016/j.auec.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
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Cabilan CJ, Boyde M, Currey E. The effectiveness of pharmacist- led discharge medication counselling in the emergency department (ExPLAIN): A pilot quasi-experimental study. PATIENT EDUCATION AND COUNSELING 2019; 102:1157-1163. [PMID: 30712945 DOI: 10.1016/j.pec.2019.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of pharmacist-led discharge medication counselling using a structured, multimodal educational strategy with teach-back (intervention) against standard care. METHODS This was a quasi-experimental study in a public, metropolitan ED. Participants discharged home with new medications were allocated to receive the intervention or standard care using convenience sampling. Participant characteristics (i.e. age, sex, socio-economic status, medications) and health literacy were collected. The outcomes measured were satisfaction with information, ED re-presentation and length of stay. RESULTS There were 51 participants: 14 received intervention, 37 had standard care. Overall, 12% had inadequate health literacy. Group characteristics and health literacy were similar. Participants who received the intervention were significantly reported higher satisfaction with information about their new medications compared to standard care (p = 0.009). Specifically, the intervention was associated with a 98% increase in satisfaction with information relating to side-effects. There were no differences in re-presentation and length of stay. CONCLUSION Pharmacist-led discharge medication counselling incorporating a structured, multimodal educational strategy and teach-back was effective in improving patient satisfaction with medication information in the ED. PRACTICE IMPLICATIONS A similar intervention could be trialled in other EDs, but outcomes other beyond satisfaction should be considered.
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Affiliation(s)
- C J Cabilan
- Emergency Department, Princess Alexandra Hospital, Brisbane, Australia.
| | - Mary Boyde
- Cardiology/Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Elizabeth Currey
- Emergency Department, Princess Alexandra Hospital, Brisbane, Australia; Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
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Schultz H, Schultz Larsen T, Möller S, Qvist N. The Effect of Patient-Controlled Oral Analgesia for Acute Abdominal Pain after Discharge. Pain Manag Nurs 2019; 20:352-357. [PMID: 31103520 DOI: 10.1016/j.pmn.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND During hospitalization, patients who were admitted with acute abdominal pain must be prepared to care for themselves at home after discharge to continue established treatment, promote recovery, and avoid readmission. AIMS Our aim was to investigate the quality of pain management after discharge, when patient-controlled oral analgesia was compared with standard care for patients admitted to hospital with acute abdominal pain. The primary outcome measures were pain intensity and patient perception of care. The secondary outcome measures were pain interference with activity, affective experiences, side effects, and use of analgesics. DESIGN A questionnaire study measuring the effect of an intervention on patient-controlled oral analgesics. SETTINGS An emergency department and a surgical department in Denmark. PARTICIPANTS Patients admitted to hospital with acute abdominal pain. METHODS A pre- and postintervention study was conducted in an emergency department and a surgical department with three subunits. Data were collected using a Danish modified Revised American Pain Society Patient Outcome Questionnaire with five subscales (scale 0-10) completed in weeks 1 and 4 after discharge. RESULTS In total, 117 patients were included. The median scores at week 1 and week 4 in the control and intervention groups were, respectively, 2/1 and 1/0 on the pain subscale (p = .11/.16), 3/0 and 3/0 on the activity subscale (p = .19/.80), 1/0 and 0/0 on the emotional subscale (p = .02/.72), 1/0 and 1/0 on the side effect subscale (p = .95/.99), and 8/5 and 7/7 on the patient perception subscale (p = .35/.49). There was no significant difference in the use of analgesics at week 1. CONCLUSIONS Patient-controlled oral analgesia during the hospital stay did not improve the quality of pain management after discharge.
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Affiliation(s)
- Helen Schultz
- Surgical Department, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN (Odense Patient Data Explorative Network), Odense University Hospital, Odense, Denmark.
| | | | - Sören Möller
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN (Odense Patient Data Explorative Network), Odense University Hospital, Odense, Denmark
| | - Niels Qvist
- Surgical Department, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Schackow L, Lape JE. Mild brain injury education: preparing the caregiver. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aim The purpose of this pre-test, post-test study was to determine if caregivers of patients diagnosed with a mild brain injury feel better prepared for the caregiving role following a single, individualised education session in the acute care hospital setting. Methods A total of 17 patients and 21 caregivers were recruited. A pre-intervention survey was used to gather baseline perceptions on preparedness, worry, and brain injury knowledge. The intervention included a review of a mild brain injury educational booklet and a caregiver handout with the patient and caregiver during a 45–60-minute session. A post-intervention survey was used to assess caregivers' perceptions following the educational session. Findings The mean Likert survey responses of the caregivers indicated an improvement in the areas of worry, preparedness for caregiving, and understanding of brain injury post-intervention. Caregivers unanimously agreed that their understanding of brain injury and ability to manage the patients' symptoms was a direct result of the intervention. Conclusions The findings from this pilot study demonstrate the benefits of a single educational session with caregivers in the hospital setting. Exploring if the educational material was used by caregivers post-discharge is warranted to further support the results.
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Affiliation(s)
- LeAnn Schackow
- Occupational Therapist, Parkview Regional Medical Center, Fort Wayne, Indiana, US
| | - Jennifer E Lape
- Associate Professor of Occupational Therapy, Chatham University, Pittsburgh, Pennsylvania, US
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Choudhry AJ, Younis M, Ray-Zack MD, Glasgow AE, Haddad NN, Habermann EB, Jenkins DH, Heller SF, Schiller HJ, Zielinski MD. Enhanced readability of discharge summaries decreases provider telephone calls and patient readmissions in the posthospital setting. Surgery 2018; 165:789-794. [PMID: 30467038 DOI: 10.1016/j.surg.2018.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/22/2018] [Accepted: 10/13/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hospital discharge instructions provide critical information necessary for patients to manage their own care; however, often they are written at a substantially higher readability level than recommended (ie, 6th-grade level) by the American Medical Association and the National Institutes of Health. We hypothesize that improving the reading level of discharge instructions will decrease the number of patient telephone calls and readmissions in the posthospital setting. METHODS We conducted a prospective observational study. Patient discharge instructions were edited and incorporated to enhance the readability level in August 2015. Return telephone call and readmissions of patients admitted before the intervention from August 1, 2014, to January 31, 2015, were compared with the prospective cohort studied from September 1, 2015, to September 30, 2016. RESULTS A total of 1,072 patients were included (preintervention: n = 493, postintervention: n = 579). Patient demographics, injury characteristics, and education level were similar among both groups. The median discharge instruction readability level in the postintervention group was significantly lower (10.0, 95% CI 10.0-10.2 vs 8.6, 95% CI 8.8-8.9; P < .0001). The proportion of patients calling after hospital discharge was significantly reduced after the intervention (21.9% vs 9.0%; P < .0001). Monthly hospital readmissions were decreased by 50% for every 100 patients discharged after the intervention (1.9% vs 0.9%; P = .002). The proportion of patients calling and readmissions for poor pain control significantly decreased after the intervention (7.1% vs 2.59%; P = .0005 and 2.8% vs 1.0%; P = .029, respectively). CONCLUSION Enhanced readability of discharge instructions was associated with a decrease in the number of telephone calls and readmissions in the posthospital setting, enhancing health literacy and simultaneously reducing the burden on providers. Improved patient instructions written to an appropriate level may also allow for better pain control in the posthospital setting.
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Affiliation(s)
| | | | | | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic, Rochester, MN
| | | | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic, Rochester, MN
| | - Donald H Jenkins
- Division of Trauma and Emergency Surgery, The University of Texas Health Science Center at San Antonio, TX
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Carvalho TPD, Okuno MFP, Campanharo CRV, Lopes MCBT, Batista REA. Patients' knowledge about medication prescription in the emergency service. Rev Bras Enferm 2018; 71:329-335. [PMID: 29412290 DOI: 10.1590/0034-7167-2017-0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/08/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify which orientations were received by the patient about the medication prescription and which professional performed it; to evaluate the patients' knowledge about prescription drugs and to correlate it to socioeconomic variables, comorbidities, and the frequency with which the patient seeks emergency service; and to evaluate the knowledge about the medication prescribed after the health care. METHOD This was a cross-sectional study on 304 patients that received emergency service's discharge along with medication prescription. Applied instruments: sociodemographic characterization and evaluation of the knowledge about the prescribed medication. We used a descriptive and inferential analysis. RESULTS Most subjects had no doubts about how or for how long to take the medication; and presented questions about adverse reactions and what to do in case of forgetting to take the medication doses. There was a significant association between age; educational level; comorbidity; the frequency of emergency service's use; and knowledge about medications. CONCLUSION a total of 48% of the patients declared to need information about adverse effects and what to do if they forget to take the medication.
