1
|
Shamash Z, Catallozzi M, Dayan PS, Chernick LS. Preferences for Expedited Partner Therapy Among Adolescents in an Urban Pediatric Emergency Department: A Mixed-Methods Study. Pediatr Emerg Care 2021; 37:e91-e96. [PMID: 30883535 PMCID: PMC6744998 DOI: 10.1097/pec.0000000000001746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Expedited partner therapy (EPT) refers to treating sexual partners of patients with sexually transmitted infections by providing prescriptions or medications to give to their partners. Expedited partner therapy is not routinely prescribed in the emergency department (ED). Our objective was to explore adolescent preferences for EPT use in the ED. METHODS We conducted a mixed-methods study using surveys and semistructured interviews in one urban ED. Sexually active patients aged 15 to 19 years completed an anonymous survey eliciting (1) sexual history and risky sexual behaviors, (2) preferences for partner notification when hypothetically testing positive for an STI, and (3) preferences for EPT. A subsample of survey respondents participated in the interviews, which were conducted until no new perspectives emerged. Investigators analyzed interviews using thematic analysis. RESULTS A total of 247 participants completed surveys; the majority were female (183/247, 74%), Hispanic (209/243, 86%), and did not use a condom at last intercourse (129/243, 53%). Two thirds of participants (152/236, 64%) did not prefer EPT for partner notification. Preference for EPT was not associated with sex, age, ethnicity, condom use, a steady sexual partner, or STI history. Qualitative data from both surveys and interviews revealed the following reasons for not preferring EPT: concern for partner safety, importance of determining partner STI status, perceived benefit of clinical interaction, and partner accountability. Reasons for preferring EPT included increased treatment accessibility and convenience. CONCLUSIONS The majority of adolescent patients in a pediatric ED did not prefer EPT. Emergency department practitioners should address common concerns regarding EPT to increase EPT adherence if prescribed.
Collapse
Affiliation(s)
- Zohar Shamash
- Zohar Shamash, MD, Division of Pediatric Emergency
Medicine, Department of Pediatrics, 3959 Broadway, CHN 1-116, Columbia University
Medical Center, NY, NY, United States;
| | - Marina Catallozzi
- Marina Catallozzi, MD, MSCE, Population and Family Health
and Pediatrics at the Columbia University Medical Center, 622 W 168
Street, PH-520, NY, NY, United States;
| | - Peter S Dayan
- Peter S Dayan, MD MSc, Division of Pediatric Emergency
Medicine, Department of Pediatrics, 3959 Broadway, CHN 1-116, Columbia University
Medical Center, NY, NY, United States;
| | - Lauren S Chernick
- Lauren Chernick MD MSc, Division of Pediatric Emergency
Medicine, Department of Pediatrics, 3959 Broadway, CHN 1-116, Columbia University
Medical Center, NY, NY, United States; ,
212-305-9825 (phone), 212-305-0682 (fax)
| |
Collapse
|
2
|
Alfandre D, Stream S, Geppert C. “Doc, I’m Going for a Walk”: Liberalizing or Restricting the Movement of Hospitalized Patients—Ethical, Legal, and Clinical Considerations. HEC Forum 2020; 32:253-267. [DOI: 10.1007/s10730-020-09398-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
3
|
Stream S, Alfandre D. "Just Getting a Cup of Coffee"-Considering Best Practices for Patients' Movement off the Hospital Floor. J Hosp Med 2019; 14:712-715. [PMID: 31251160 PMCID: PMC6827542 DOI: 10.12788/jhm.3227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sara Stream
- Section of Hospital Medicine, Medical Service, VA New York Harbor Healthcare System, Manhattan Campus, Department of Medicine, NYU School of Medicine, New York, New York
- Corresponding Author: Sara Stream, MD; E-mail: ; Phone: 212-951-6868
| | - David Alfandre
- Section of Hospital Medicine, Medical Service, VA New York Harbor Healthcare System, Manhattan Campus, Department of Medicine, NYU School of Medicine, New York, New York
- National Center for Ethics in Health Care, US Department of Veterans Affairs, Washington, DC
| |
Collapse
|
4
|
