1
|
Walsh A, Bodaghkhani E, Etchegary H, Alcock L, Patey C, Senior D, Asghari S. Patient-centered care in the emergency department: a systematic review and meta-ethnographic synthesis. Int J Emerg Med 2022; 15:36. [PMID: 35953783 PMCID: PMC9367087 DOI: 10.1186/s12245-022-00438-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-centered care (PCC) is an emerging priority in many healthcare settings but lacks clarity in the emergency department (ED). It is of interest to know what PCC practices are most important to patients to better their experience. The objective of this study was to conduct a mixed-methods systematic review of PCC in the ED. METHODS We used stakeholder and patient engagement to consult with clinicians, subject-matter experts, patient partners, and community organizations to determine patient needs. We examined all articles in the ED context with PCC as the intervention. Two independent reviewers screened 3136 articles and 13 were included. A meta-ethnographic analysis was conducted to determine common themes of PCC. RESULTS Themes included emotional support, communication, education, involvement of patient/family in information sharing and decision making, comfort of environment, respect and trust, continuity, and transition of care. Challenges in the ED reflected a lack of PCC. Moreover, implementation of PCC had many benefits including higher patient satisfaction with their care. Though there were commonalities of PCC components, there was no consistently used definition for PCC in the ED. CONCLUSION The findings of this review support the evidence that PCC is of high value to the ED setting and should be standardized in practice.
Collapse
Affiliation(s)
- Anna Walsh
- Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Elnaz Bodaghkhani
- Emergency Medicine Department, The University of British Columbia, Vancouver, Canada
| | - Holly Etchegary
- Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Lindsay Alcock
- Health Sciences Library, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Christopher Patey
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Dorothy Senior
- Community Scholar with Center for Rural Health Studies, Discipline of Family Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada. .,Department of Family Medicine, Centre for Rural Health Studies Faculty of Medicine, Memorial University of Newfoundland and Labrador Health Sciences Centre, 300 Prince Philip Drive, NL, A1B 3V6, St. John's, Canada.
| |
Collapse
|
2
|
Imhoff B, Marshall KD, Joseph JW, Sarani N, Kelman J, Nazir N. The effect of batched patient–physician assignment on patient length of stay in the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12784. [PMID: 35919514 PMCID: PMC9338821 DOI: 10.1002/emp2.12784] [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: 05/05/2022] [Revised: 06/11/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives Queuing theory suggests that signing up for multiple patients at once (batching) can negatively affect patients’ length of stay (LOS). At academic centers, resident assignment adds a second layer to this effect. In this study, we measured the rate of batched patient assignment by resident physicians, examined the effect on patient in‐room LOS, and surveyed residents on underlying drivers and perceptions of batching. Methods This was a retrospective study of discharged patients from August 1, 2020 to October 27, 2020, supplemented with survey data conducted at a large, urban, academic hospital with an emergency medicine training program in which residents self‐assign to patients. Time stamps were extracted from the electronic health record and a definition of batching was set based on findings of a published time and motion study. Results A total of 3794 patients were seen by 28 residents and ultimately discharged during the study period. Overall, residents batched 23.7% of patients, with a greater rate of batching associated with increasing resident seniority and during the first hour of resident shifts. In‐room LOS for batched assignment patients was 15.9 minutes longer than single assignment patients (P value < 0.01). Residents’ predictions of their rates of batching closely approximated actual rates; however, they underestimated the effect of batching on LOS. Conclusions Emergency residents often batch patients during signup with negative consequences to LOS. Moreover, residents significantly underestimate this negative effect.
Collapse
Affiliation(s)
- Bryan Imhoff
- Department of Emergency Medicine University of Kansas Medical Center Kansas City KS USA
| | - Kenneth D. Marshall
- Department of Emergency Medicine University of Kansas Medical Center Kansas City KS USA
| | - Joshua W. Joseph
- Department of Emergency Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Nima Sarani
- Department of Emergency Medicine University of Kansas Medical Center Kansas City KS USA
| | - Julie Kelman
- Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston MA USA
| | - Niaman Nazir
- Department of Population Health University of Kansas Medical Center Kansas City KS USA
| |
Collapse
|
3
|
Lipson-Smith R, McLaughlan R. Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:351-374. [PMID: 35356828 DOI: 10.1177/19375867221089702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To provide a taxonomy of spatial observation methods that are commonly used in healthcare environments research and to describe their relative success. BACKGROUND Spatial observation is a valuable but resource intensive research method that is often used in healthcare environments research, but which frequently fails to deliver conclusive results. There is no existing catalog of the different spatial and behavioral observation methods that are used in healthcare design research and their benefits or limitations. METHODS The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ten key databases were searched, and articles were screened by both authors. RESULTS Across 67 included studies, 79 observation methods were reported. We categorized those into four, distinct methodological approaches, outlining the benefits, limitations, and suitability of each for obtaining different types of results. Common limitations included difficulty generalizing to other contexts and a lack of detailed description during data collection which led to key environment variables not being recorded. More concrete conclusions were drawn when observation methods were combined with complimentary methods such as interview. CONCLUSIONS The relative success of spatial observation studies is dependent on the fit of the method selected relative to the research question, approach, and healthcare setting; any complimentary methods delivered alongside it; and the analysis model employed. This article provides researchers with practical advice to guide the appropriate selection of spatial observation methods.