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Affiliation(s)
- Thaynara Paola de Carvalho
- Universidade Federal de São Paulo, Multi-professional Residency in Urgency and Emergency. São Paulo, Brazil
| | | | | | | | - Ruth Ester Assayag Batista
- Universidade Federal de São Paulo, Multi-professional Residency in Urgency and Emergency. São Paulo, Brazil
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Benjamin LS, Carney MM. Furthering the Value of the Emergency Department Beyond Its Walls: Transitions to the Medical Home for Pediatric Emergency Patients. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Malpractice in Emergency Medicine-A Review of Risk and Mitigation Practices for the Emergency Medicine Provider. J Emerg Med 2018; 55:659-665. [PMID: 30166074 DOI: 10.1016/j.jemermed.2018.06.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Malpractice in emergency medicine is of high concern for medical providers, the fear of which continues to drive decision-making. The body of evidence evaluating risk specific to emergency physicians is disjointed, and thus it remains difficult to derive cohesive themes and strategies for risk minimization. OBJECTIVE This review evaluates the state of malpractice in emergency medicine and summarizes a concise approach for the emergency physician to minimize risk. DISCUSSION The environment of the emergency department (ED) represents moderate overall malpractice risk and yields a heavy burden in finance and time. Key areas of relatively high litigation occurrence include missed acute myocardial infarction, missed fractures/foreign bodies, abdominal pain/appendicitis, wounds, intracranial bleeding, aortic aneurysm, and pediatric meningitis. Mitigation of risk is best accomplished through constructive communication, intelligent documentation, utilization of clinical practice guidelines and generalizable diagnoses, careful management of discharge against medical advice, and establishing follow-up for diagnostic studies ordered while in the ED (especially x-ray studies). Communication breakdown seems to be more predictive of malpractice litigation than injury experienced. CONCLUSIONS There are consistent diagnoses that are associated with increased litigation incidence. A combination of mitigation approaches may assist providers in mitigation of malpractice risk.
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Audio-Recorded Discharge Instructions for Limited English Proficient Parents: A Pilot Study. Jt Comm J Qual Patient Saf 2018; 45:98-107. [PMID: 30126714 DOI: 10.1016/j.jcjq.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Parents with limited English proficiency (LEP) demonstrate lower comprehension of discharge instructions. A study was conducted to (1) determine the feasibility of providing a greeting card with language-specific, audio-recorded discharge instructions to LEP parents; (2) describe use of and satisfaction with the cards; and (3) evaluate card effect on instruction comfort with home care and comprehension. METHODS LEP parents of children undergoing day surgery from April to September 2016 were eligible. Participants were randomized to usual discharge instructions, or usual instructions plus a three-minute card with language-specific audio instructions that could be replayed repeatedly. Parents were surveyed by telephone two to seven days postdischarge to assess card use and satisfaction, comfort with home care, and discharge instruction recall (medications, home care, follow-up, and return precautions). Parent-reported instructions were compared to instructions in the medical record; concordance was determined by two blinded reviewers. Due to difficulty achieving recruitment goals, analysis focused on feasibility and acceptability. RESULTS Of 83 parents enrolled, 66 (79.5%) completed the follow-up survey. Most had not completed high school (61.0%) and spoke Spanish (89.2%). Parents reported high satisfaction with the card (4.5/5 for ease of use, helpfulness, and understandability). Ninety-four percent shared the card with others, and 45.2% reported listening > 5 times. Besides reviewing the care instructions generally, parents reported using the card to review medications and engage others in the child's care. CONCLUSION Providing language-concordant, audio-recorded discharge instructions was feasible, and parents reported high satisfaction with and frequent use of the cards with multiple caregivers.
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Common Medication Management Approaches for Older Adults in the Emergency Department. Clin Geriatr Med 2018; 34:415-433. [DOI: 10.1016/j.cger.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Patient understanding of discharge instructions in the emergency department: do different patients need different approaches? Int J Emerg Med 2018; 11:5. [PMID: 29423767 PMCID: PMC5805670 DOI: 10.1186/s12245-018-0164-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 01/22/2018] [Indexed: 11/26/2022] Open
Abstract
Background Previous studies have demonstrated that patients have poor understanding of the discharge instructions provided from the emergency department (ED). The aims of this study are to determine if patient factors, such as income and level of education, correlate with patient understanding of discharge instructions and to explore if different patient populations prefer different resources for receiving discharge instructions. Methods We conducted live observations of physicians providing discharge instructions in the ED to 100 patients followed by a patient survey to determine their understanding in four domains (diagnosis, treatment plan, follow-up instructions, and return to ED (RTED) instructions) and collect patient demographics. We enrolled patients over the age of 18 being discharged home. We excluded non-English- or French-speaking patients and those with significant psychiatric history or cognitive impairment. We performed a two-way ANOVA analysis of patient factors and patient understanding. Results We found that patients had poor understanding of discharge instructions, ranging from 24.0% having poor understanding of their follow-up plan to 64.0% for RTED instructions. Almost half (42%) of patients did not receive complete discharge instructions. Lower income was correlated with a significant decrease in patient understanding of discharge diagnosis (p = 0.01) and RTED instructions (p = 0.04). Patients who did not complete high school trended towards lower levels of understanding of their diagnosis and treatment plan (p = 0.06). Lower income patients had a preference for receiving a follow-up phone call by a nurse, while higher income patients preferred online resources. Conclusions Lower income patients and those who have not completed high school are at a higher risk of poor understanding discharge instructions. As new technological solutions emerge to aid patient understanding of discharge instructions, our study suggests they may not aid those who are at the highest risk of failing to understand their instructions. Electronic supplementary material The online version of this article (10.1186/s12245-018-0164-0) contains supplementary material, which is available to authorized users.
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Da Dalt L, Parri N, Amigoni A, Nocerino A, Selmin F, Manara R, Perretta P, Vardeu MP, Bressan S. Italian guidelines on the assessment and management of pediatric head injury in the emergency department. Ital J Pediatr 2018; 44:7. [PMID: 29334996 PMCID: PMC5769508 DOI: 10.1186/s13052-017-0442-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/18/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury. METHODS These guidelines were commissioned by the Italian Society of Pediatric Emergency Medicine and include a systematic review and analysis of the literature published since 2005. Physicians with expertise and experience in the fields of pediatrics, pediatric emergency medicine, pediatric intensive care, neurosurgery and neuroradiology, as well as an experienced pediatric nurse and a parent representative were the components of the guidelines working group. Areas of direct interest included 1) initial assessment and stabilization in the ED, 2) diagnosis of clinically important traumatic brain injury in the ED, 3) management and disposition in the ED. The guidelines do not provide specific guidance on the identification and management of possible associated cervical spine injuries. Other exclusions are noted in the full text. CONCLUSIONS Recommendations to guide physicians practice when assessing children presenting to the ED following blunt head trauma are reported in both summary and extensive format in the guideline document.
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Affiliation(s)
- Liviana Da Dalt
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Niccolo' Parri
- Department of Pediatric Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Angela Amigoni
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Agostino Nocerino
- Department of Pediatrics, S. Maria della Misericordia University Hospital, University of Udine, Udine, Italy
| | - Francesca Selmin
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Renzo Manara
- Department of Radiology, Neuroradiology Unit, University of Salerno, Salerno, Italy
| | - Paola Perretta
- Neurosurgery Unit, Regina Margherita Pediatric Hospital, Torino, Italy
| | - Maria Paola Vardeu
- Pediatric Emergency Department, Regina Margherita Pediatric Hospital, Torino, Italy
| | - Silvia Bressan
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
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Biese KJ, Busby-Whitehead J, Cai J, Stearns SC, Roberts E, Mihas P, Emmett D, Zhou Q, Farmer F, Kizer JS. Telephone Follow-Up for Older Adults Discharged to Home from the Emergency Department: A Pragmatic Randomized Controlled Trial. J Am Geriatr Soc 2017; 66:452-458. [DOI: 10.1111/jgs.15142] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kevin J. Biese
- Department of Emergency Medicine; University of North Carolina; Chapel Hill North Carolina
- Center for Aging and Health; Department of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jan Busby-Whitehead
- Center for Aging and Health; Department of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jianwen Cai
- Department of Biostatistics; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Sally C. Stearns
- Department of Health Policy and Management; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Ellen Roberts
- Center for Aging and Health; Department of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Paul Mihas
- Howard W. Odum Institute for Research in Social Science; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Doug Emmett
- Center for Aging and Health; Department of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Qingning Zhou
- Department of Biostatistics; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Franklin Farmer
- Center for Aging and Health; Department of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - John S. Kizer
- Center for Aging and Health; Department of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
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Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series). Emerg Med Australas 2017; 30:152-180. [PMID: 29235235 DOI: 10.1111/1742-6723.12904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 09/26/2017] [Indexed: 12/16/2022]
Abstract
Ankle and foot injuries are the most common musculoskeletal injuries presenting to Australian EDs and are associated with a large societal and economic impact. The quality of ED care provided to patients with ankle and foot fractures or soft tissue injuries is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common ankle and foot injuries in the ED. Databases including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English language articles published in the last 12 years that addressed the acute assessment, management or prognosis in the ED were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 1242 articles, of which 71 were included in the review (n = 22 primary articles, n = 35 systematic reviews and n = 14 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the ankle and foot in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. Following a thorough history and physical examination, including the application of the Ottawa ankle rules, ED clinicians should not only provide a diagnosis, but rate the severity of soft tissue injuries, or stability of fractures and dislocations, which are the pivotal decision points in guiding ED treatment, specialist referral and the follow-up plan.
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Affiliation(s)
- Kirsten Strudwick
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan McPhee
- Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Anthony Bell
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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The Impact of Teach-Back Method on Retention of Key Domains of Emergency Department Discharge Instructions. J Emerg Med 2017; 53:e59-e65. [DOI: 10.1016/j.jemermed.2017.06.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/19/2017] [Accepted: 06/28/2017] [Indexed: 11/18/2022]
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A Web-based module and online video for pain management education for caregivers of children with fractures: A randomized controlled trial. CAN J EMERG MED 2017; 20:882-891. [PMID: 29041997 DOI: 10.1017/cem.2017.414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
IntroductionOver 80% of children experience compromise in functioning following a fracture. Digital media may improve caregiver knowledge of managing fracture pain at home. OBJECTIVES To determine whether an educational video was superior to an interactive web-based module (WBM) and verbal instructions, the standard of care (SOC). METHODS This randomized trial included caregivers of children 0-17 years presenting to the emergency department (ED) with non-operative fractures. Primary outcome was the gain score (pre-post intervention) on a 21-item questionnaire testing knowledge surrounding pain recognition and management for children with fractures. Secondary outcomes included survey of caregiver confidence in managing pain (five-item Likert scale), number of days with difficulty sleeping, before return to a normal diet, and work/school missed. RESULTS We analyzed 311 participants (WBM 99; video 108; SOC 104) with a mean (SD) child age of 9.6 (4.2) years, of which 125/311 (40.2%) were female. The video (delta=2.3, 95% CI: 1.3, 3.3; p<0.001) and WBM (delta=1.6; 95% CI: 0.5, 2.6; p=0.002) groups had significantly greater gain scores than the SOC group. The mean video gain score was not significantly greater than WBM (delta=0.7; 95% CI: -0.3, 1.8; p=0.25). There were no significant differences in caregiver confidence (p=0.4), number of absent school days (p=0.43), nights with difficulty sleeping (p=0.94), days before return to a normal diet (p=0.07), or workdays missed (p=0.95). CONCLUSIONS A web-based module and online video are superior to verbal instructions for improving caregiver knowledge on management of children's fracture pain without improvement in functional outcomes.
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70
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Abstract
Education to improve symptom management is an agreed-upon strategy to reduce the impact of symptoms on the quality of life for persons with mild traumatic brain injury. The purpose of this study was to investigate whether current discharge education practices are deemed adequate by persons treated and released from the emergency department with concussion. A review of current literature identified a need for patient education improvements in emergency departments. Strategies for improving information retention in the mild traumatic brain injury patient population for effective symptom management are identified. A concussion symptom management booklet was created using current scientific information. The concussion education booklet along with standardized postconcussion education was provided to patients with mild traumatic brain injuries who were discharged from a level I trauma center emergency department. A prospective small-scale study was performed to establish the ease of use and usefulness of the newly created concussion education booklet and determine whether patients preferred the booklet of information over the standard discharge instructions.
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71
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Glick AF, Farkas JS, Nicholson J, Dreyer BP, Fears M, Bandera C, Stolper T, Gerber N, Yin HS. Parental Management of Discharge Instructions: A Systematic Review. Pediatrics 2017; 140:e20164165. [PMID: 28739657 PMCID: PMC5527669 DOI: 10.1542/peds.2016-4165] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 12/24/2022] Open
Abstract
CONTEXT Parents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can put children at risk for adverse outcomes. Parents' ability to manage discharge instructions has not been examined before in a systematic review. OBJECTIVE To perform a systematic review of the literature related to parental management (knowledge and execution) of inpatient and ED discharge instructions. DATA SOURCES We consulted PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane CENTRAL (from database inception to January 1, 2017). STUDY SELECTION We selected experimental or observational studies in the inpatient or ED settings in which parental knowledge or execution of discharge instructions were evaluated. DATA EXTRACTION Two authors independently screened potential studies for inclusion and extracted data from eligible articles by using a structured form. RESULTS Sixty-four studies met inclusion criteria; most (n = 48) were ED studies. Medication dosing and adherence errors were common; knowledge of medication side effects was understudied (n = 1). Parents frequently missed follow-up appointments and misunderstood return precaution instructions. Few researchers conducted studies that assessed management of instructions related to diagnosis (n = 3), restrictions (n = 2), or equipment (n = 1). Complex discharge plans (eg, multiple medicines or appointments), limited English proficiency, and public or no insurance were associated with errors. Few researchers conducted studies that evaluated the role of parent health literacy (ED, n = 5; inpatient, n = 0). LIMITATIONS The studies were primarily observational in nature. CONCLUSIONS Parents frequently make errors related to knowledge and execution of inpatient and ED discharge instructions. Researchers in the future should assess parental management of instructions for domains that are less well studied and focus on the design of interventions to improve discharge plan management.
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Affiliation(s)
- Alexander F Glick
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Jonathan S Farkas
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | | | - Benard P Dreyer
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Melissa Fears
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Christopher Bandera
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Tanya Stolper
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Nicole Gerber
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - H Shonna Yin
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
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Fermann GJ, Levy PD, Pang P, Butler J, Ayaz SI, Char D, Dunn P, Jenkins CA, Kampe C, Khan Y, Kumar VA, Lindenfeld J, Liu D, Miller K, Peacock WF, Rizk S, Robichaux C, Rothman RL, Schrock J, Singer A, Sterling SA, Storrow AB, Walsh C, Wilburn J, Collins SP. Design and Rationale of a Randomized Trial of a Care Transition Strategy in Patients With Acute Heart Failure Discharged From the Emergency Department: GUIDED-HF (Get With the Guidelines in Emergency Department Patients With Heart Failure). Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003581. [PMID: 28188268 DOI: 10.1161/circheartfailure.116.003581] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/18/2017] [Indexed: 11/16/2022]
Abstract
GUIDED-HF (Get With the Guidelines in Emergency Department Patients With Heart Failure) is a multicenter randomized trial of a patient-centered transitional care intervention in patients with acute heart failure (AHF) who are discharged either directly from the emergency department (ED) or after a brief period of ED-based observation. To optimize care and reduce ED and hospital revisits, there has been significant emphasis on improving transitions at the time of hospital discharge for patients with HF. Such efforts have been almost exclusively directed at hospitalized patients; individuals with AHF who are discharged from the ED or ED-based observation are not included in these transitional care initiatives. Patients with AHF discharged directly from the ED or after a brief period of ED-based observation are randomly assigned to our transition GUIDED-HF strategy or standard ED discharge. Patients in the GUIDED arm receive a tailored discharge plan via the study team, based on their identified barriers to outpatient management and associated guideline-based interventions. This plan includes conducting a home visit soon after ED discharge combined with close outpatient follow-up and subsequent coaching calls to improve postdischarge care and avoid subsequent ED revisits and inpatient admissions. Up to 700 patients at 11 sites will be enrolled over 3 years of the study. GUIDED-HF will test a novel approach to AHF management strategy that includes tailored transitional care for patients discharged from the ED or ED-based observation. If successful, this program may significantly alter the current paradigm of AHF patient care. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02519283.
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Affiliation(s)
- Gregory J Fermann
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Phillip D Levy
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Peter Pang
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Javed Butler
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - S Imran Ayaz
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Douglas Char
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Patrick Dunn
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Cathy A Jenkins
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Christy Kampe
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Yosef Khan
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Vijaya A Kumar
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - JoAnn Lindenfeld
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Dandan Liu
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Karen Miller
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - W Frank Peacock
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Samaa Rizk
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Chad Robichaux
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Russell L Rothman
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Jon Schrock
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Adam Singer
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Sarah A Sterling
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Alan B Storrow
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Cheryl Walsh
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - John Wilburn
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Sean P Collins
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.).
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Que comprennent les patients laissés sur place par le Smur quant aux informations communiquées par le médecin ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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An Intervention to Improve Caregiver Adherence to Oral Rehydration Therapy. Pediatr Qual Saf 2017; 2:e020. [PMID: 30229158 PMCID: PMC6132460 DOI: 10.1097/pq9.0000000000000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 02/28/2017] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objective: To improve oral rehydration therapy (ORT) after discharge for children presenting to the emergency department (ED) with acute gastroenteritis (AGE). Methods: We designed and implemented a quality improvement initiative to improve caregiver adherence to ORT in children 6 months to 21 years old with AGE. The intervention consisted of ORT “kits” with rehydration supplies and caregiver instructions. In the preintervention period we monitored patient/caregiver adherence to ORT recommendations and additionally monitored ORT kit and educational material distribution during the intervention phase via a caregiver survey after discharge. We utilized statistical process control methodology to assess responses to the intervention. As a balancing measure, we monitored the ED length of stay for patients with AGE. Results: Over the study period from November 2013 to April 2015, we included 174 encounters during the preintervention period and 256 encounters during the intervention period. More than 9 of 10 children received ORT kits in the intervention period. Self-reported adherence to ORT between the 2 time periods remained constant. The ED length of stay did not change between the preintervention and intervention period. Conclusions: Despite successful distribution of novel ORT materials and education for caregivers of children with AGE in a pediatric ED, caregiver self-reported adherence to ORT postdischarge visit was unchanged. An unexpected high baseline adherence to ORT practices may have limited improvement.