Collapse
Affiliation(s)
- Ruby Lipson-Smith
- School of Architecture and the Built Environment, University of Newcastle, Australia
| | - Rebecca McLaughlan
- School of Architecture and the Built Environment, University of Newcastle, Australia.,Sydney School of Architecture, Design & Planning, The University of Sydney, Australia
| |
Collapse
|
4
|
Tindle K, David A, Carlisle S, Faircloth B, Fields JM, Hayden G, Ku B. Relationship of the Built Environment on Nursing Communication Patterns in the Emergency Department: A Task Performance and Analysis Time Study. J Emerg Nurs 2020; 46:440-448. [PMID: 32507726 DOI: 10.1016/j.jen.2020.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The physical layout of the emergency department affects the way in which patients and providers move within the space and can cause substantial changes in workflow and, therefore, affect communication patterns between providers. There is no 1 ED design that enables the best patient care, and quantitative studies looking at ED design are limited. The goal of this study was to examine how different ED designs, centralized and decentralized, are associated with communication patterns among health care professionals. METHODS A task performance, direct observation time study was used. By developing a novel tablet-based digital mapping tool using a cloud-based mapping platform (ArcGIS), data on provider actions and interactions were collected and mapped to a precise location within the emergency department throughout an entire nursing shift. RESULTS The difference in the duration of nurse-physician interactions between the 2 ED designs was statistically significant. Within the centralized design, nurse-physician interactions totaled 14 minutes and 38 seconds compared with 30 minutes and 11 seconds in the decentralized design (t = 2.31, P = 0.02). More conversations between nurses and physicians occurred inside the patient's room in the decentralized design. DISCUSSION Our findings suggest that the ED design affects communication patterns among health care providers and that the design has the potential to affect the quality of patient care.
Collapse
|
5
|
Accidental and Unintentional Findings From the Midstream Clean-Catch Urine Contamination Study: Insights From Applying the Behavior Engineering Model. J Emerg Nurs 2019; 45:484-487. [DOI: 10.1016/j.jen.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
6
|
Castner J, Mammen MJ, Jungquist CR, Licata O, Pender JJ, Wilding GE, Sethi S. Validation of fitness tracker for sleep measures in women with asthma. J Asthma 2018; 56:719-730. [PMID: 29972657 DOI: 10.1080/02770903.2018.1490753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Nighttime wakening with asthma symptoms is a key to assessment and therapy decisions, with no gold standard objective measure. The study aims were to (1) determine the feasibility, (2) explore equivalence, and (3) test concordance of a consumer-based accelerometer with standard actigraphy for measurement of sleep patterns in women with asthma as an adjunct to self-report. METHODS Panel study design of women with poorly controlled asthma from a university-affiliated primary care clinic system was used. We assessed sensitivity and specificity, equivalence and concordance of sleep time, sleep efficiency, and wake counts between the consumer-based accelerometer Fitbit Charge™ and Actigraph wGT3X+. We linked data between devices for comparison both automatically by 24-hour period and manually by sleep segment. RESULTS Analysis included 424 938 minutes, 738 nights, and 833 unique sleep segments from 47 women. The fitness tracker demonstrated 97% sensitivity and 40% specificity to identify sleep. Between device equivalence for total sleep time (15 and 42-minute threshold) was demonstrated by sleep segment. Concordance improved for wake counts and sleep efficiency when adjusting for a linear trend. CONCLUSIONS There were important differences in total sleep time, efficiency, and wake count measures when comparing individual sleep segments versus 24-hour measures of sleep. Fitbit overestimates sleep efficiency and underestimates wake counts in this population compared to actigraphy. Low levels of systematic bias indicate the potential for raw measurements from the devices to achieve equivalence and concordance with additional processing, algorithm modification, and modeling. Fitness trackers offer an accessible and inexpensive method to quantify sleep patterns in the home environment as an adjunct to subjective reports, and require further informatics development.
Collapse
Affiliation(s)
- Jessica Castner
- a The Rockefeller University Heilbrunn Family Center for Research Nursing , New York , NY , USA.,b University at Buffalo , Buffalo , NY , USA.,c Castner Incorporated , Grand Island , New York , NY , USA
| | - Manoj J Mammen
- d Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo , Buffalo , NY , USA.,e Department of Medicine, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo , Buffalo , NY , USA
| | | | - Olivia Licata
- g Department of Materials Design and Innovation, School of Engineering and Applied Sciences , University at Buffalo , Buffalo , NY , USA.,h Department of Biomedical Engineering, School of Engineering and Applied Sciences , University at Buffalo , Buffalo , NY , USA
| | - John J Pender
- f School of Nursing , University at Buffalo , Buffalo , NY , USA
| | - Gregory E Wilding
- i Department of Biostatistics, School of Public Health and Health Professions , University at Buffalo , Buffalo , NY , USA
| | - Sanjay Sethi
- e Department of Medicine, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo , Buffalo , NY , USA
| |
Collapse
|