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Curran JA, Bishop A, Plint A, MacPhee S, Zemek R, Chorney J, Jabbour M, Porter S, Sawyer S. Understanding discharge communication behaviours in a pediatric emergency care context: a mixed methods observation study protocol. BMC Health Serv Res 2017; 17:276. [PMID: 28412951 PMCID: PMC5392912 DOI: 10.1186/s12913-017-2204-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the most important transitions in the continuum of care for children is discharge to home. Optimal discharge communication between healthcare providers and caregivers (e.g., parents or other guardians) who present to the emergency department (ED) with their children is not well understood. The lack of policies and considerable variation in practice regarding discharge communication in pediatric EDs pose a quality and safety risk for children and their parents. METHODS The aim of this mixed methods study is to better understand the process and structure of discharge communication in a pediatric ED context to contribute to the design and development of discharge communication interventions. We will use surveys, administrative data and real-time video observation to characterize discharge communication for six common illness presentations in a pediatric ED: (1) asthma, (2) bronchiolitis, (3) abdominal pain, (4) fever, (5) diarrhea and vomiting, and (6) minor head injury. Participants will be recruited from one of two urban pediatric EDs in Canada. Video recordings will be analyzed using Observer XT. We will use logistic regression to identify potential demographic and visit characteristic cofounders and multivariate logistic regression to examine association between verbal and non-verbal behaviours and parent recall and comprehension. DISCUSSION Video recording of discharge communication will provide an opportunity to capture important data such as temporality, sequence and non-verbal behaviours that might influence the communication process. Given the importance of better characterizing discharge communication to identify potential barriers and enablers, we anticipate that the findings from this study will contribute to the development of more effective discharge communication policies and interventions.
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Affiliation(s)
- Janet A. Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia B3H 4R2 Canada
| | - Andrea Bishop
- School of Nursing, Dalhousie University, Halifax, Nova Scotia B3H 4R2 Canada
| | - Amy Plint
- Department of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario K1H 8M5 Canada
- Children’s Hospital of Eastern Ontario Research Insititute, Ottawa, Ontario Canada
| | - Shannon MacPhee
- Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia B3H 4R2 Canada
| | - Roger Zemek
- Department of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario K1H 8M5 Canada
- Children’s Hospital of Eastern Ontario Research Insititute, Ottawa, Ontario Canada
| | - Jill Chorney
- Department of Anesthesia, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia B3H 4R2 Canada
| | - Mona Jabbour
- Department of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario K1H 8M5 Canada
- Children’s Hospital of Eastern Ontario Research Insititute, Ottawa, Ontario Canada
| | - Stephen Porter
- Division Of Emergency Medicine, Hospital for Sick Children, Toronto, M5G 1X8 Ontario Canada
| | - Scott Sawyer
- Pediatric Emergency Medicine, Manitoba Children’s Hospital, Winnipeg, Manitoba R3A 1S1 Canada
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Alberti TL, Morris NJ. Health literacy in the urgent care setting: What factors impact consumer comprehension of health information? J Am Assoc Nurse Pract 2017; 29:242-247. [PMID: 28296227 DOI: 10.1002/2327-6924.12452] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/25/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND An increasing number of Americans are using urgent care (UC) clinics due to: improved health insurance coverage, the need to decrease cost, primary care offices with limited appointment availability, and a desire for convenient care. Patients are treated by providers they may not know for episodic illness or injuries while in pain or not feeling well. Treatment instructions and follow-up directions are provided quickly. PURPOSE To examine health literacy in the adult UC population and identify patient characteristics associated with health literacy risk. METHODS As part of a larger cross-sectional study, UC patients seen between October 2013 and January 2014 completed a demographic questionnaire and the Newest Vital Sign. Descriptive, nonparametric analyses, and a multinomial logistic regression were done to assess health literacy, associated and predictive factors. RESULTS A total of 57.5% of 285 participants had adequate health literacy. The likelihood of limited health literacy was associated with increased age (p < .001), less education (p < .001), and lower income (p = .006). CONCLUSIONS/IMPLICATIONS Limited health literacy is common in a suburban UC setting, increasing the risk that consumers may not understand vital health information. Clear provider communication and confirmation of comprehension of discharge instructions for self-management is essential to optimize outcomes for UC patients.
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Affiliation(s)
- Traci L Alberti
- Department of Health Sciences, Merrimack College, North Andover, Massachusetts
| | - Nancy J Morris
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts
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Abstract
OBJECTIVE This study aimed to determine the level of health literacy in a postoperative orthopaedic trauma population and to evaluate the efficacy of a simple predischarge discussion strategy, targeted at improving health literacy. DESIGN A pre-post intervention study was conducted from April 2014 to January 2015. SETTING Academic Level 1 trauma center. PARTICIPANTS One hundred ninety consecutive orthopaedic trauma patients with operatively managed lower limb fractures were recruited. All eligible participants agreed to participate. INTERVENTION The first ninety-nine patients received usual care (UC). The following 91 patients received a structured predischarge discussion, including x-rays, written and verbal information, from the orthopaedic staff (DG). Patients were then randomized into health literacy evaluation before first outpatient review or after first outpatient review. MAIN OUTCOME MEASURES The primary outcome measure was a questionnaire determining health literacy. RESULTS Ninety-six (97%) of the UC patients and 87 (96%) of the discussion patients (DG) completed the interview. UC preoutpatient (n = 46) demonstrated a mean score of 4.67 of a maximum 8. UC postoutpatient (n = 50) demonstrated a mean score of 5.42. DG preoutpatient (n = 47) demonstrated a mean score of 6.70. DG postoutpatient (n = 40) demonstrated a mean score of 7.08. CONCLUSIONS Australian orthopaedic trauma patients demonstrate poor health literacy, with this not showing improvement after their first outpatient follow-up visit. The use of a time efficient, structured predischarge discussion improved patient health literacy. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Hernandez J, Corker J, Roppolo L, Jones K, Hsu D, Arthur DE, Hynan L. Evaluation of the R2D2 protocol: A Novel Method for Assessing Emergency Department Disposition for Residents. AEM EDUCATION AND TRAINING 2017; 1:34-40. [PMID: 30051006 PMCID: PMC6001825 DOI: 10.1002/aet2.10007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 06/08/2023]
Abstract
BACKGROUND The emergency department (ED) disposition and discharge process is a critical period in a patient's transition from an acute care setting to self-care or a bridge to other healthcare providers. The emergency physician plays a pivotal role in this process and is ultimately responsible for ensuring that patients are safely released from their care. We developed a protocol to guide residents through the ED discharge process using the mnemonic "R2D2": reassess the patient, recheck the workup, discuss the disposition plan with the attending, and finally discuss the discharge plan with the patient. OBJECTIVES The objective was to assess the effectiveness of the R2D2 discharge protocol, executed by resident physicians, in improving patients' understanding of their diagnosis and treatment plans. METHODS This is a before-and-after study in the ED of a county hospital and included all patients discharged by a resident physician from the ED 1 week before and 1 week after implementation of the R2D2 protocol. All participating resident physicians received a brief 10-minute orientation to the R2D2 protocol at the end of the first week of the study period. Consecutive patients were identified, consented, and given a brief questionnaire about their discharge by research assistants. Certain exclusion criteria applied such as inability to speak English or Spanish or no phone for follow-up. One to 2 weeks after ED discharge, patients from both groups were contacted by phone to assess their recall of their discharge instructions. Data analyses were performed using Fisher's exact, chi-square tests, or two independent-sample proportions tests as appropriate. RESULTS We recruited 164 patients in the control group and 148 patients in the intervention group, totaling 312 patients. A total of 73.8% of the control group patients and 77.0% of the intervention group patients completed the follow-up. On telephone follow-up, 88% of the intervention patients knew their discharge diagnosis versus only 74% of control patients (p = 0.0062). Eighty percent of intervention patients knew their discharge treatment plan versus only 67% of control patients (p = 0.0259). CONCLUSIONS The R2D2 protocol resulted in significant improvement in patients' understanding of their discharge diagnosis and treatment plan.
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Affiliation(s)
| | - John Corker
- Department of Emergency MedicineUniversity Texas SouthwesternDallasTX
| | - Lynn Roppolo
- Department of Emergency MedicineUniversity Texas SouthwesternDallasTX
| | - Kyle Jones
- Medical StudentUniversity Texas SouthwesternDallasTX
| | - Daniel Hsu
- Medical StudentUniversity Texas SouthwesternDallasTX
| | - D'Ann Elizabeth Arthur
- Department of Emergency MedicineUniversity Texas SouthwesternDallasTX
- Department of OrthopedicsHarbor UCLA Medical CenterLos AngelesCA
| | - Linda Hynan
- Department of Clinical Sciences and PsychiatryUniversity Texas SouthwesternDallasTX
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Hogan TM, Richmond NL, Carpenter CR, Biese K, Hwang U, Shah MN, Escobedo M, Berman A, Broder JS, Platts-Mills TF. Shared Decision Making to Improve the Emergency Care of Older Adults: A Research Agenda. Acad Emerg Med 2016; 23:1386-1393. [PMID: 27561819 DOI: 10.1111/acem.13074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/01/2016] [Accepted: 08/23/2016] [Indexed: 12/20/2022]
Abstract
Older emergency department patients have high rates of serious illness and injury, are at high risk for side effects and adverse events from treatments and diagnostic tests, and in many cases, have nuanced goals of care in which pursuing the most aggressive approach is not desired. Although some forms of shared decision making (SDM) are commonly practiced by emergency physicians caring for older adults, broader use of SDM in this setting is limited by a lack of knowledge of the types of patients and conditions for which SDM is most helpful and the approaches and tools that can best facilitate this process. We describe a research agenda to generate new knowledge to optimize the use of SDM during the emergency care of older adults.
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Affiliation(s)
| | - Natalie L. Richmond
- School of Medicine; University of North Carolina at Chapel Hill; Chapel Hill NC
| | | | - Kevin Biese
- Department of Emergency Medicine; University of North Carolina at Chapel Hill; Chapel Hill NC
| | - Ula Hwang
- Icahn School of Medicine at Mount Sinai; New York NY
| | - Manish N. Shah
- Department of Emergency Medicine; University of Wisconsin; Madison WI
| | | | - Amy Berman
- John A. Hartford Foundation; New York NY
| | | | - Timothy F. Platts-Mills
- Department of Emergency Medicine and the Department of Anesthesiology; University of North Carolina at Chapel Hill; Chapel Hill NC
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Choo EK, Tapé C, Glerum KM, Mello MJ, Zlotnick C, Guthrie KM. "That's Where the Arguments Come in": A Qualitative Analysis of Booster Sessions Following a Brief Intervention for Drug Use and Intimate Partner Violence in the Emergency Department. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:77-87. [PMID: 27660459 PMCID: PMC5021012 DOI: 10.4137/sart.s33388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/22/2016] [Accepted: 05/27/2016] [Indexed: 12/31/2022]
Abstract
Although booster phone calls have been used to enhance the impact of brief interventions in the emergency department, there has been less number of studies describing the content of these boosters. We conducted a qualitative analysis of booster calls occurring two weeks after an initial Web-based intervention for drug use and intimate partner violence (IPV) among women presenting for emergency care, with the objective of identifying the following: progress toward goals set during the initial emergency department visit, barriers to positive change, and additional resources and services needed in order to inform improvements in future booster sessions. The initial thematic framework was developed by summarizing codes by major themes and subthemes; the study team collaboratively decided on a final thematic framework. Eighteen participants completed the booster call. Most of them described a therapeutic purpose for their drug use. Altering the social milieu was the primary means of drug use change; this seemed to increase isolation of women already in abusive relationships. Women described IPV as interwoven with drug use. Participants identified challenges in attending substance use treatment service and domestic violence agencies. Women with substance use disorders and in abusive relationships face specific barriers to reducing drug use and to seeking help after a brief intervention.
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Affiliation(s)
- Esther K Choo
- Injury Prevention Center, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.; Division of Sex and Gender in Emergency Medicine, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.; Brown University School of Public Health, Providence, RI, USA.; Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Chantal Tapé
- Division of Sex and Gender in Emergency Medicine, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Michael J Mello
- Injury Prevention Center, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.; Brown University School of Public Health, Providence, RI, USA
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kate Morrow Guthrie
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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Mowery DL, South BR, Christensen L, Leng J, Peltonen LM, Salanterä S, Suominen H, Martinez D, Velupillai S, Elhadad N, Savova G, Pradhan S, Chapman WW. Normalizing acronyms and abbreviations to aid patient understanding of clinical texts: ShARe/CLEF eHealth Challenge 2013, Task 2. J Biomed Semantics 2016; 7:43. [PMID: 27370271 PMCID: PMC4930590 DOI: 10.1186/s13326-016-0084-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 06/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ShARe/CLEF eHealth challenge lab aims to stimulate development of natural language processing and information retrieval technologies to aid patients in understanding their clinical reports. In clinical text, acronyms and abbreviations, also referenced as short forms, can be difficult for patients to understand. For one of three shared tasks in 2013 (Task 2), we generated a reference standard of clinical short forms normalized to the Unified Medical Language System. This reference standard can be used to improve patient understanding by linking to web sources with lay descriptions of annotated short forms or by substituting short forms with a more simplified, lay term. METHODS In this study, we evaluate 1) accuracy of participating systems' normalizing short forms compared to a majority sense baseline approach, 2) performance of participants' systems for short forms with variable majority sense distributions, and 3) report the accuracy of participating systems' normalizing shared normalized concepts between the test set and the Consumer Health Vocabulary, a vocabulary of lay medical terms. RESULTS The best systems submitted by the five participating teams performed with accuracies ranging from 43 to 72 %. A majority sense baseline approach achieved the second best performance. The performance of participating systems for normalizing short forms with two or more senses with low ambiguity (majority sense greater than 80 %) ranged from 52 to 78 % accuracy, with two or more senses with moderate ambiguity (majority sense between 50 and 80 %) ranged from 23 to 57 % accuracy, and with two or more senses with high ambiguity (majority sense less than 50 %) ranged from 2 to 45 % accuracy. With respect to the ShARe test set, 69 % of short form annotations contained common concept unique identifiers with the Consumer Health Vocabulary. For these 2594 possible annotations, the performance of participating systems ranged from 50 to 75 % accuracy. CONCLUSION Short form normalization continues to be a challenging problem. Short form normalization systems perform with moderate to reasonable accuracies. The Consumer Health Vocabulary could enrich its knowledge base with missed concept unique identifiers from the ShARe test set to further support patient understanding of unfamiliar medical terms.
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Affiliation(s)
- Danielle L Mowery
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
| | - Brett R South
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Lee Christensen
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Jianwei Leng
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Laura-Maria Peltonen
- Nursing Science, University of Turku, and Turku University Hospital, Turku, Finland
| | - Sanna Salanterä
- Nursing Science, University of Turku, and Turku University Hospital, Turku, Finland
| | - Hanna Suominen
- Data61, CSIRO, The Australian National University, University of Canberra, and University of Turku, Locked Bag 8001, Canberra, 2601, ACT, Australia
| | - David Martinez
- MedWhat.com, San Francisco, CA, USA.,University of Melbourne, Parkville, VIC, Australia
| | - Sumithra Velupillai
- Department of Computer and Systems Sciences (DSV), Stockholm University, Stockholm, Sweden
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Guergana Savova
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sameer Pradhan
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wendy W Chapman
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
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82
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Ackermann S, Ghanim L, Heierle A, Hertwig R, Langewitz W, Mata R, Bingisser R. Information structuring improves recall of emergency discharge information: a randomized clinical trial. PSYCHOL HEALTH MED 2016; 22:646-662. [PMID: 27309340 DOI: 10.1080/13548506.2016.1198816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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83
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Anderson RE, Birge SJ. Cognitive Dysfunction, Medication Management, and the Risk of Readmission in Hospital Inpatients. J Am Geriatr Soc 2016; 64:1464-8. [PMID: 27305636 DOI: 10.1111/jgs.14200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether cognitive dysfunction, in particular impaired executive function, may be a risk factor for early readmission in older adults independently managing their medications. DESIGN Prospective observational study. SETTING Tertiary hospital. PARTICIPANTS Individuals aged 65 years and older discharged to home from the medicine service of a tertiary hospital (N = 452). MEASUREMENTS Participants underwent a cognitive assessment including the Short Blessed Test (SBT), the executive function component of the Montreal Cognitive Assessment, and the Trail-Making Test Part B (TMT-B). Hospital use and demographic data were obtained. A logistic regression model was used to fit the likelihood of readmission on the basis of participant characteristics, medication management, and cognitive performance. Likelihood of hospital readmission within 30 days was determined. RESULTS For participants managing medications themselves, adjusted 30-day odds of readmission increased 13% on average with each point decrease in SBT score (P = .003) and 9% on average with each 0.01 decrease in TMT-B score (P = .02). For participants who were independent in medication management with more than seven medications, the odds of 30-day readmission increased 16% on average with each point decrease in SBT score (P = .01) and 15% on average with each 0.01 decrease in TMT-B score (P = .03). CONCLUSION Cognitive dysfunction, particularly executive dysfunction, is a risk factor for readmission in individuals managing their own medications. This risk is greater in individuals taking more than seven medications. The interaction of cognitive function, medication management, and number of medications may enhance risk-stratification efforts to identify individuals at risk of early readmission.
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Affiliation(s)
- Ryan E Anderson
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stanley J Birge
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
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84
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Primary Care Follow-up After Emergency Department Visits for Routine Complaints: What Primary Care Physicians Prefer and What Emergency Department Physicians Currently Recommend. Pediatr Emerg Care 2016; 32:371-6. [PMID: 25695845 DOI: 10.1097/pec.0000000000000314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Given that the vast majority of pediatric patients that present to the emergency department (ED) are discharged home after their visit, one issue for study is the appropriate recommendations for follow-up after the ED visit. Numerous PubMed searches using various keywords revealed a gap in the literature regarding the desires of primary care physicians (PCPs) concerning follow-up after ED visits. This study was conducted to determine how pediatric emergency medicine (PEM) physicians' recommendations for follow-up align with the desires of (PCPs) for follow-up after ED visits. METHODS An electronic survey was distributed to pediatric emergency physicians at one community-based academic institution regarding current recommendations for follow-up with PCPs for 12 common diagnoses seen in the ED. A similar survey was sent to pediatricians in the same community inquiring about their desires for follow-up after their patients are seen in the ED for the same diagnoses. RESULTS Completion rates for the survey were 40/40 (100%) for PEM physicians and 78/145 (54%) for pediatricians. In 11/12 of the diagnoses included, PEM physicians recommended a statistically significant (P < 0.05) closer follow-up than desired by the PCPs. CONCLUSIONS Recommendations for follow-up made by PEM physicians and desired by PCPs vary significantly. Overall, PEM physicians recommend closer follow-up than desired by PCPs for low acuity complaints. Closing of this gap may allow for a better allocation of resources and consistency of care.
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85
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Hill B, Perri-Moore S, Kuang J, Bray BE, Ngo L, Doig A, Zeng-Treitler Q. Automated pictographic illustration of discharge instructions with Glyph: impact on patient recall and satisfaction. J Am Med Inform Assoc 2016; 23:1136-1142. [PMID: 27234601 DOI: 10.1093/jamia/ocw019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 12/07/2015] [Accepted: 01/23/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES First, to evaluate the effect of standard vs pictograph-enhanced discharge instructions on patients' immediate and delayed recall of and satisfaction with their discharge instructions. Second, to evaluate the effect of automated pictograph enhancement on patient satisfaction with their discharge instructions. MATERIALS AND METHODS Glyph, an automated healthcare informatics system, was used to automatically enhance patient discharge instructions with pictographs. Glyph was developed at the University of Utah by our research team. Patients in a cardiovascular medical unit were randomized to receive pictograph-enhanced or standard discharge instructions. Measures of immediate and delayed recall and satisfaction with discharge instructions were compared between two randomized groups: pictograph (n = 71) and standard (n = 73). RESULTS Study participants who received pictograph-enhanced discharge instructions recalled 35% more of their instructions at discharge than those who received standard discharge instructions. The ratio of instructions at discharge was: standard = 0.04 ± 0.03 and pictograph-enhanced = 0.06 ± 0.03. The ratio of instructions at 1 week post discharge was: standard = 0.04 ± 0.02 and pictograph-enhanced 0.04 ± 0.02. Additionally, study participants who received pictograph-enhanced discharge instructions were more satisfied with the understandability of their instructions at 1 week post-discharge than those who received standard discharge instructions. DISCUSSION Pictograph-enhanced discharge instructions have the potential to increase patient understanding of and satisfaction with discharge instructions. CONCLUSION It is feasible to automatically illustrate discharge instructions and provide them to patients in a timely manner without interfering with clinical work. Illustrations in discharge instructions were found to improve patients' short-term recall of discharge instructions and delayed satisfaction (1-week post hospitalization) with the instructions. Therefore, it is likely that patients' understanding of and interaction with their discharge instructions is improved by the addition of illustrations.
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Affiliation(s)
- Brent Hill
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Seneca Perri-Moore
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Jinqiu Kuang
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Bruce E Bray
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Long Ngo
- Harvard School of Medicine, Harvard University, Boston, MA, USA
| | - Alexa Doig
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Qing Zeng-Treitler
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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86
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Sarzynski E, Hashmi H, Subramanian J, Fitzpatrick L, Polverento M, Simmons M, Brooks K, Given C. Opportunities to improve clinical summaries for patients at hospital discharge. BMJ Qual Saf 2016; 26:372-380. [PMID: 27154878 DOI: 10.1136/bmjqs-2015-005201] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/30/2016] [Accepted: 04/15/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Clinical summaries are electronic health record (EHR)-generated documents given to hospitalised patients during the discharge process to review their hospital stays and inform postdischarge care. Presently, it is unclear whether clinical summaries include relevant content or whether healthcare organisations configure their EHRs to generate content in a way that promotes patient self-management after hospital discharge. We assessed clinical summaries in three relevant domains: (1) content; (2) organisation; and (3) readability, understandability and actionability. METHODS Two authors performed independent retrospective chart reviews of 100 clinical summaries generated at two Michigan hospitals using different EHR vendors for patients discharged 1 April -30 June 2014. We developed an audit tool based on the Meaningful Use view-download-transmit objective and the Society of Hospital Medicine Discharge Checklist (content); the Institute of Medicine recommendations for distributing easy-to-understand print material (organisation); and five readability formulas and the Patient Education Materials Assessment Tool (readability, understandability and actionability). RESULTS Clinical summaries averaged six pages (range 3-12). Several content elements were universally auto-populated into clinical summaries (eg, medication lists); others were not (eg, care team). Eighty-five per cent of clinical summaries contained discharge instructions, more often generated from third-party sources than manually entered by clinicians. Clinical summaries contained an average of 14 unique messages, including non-clinical elements irrelevant to postdischarge care. Medication list organisation reflected reconciliation mandates, and dosing charts, when present, did not carry column headings over to subsequent pages. Summaries were written at the 8th-12th grade reading level and scored poorly on assessments of understandability and actionability. Inter-rater reliability was strong for most elements in our audit tool. CONCLUSIONS Our study highlights opportunities to improve clinical summaries for guiding patients' postdischarge care.
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Affiliation(s)
- Erin Sarzynski
- Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.,Institute for Health Policy, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Hamza Hashmi
- Grand Rapids Medical Education Partners, Grand Rapids, Michigan, USA
| | | | - Laurie Fitzpatrick
- Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Molly Polverento
- Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.,Institute for Health Policy, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | | | - Kevin Brooks
- Institute for Health Policy, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Charles Given
- Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.,Institute for Health Policy, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
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87
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Ismail S, McIntosh M, Kalynych C, Joseph M, Wylie T, Butterfield R, Smotherman C, Kraemer DF, Osian SR. Impact of Video Discharge Instructions for Pediatric Fever and Closed Head Injury from the Emergency Department. J Emerg Med 2016; 50:e177-83. [DOI: 10.1016/j.jemermed.2015.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/17/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
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88
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Perri S, Argo L, Kuang J, Bui D, Hill B, Bray B, Treitler-Zeng Q. A PICTURE'S MEANING: THE DESIGN AND EVALUATION OF PICTOGRAPHS ILLUSTRATING PATIENT DISCHARGE INSTRUCTIONS. JOURNAL OF COMMUNICATION IN HEALTHCARE 2016; 8:335-349. [PMID: 36876228 PMCID: PMC9983759 DOI: 10.1080/17538068.2016.1145877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Seneca Perri
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste. 140, Salt Lake City, UT 84112
| | - Lauren Argo
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste. 140, Salt Lake City, UT 84112
| | - Jinqiu Kuang
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste. 140, Salt Lake City, UT 84112
| | - Duy Bui
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste. 140, Salt Lake City, UT 84112
| | - Brent Hill
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste. 140, Salt Lake City, UT 84112
- College of Nursing, University of Utah, Salt Lake City, Utah, 10 South 2000 East,
Salt Lake City, UT 84112
| | - Bruce Bray
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste. 140, Salt Lake City, UT 84112
- School of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132
| | - Qing Treitler-Zeng
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste. 140, Salt Lake City, UT 84112
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89
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DeLaney MC, Page DB, Kunstadt EB, Ragan M, Rodgers J, Wang HE. Inability of Physicians and Nurses to Predict Patient Satisfaction in the Emergency Department. West J Emerg Med 2016; 16:1088-93. [PMID: 26759661 PMCID: PMC4703155 DOI: 10.5811/westjem.2015.9.28177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/03/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Patient satisfaction is a commonly assessed dimension of emergency department (ED) care quality. The ability of ED clinicians to estimate patient satisfaction is unknown. We sought to evaluate the ability of emergency medicine resident physicians and nurses to predict patient-reported satisfaction with physician and nursing care, pain levels, and understanding of discharge instructions. Methods We studied a convenience sample of 100 patients treated at an urban academic ED. Patients rated satisfaction with nursing care, physician care, pain level at time of disposition and understanding of discharge instructions. Resident physicians and nurses estimated responses for each patient. We compared patient, physician and nursing responses using Cohen’s kappa, weighting the estimates to account for the ordinal responses. Results Overall, patients had a high degree of satisfaction with care provided by the nurses and physicians, although this was underestimated by providers. There was poor agreement between physician estimation of patient satisfaction (weighted κ=0.23, standard error: 0.078) and nursing estimates of patient satisfaction (weighted κ=0.11, standard error: 0.043); physician estimation of patient pain (weighted κ=0.43, standard error: 0.082) and nursing estimates (weighted κ=0.39, standard error: 0.081); physician estimates of patient comprehension of discharge instruction (weighted κ=0.19, standard error: 0.082) and nursing estimates (weighted κ=0.13, standard error: 0.078). Providers underestimated pain and patient comprehension of discharge instructions. Conclusion ED providers were not able to predict patient satisfaction with nurse or physician care, pain level, or understanding of discharge instructions.
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Affiliation(s)
- Matthew C DeLaney
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama
| | - David B Page
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama
| | - Ethan B Kunstadt
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama
| | - Matt Ragan
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama
| | - Joel Rodgers
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama
| | - Henry E Wang
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama
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90
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Ackermann S, Heierle A, Bingisser MB, Hertwig R, Padiyath R, Nickel CH, Langewitz W, Bingisser R. Discharge Communication in Patients Presenting to the Emergency Department With Chest Pain: Defining the Ideal Content. HEALTH COMMUNICATION 2016; 31:557-65. [PMID: 26503453 DOI: 10.1080/10410236.2014.979115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In an emergency department (ED), discharge communication represents a crucial step in medical care. In theory, it fosters patient satisfaction and adherence to medication, reduces anxiety, and ultimately promotes better outcomes. In practice, little is known about the extent to which patients receiving discharge information understand their medical condition and are able to memorize and retrieve instructions. Even less is known about the ideal content of these instructions. Focusing on patients with chest pain, we systematically assessed physicians' and patients' informational preferences and created a memory aid to support both the provision of information (physicians) and its retrieval (patients). In an iterative process, physicians of different specialties (N = 47) first chose which of 81 items to include in an ED discharge communication for patients with acute chest pain. A condensed list of 34 items was then presented to 51 such patients to gauge patients' preferences. Patients' and physicians' ratings of importance converged in 32 of the 34 items. Finally, three experts grouped the 34 items into five categories: (1) information on diagnosis; (2) follow-up suggestions; (3) advice on self-care; (4) red flags; and (5) complete treatment, from which we generated the mnemonic acronym "InFARcT." Defining and structuring the content of discharge information seems especially important for ED physicians and patients, as stress and time constraints jeopardize effective communication in this context. Chest pain accounts for up to 10% of all patient presentations in emergency departments (EDs) (Konkelberg & Esterman, 2003). The majority of these patients will usually be discharged within hours, after exclusion of serious conditions such as myocardial infarction (Goodacre et al., 2011). A comprehensive workup of low- to intermediate-risk patients is not feasible in the ED (Reichlin et al., 2009). Yet many of these patients go on to suffer from repeated episodes of chest pain, associated with anxiety and uncertainty about diagnosis and outcome (Jones & Mountain, 2009). Effective discharge communication, empowering patients to understand and memorize medical information, should therefore be an integral part of patient care. It is a likely contributor to better outcomes (Bishop, Barlow, Hartley, & William, 1997; Kessels, 2003), higher patient satisfaction (Kessels, 2003), better adherence to medication (Cameron, 1996; Kessels, 2003), more adequate disease management, and reduced anxiety (Galloway et al., 1997; Mossman, Boudioni, & Slevin, 1999).
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Affiliation(s)
- Selina Ackermann
- a Department of Psychology , University of Basel
- b Department of Emergency Medicine , University Hospital , Basel
| | - Anette Heierle
- b Department of Emergency Medicine , University Hospital , Basel
| | | | - Ralph Hertwig
- d Center for Adaptive Rationality , Max Planck Institute for Human Development
| | - Rakesh Padiyath
- b Department of Emergency Medicine , University Hospital , Basel
| | | | - Wolf Langewitz
- c Department of Psychosomatic Medicine , University Hospital , Basel
| | - Roland Bingisser
- b Department of Emergency Medicine , University Hospital , Basel
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91
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Kuang J, Argo L, Stoddard G, Bray BE, Zeng-Treitler Q. Assessing Pictograph Recognition: A Comparison of Crowdsourcing and Traditional Survey Approaches. J Med Internet Res 2015; 17:e281. [PMID: 26678085 PMCID: PMC4704927 DOI: 10.2196/jmir.4582] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/16/2015] [Accepted: 11/05/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Compared to traditional methods of participant recruitment, online crowdsourcing platforms provide a fast and low-cost alternative. Amazon Mechanical Turk (MTurk) is a large and well-known crowdsourcing service. It has developed into the leading platform for crowdsourcing recruitment. OBJECTIVE To explore the application of online crowdsourcing for health informatics research, specifically the testing of medical pictographs. METHODS A set of pictographs created for cardiovascular hospital discharge instructions was tested for recognition. This set of illustrations (n=486) was first tested through an in-person survey in a hospital setting (n=150) and then using online MTurk participants (n=150). We analyzed these survey results to determine their comparability. RESULTS Both the demographics and the pictograph recognition rates of online participants were different from those of the in-person participants. In the multivariable linear regression model comparing the 2 groups, the MTurk group scored significantly higher than the hospital sample after adjusting for potential demographic characteristics (adjusted mean difference 0.18, 95% CI 0.08-0.28, P<.001). The adjusted mean ratings were 2.95 (95% CI 2.89-3.02) for the in-person hospital sample and 3.14 (95% CI 3.07-3.20) for the online MTurk sample on a 4-point Likert scale (1=totally incorrect, 4=totally correct). CONCLUSIONS The findings suggest that crowdsourcing is a viable complement to traditional in-person surveys, but it cannot replace them.
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Affiliation(s)
- Jinqiu Kuang
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States.
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92
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McCauley JL, Leite RS, Melvin CL, Fillingim RB, Brady KT. Dental opioid prescribing practices and risk mitigation strategy implementation: Identification of potential targets for provider-level intervention. Subst Abus 2015; 37:9-14. [PMID: 26675303 PMCID: PMC4816206 DOI: 10.1080/08897077.2015.1127870] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Given the regular use of immediate-release opioids for dental pain management, as well as documented opioid misuse among dental patients, the dental visit may provide a viable point of intervention to screen, identify, and educate patients regarding the risks associated with prescription opioid misuse and diversion. The aims of this statewide survey of dental practitioners were to assess (a) awareness of the scope of prescription opioid misuse and diversion; (b) current opioid prescribing practices; (c) use of and opinions regarding risk mitigation strategies; and (d) use and perceived utility of drug monitoring programs. METHODS This cross-sectional study surveyed dentists (N = 87) participating in statewide professional and alumni organizations. Dentists were invited via e-mail and listserv announcement to participate in a one-time, online, 59-item, self-administered survey. RESULTS A majority of respondents reported prescribing opioids (n = 66; 75.8%). A minority of respondents (n = 38; 44%) reported regularly screening for current prescription drug abuse. Dentists reported low rates of requesting prior medical records (n = 5; 5.8%). Only 38% (n = 33) of respondents had ever accessed a prescription drug monitoring program (PDMP), and only 4 (4.7%) consistently used a PDMP. Dentists reporting prior training in drug diversion were significantly more likely to have accessed their PDMP, P < .01. Interest in continuing education regarding assessment of prescription drug abuse/diversion and use of drug monitoring programs was high. CONCLUSIONS Although most dentists received training related to prescribing opioids, findings identified a gap in existing dental training in the assessment/identification of prescription opioid misuse and diversion. Findings also identified gaps in the implementation of recommended risk mitigation strategies, including screening for prescription drug abuse, consistent provision of patient education, and use of a PDMP prior to prescribing opioids.
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Affiliation(s)
- Jenna L. McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Renata S. Leite
- College of Dental Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Cathy L. Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Kathleen T. Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Lin MJ, Tirosh AG, Landry A. Examining patient comprehension of emergency department discharge instructions: Who says they understand when they do not? Intern Emerg Med 2015; 10:993-1002. [PMID: 26358466 DOI: 10.1007/s11739-015-1311-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/22/2015] [Indexed: 11/26/2022]
Abstract
Patient comprehension of emergency department (ED) discharge instructions is important for ensuring that patients understand their diagnosis, recommendations for treatment, appropriate follow-up, and reasons to return. However, many patients may not fully understand their instructions. Furthermore, some patients may state they understand their instructions even when they do not. We surveyed 75 patients on their perception of their understanding of their ED discharge instructions, and asked them specific questions about the instructions. We also performed a chart review, and examined patients' answers for correlation with the written instructions and medical chart. We then performed a statistical analysis evaluating which patients claimed understanding but who were found to have poor understanding on chart review. Overall, there was no significant correlation between patient self-reported understanding and physician evaluation of their understanding (ρ = 0.221, p = 0.08). However, among female patients and patients with less than 4 years of college, there was significant positive correlation between self-report and physician evaluation of comprehension (ρ = 0.326, p = 0.04 and ρ = 0.344, p = 0.04, respectively), whereas there was no correlation for male patients and those with more than 16 years of education (ρ = 0.008, p = 0.9, ρ = -0.041, p = 0.84, respectively). Patients' perception of their understanding may not be accurate, especially among men, and those with greater than college education. Identifying which patients say they understand their discharge instructions, but may actually have poor comprehension could help focus future interventions on improving comprehension.
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Affiliation(s)
- Margaret Jane Lin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, WCC-2, Boston, MA, 02215, USA.
| | - Adva Gutman Tirosh
- Soroka Clinical Research Center, Soroka University Medical Center, Beersheba, Israel.
| | - Alden Landry
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, WCC-2, Boston, MA, 02215, USA.
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Affiliation(s)
- Roberta Kaplow
- Oncology Clinical Nurse Specialist, Emory University Hospital, 1364 Clifton Road, E734, Atlanta, GA 30322.
| | - Renee Spinks
- Oncology Clinical Nurse Specialist, Emory University Hospital, 1364 Clifton Road, E834, Atlanta, GA 30322.
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95
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Kaestli LZ, Noble S, Combescure C, Lacroix L, Galetto A, Gervaix A, Fonzo-Christe C, Bonnabry P. Drug information leaflets improve parental knowledge of their child's treatment at paediatric emergency department discharge. Eur J Hosp Pharm 2015; 23:151-155. [PMID: 31156837 DOI: 10.1136/ejhpharm-2015-000776] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 11/04/2022] Open
Abstract
Background Hospital discharge is a complex multidisciplinary process that can lead to non-compliance and drugs-related problems. Crucial issue for children is parental knowledge of discharge treatments, especially in the time-limited and stressful environment of an emergency department (ED). Objective To compare parental correct knowledge of treatment with and without supply of customised drug information leaflets for the 10 most commonly prescribed drugs. Method Inclusion criteria: paediatric patients (0-16 years) with French-speaking parents discharged from ED of the paediatric department of Geneva University Hospitals before (phase A) and after (phase B) intervention. Intervention Supply and brief comment of drug information leaflets focusing on specific information not available in official drugs information documents. Follow-up Semi-structured phone interview within 72 h after discharge to evaluate the percentage of parents with correct knowledge of dose, frequency, duration and indication of drugs. Multivariate analysis to identify factors associated with correct knowledge (phases A/B, drugs collection at usual pharmacy, drugs categories). Results 125 patients were included (phase A: 56; phase B: 69). Drug information leaflets were given to 63/69 ED patients (91%), covering 96/138 prescribed drugs (70%). Parental knowledge was significantly improved in phase B (dose: 62.3% to 89.1%; frequency: 57.9% to 85.5%; duration: 34.2% to 66.7%; indication: 70.2% to 94.9%; p<0.0001). Phase B and collection of drugs at usual pharmacy were significant factors associated with correct knowledge. Conclusions Drug information leaflets significantly improved treatment knowledge of French-speaking parents after paediatric ED discharge. Leaflets are now available online for general population.
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Affiliation(s)
- L Z Kaestli
- Department of Pharmacy, University Hospitals of Geneva, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - S Noble
- Department of Pharmacy, University Hospitals of Geneva, Geneva, Switzerland
| | - C Combescure
- Clinical Research Centre and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - L Lacroix
- Paediatric Emergency Department, University Hospitals of Geneva, Geneva, Switzerland
| | - A Galetto
- Paediatric Emergency Department, University Hospitals of Geneva, Geneva, Switzerland
| | - A Gervaix
- Paediatric Emergency Department, University Hospitals of Geneva, Geneva, Switzerland
| | - C Fonzo-Christe
- Department of Pharmacy, University Hospitals of Geneva, Geneva, Switzerland
| | - P Bonnabry
- Department of Pharmacy, University Hospitals of Geneva, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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96
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VonHoltz LAH, Hypolite KA, Carr BG, Shofer FS, Winston FK, Hanson CW, Merchant RM. Use of mobile apps: a patient-centered approach. Acad Emerg Med 2015; 22:765-8. [PMID: 25998446 DOI: 10.1111/acem.12675] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/10/2014] [Accepted: 12/04/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study explored what smartphone health applications (apps) are used by patients, how they learn about health apps, and how information about health apps is shared. METHODS Patients seeking care in an academic ED were surveyed about the following regarding their health apps: use, knowledge, sharing, and desired app features. Demographics and health information were characterized by summary statistics. RESULTS Of 300 participants, 212 (71%) owned smartphones, 201 (95%) had apps, and 94 (44%) had health apps. The most frequently downloaded health apps categories were exercise 46 (49%), brain teasers 30 (32%), and diet 23 (24%). The frequency of use of apps varied as six (6%) of health apps were downloaded but never used, 37 (39%) apps were used only a few times, and 40 (43%) health apps were used once per month. Only five apps (2%) were suggested to participants by health care providers, and many participants used health apps intermittently (55% of apps ≤ once a month). Participants indicated sharing information from 64 (59%) health apps, mostly within social networks (27 apps, 29%) and less often with health care providers (16 apps, 17%). CONCLUSIONS While mobile health has experienced tremendous growth over the past few years, use of health apps among our sample was low. The most commonly used apps were those that had broad functionality, while the most frequently used health apps encompassed the topics of exercise, diet, and brain teasers. While participants most often shared information about health apps within their social networks, information was less frequently shared with providers, and physician recommendation played a small role in influencing patient use of health apps.
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Affiliation(s)
- Lauren A. Houdek VonHoltz
- Department of Emergency Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
- Penn Medicine Social Media and Health Innovation Lab; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Kendra A. Hypolite
- Department of Emergency Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
| | - Brendan G. Carr
- Department of Emergency Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
| | - Frances S. Shofer
- Department of Emergency Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
| | - Flaura K. Winston
- Center for Injury Research and Prevention; The Children's Hospital of Philadelphia; Philadelphia PA
| | - C. William Hanson
- Department of Anesthesiology and Critical Care; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Raina M. Merchant
- Department of Emergency Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
- Penn Medicine Social Media and Health Innovation Lab; Hospital of the University of Pennsylvania; Philadelphia PA
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97
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Choi J. Effect of Pictograph-Based Discharge Instructions on Older Adults' Comprehension and Recall: A Pilot Study. Res Gerontol Nurs 2015; 9:66-71. [PMID: 26020574 DOI: 10.3928/19404921-20150513-05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/05/2015] [Indexed: 11/20/2022]
Abstract
Many older adults return home with limited comprehension of hospital discharge instructions because current text-based instructions are difficult to understand. To address this issue, the author developed discharge instructions using pictographs (i.e., simple line drawings showing step-by-step discharge actions) for older adults under care of hip replacement surgery. The purpose of the current study was to examine the effect of pictograph-based discharge instructions on comprehension and recall of older adults with low literacy skills. A posttest-only comparison group design was used to compare pictograph-based (n = 21) to text-only (n = 21) discharge instructions at 4 weeks after discharge instruction education. Significantly greater improvements in scores on comprehension and recall were demonstrated by the pictograph group than the text-only group. A follow-up, full-scale study is suggested to examine the effect of pictograph-based instructions on adherence to instructions and health outcomes.
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98
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Chang W, Goopy S, Lin CC, Barnard A, Liu HE, Han CY. Registered Nurses and Discharge Planning in a Taiwanese ED: A Neglected Issue? Clin Nurs Res 2015; 25:512-31. [PMID: 25940582 DOI: 10.1177/1054773815584138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses' perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents' and relatives' attitudes were barriers to implementing discharge teaching in the ED.
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Affiliation(s)
- Wen Chang
- Chang Gung University of Science and Technology, Taiwan, Republic of China
| | | | - Chun-Chih Lin
- Chang Gung University of Science and Technology, Taiwan, Republic of China
| | - Alan Barnard
- Queensland University of Technology, Brisbane, Australia
| | | | - Chin-Yen Han
- Chang Gung University of Science and Technology, Taiwan, Republic of China
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99
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Mueller SK, Giannelli K, Boxer R, Schnipper JL. Readability of patient discharge instructions with and without the use of electronically available disease-specific templates. J Am Med Inform Assoc 2015; 22:857-63. [PMID: 25882030 DOI: 10.1093/jamia/ocv005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/10/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Low health literacy is common, leading to patient vulnerability during hospital discharge, when patients rely on written health instructions. We aimed to examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge. MATERIALS AND METHODS We performed a retrospective cohort study of 233 patients discharged from a large tertiary care hospital to their homes following the implementation of a web-based "discharge module," which included the optional use of diagnosis-specific templated discharge instructions. We compared the readability of discharge instructions, as measured by the Flesch Reading Ease Level test (FREL, on a 0-100 scale, with higher scores indicating greater readability) and the Flesch-Kincaid Grade Level test (FKGL, measured in grade levels), between discharges that used templated instructions (with or without modification) versus discharges that used clinician-generated instructions (with or without available templated instructions for the specific discharge diagnosis). RESULTS Templated discharge instructions were provided to patients in 45% of discharges. Of the 55% of patients that received clinician-generated discharge instructions, the majority (78.1%) had no available templated instruction for the specific discharge diagnosis. Templated discharge instructions had higher FREL scores (71 vs. 57, P < .001) and lower FKGL scores (5.6 vs. 7.6, P < .001), compared to clinician-generated discharge instructions. DISCUSSION The use of electronically available templated discharge instructions was associated with better readability (a higher FREL score and a lower FKGL score) than the use of clinician-generated discharge instructions. The main reason for clinicians to create discharge instructions was the lack of available templates for the patient's specific discharge diagnosis. CONCLUSIONS Use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion.
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Affiliation(s)
- Stephanie K Mueller
- BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kyla Giannelli
- BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert Boxer
- BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey L Schnipper
- BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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100
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Rising KL, Padrez KA, O’Brien M, Hollander JE, Carr BG, Shea JA. Return Visits to the Emergency Department: The Patient Perspective. Ann Emerg Med 2015; 65:377-386.e3. [DOI: 10.1016/j.annemergmed.2014.07.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/06/2014] [Accepted: 07/10/2014] [Indexed: 10/24/2022]
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