Pettit KE, Turner JS, Pollard KA, Buente BB, Humbert AJ, Perkins AJ, Hobgood CD, Kline JA. Effect of an Educational Intervention on Medical Student Scripting and Patient Satisfaction: A Randomized Trial. West J Emerg Med 2018; 19:585-592. [PMID: 29760860 PMCID: PMC5942029 DOI: 10.5811/westjem.2018.1.35992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Effective communication between clinicians and patients has been shown to improve patient outcomes, reduce malpractice liability, and is now being tied to reimbursement. Use of a communication strategy known as "scripting" has been suggested to improve patient satisfaction in multiple hospital settings, but the frequency with which medical students use this strategy and whether this affects patient perception of medical student care is unknown. Our objective was to measure the use of targeted communication skills after an educational intervention as well as to further clarify the relationship between communication element usage and patient satisfaction. METHODS Medical students were block randomized into the control or intervention group. Those in the intervention group received refresher training in scripted communication. Those in the control group received no instruction or other intervention related to communication. Use of six explicit communication behaviors were recorded by trained study observers: 1) acknowledging the patient by name, 2) introducing themselves as medical students, 3) explaining their role in the patient's care, 4) explaining the care plan, 5) providing an estimated duration of time to be spent in the emergency department (ED), and 6) notifying the patient that another provider would also be seeing them. Patients then completed a survey regarding their satisfaction with the medical student encounter. RESULTS We observed 474 medical student-patient encounters in the ED (231 in the control group and 243 in the intervention group). We were unable to detect a statistically significant difference in communication element use between the intervention and control groups. One of the communication elements, explaining steps in the care plan, was positively associated with patient perception of the medical student's overall communication skills. Otherwise, there was no statistically significant association between element use and patient satisfaction. CONCLUSION We were unable to demonstrate any improvement in student use of communication elements or in patient satisfaction after refresher training in scripted communication. Furthermore, there was little variation in patient satisfaction based on the use of scripted communication elements. Effective communication with patients in the ED is complicated and requires further investigation on how to provide this skill set.
Collapse
Affiliation(s)
- Katie E Pettit
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Joseph S Turner
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Katherine A Pollard
- Washington University School of Medicine, Department of Medicine, St. Louis, Missouri
| | - Bryce B Buente
- Marion University College of Osteopathic Medicine, Indianapolis, Indiana
| | - Aloysius J Humbert
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Anthony J Perkins
- Indiana University Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana
| | - Cherri D Hobgood
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Jeffrey A Kline
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| |
Collapse
|
5
|
Education in the Waiting Room: Description of a Pediatric Emergency Department Educational Initiative. Pediatr Emerg Care 2017; 33:e87-e91. [PMID: 28419020 DOI: 10.1097/pec.0000000000001140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to understand parents' awareness of and reactions to a slide presentation based waiting-room educational initiative. METHODS This was a prospective observational study at a Canadian tertiary-care pediatric emergency department (ED) with an annual census of 68,000 visits. An anonymous parental survey was developed de novo, and parents were asked to complete the survey during their low-acuity ED visit over a 2-week study period. Descriptive statistics were used to describe responses and themes. RESULTS Parents completed 520 surveys (733 approached, 70.9% response rate). Eighty-three percent of respondents had previously sought care in the ED. Most parents (68.9%) were aware of the slide presentation, but only 33.7% were able to watch it in its entirety (20 minutes' duration). Of those who watched the whole presentation, 62.9% understood that lower-acuity cases are assessed in the ambulatory zone of the ED, and sicker children are assessed in the acute zone (89.4%), 79.9% felt the presentation helped them to understand how the ambulatory zone functions, and 83.2% appreciated the current wait-time information. General questions about common health concerns were answered correctly in 58.3% (fever), 56.0% (gastroenteritis), 50.5% (abdominal pain/constipation), 35.7% (earache), and 17.0% (head injury). CONCLUSIONS The majority of parents were aware of this waiting-room educational initiative, but there was variable uptake of information. Parents watching the entire presentation appreciated the information provided, especially wait-time information, and felt it improved their experience. Knowledge of common health conditions was low; novel methods of knowledge transfer must be utilized and evaluated.
Collapse
|
6
|
Seiler A, Knee A, Shaaban R, Bryson C, Paadam J, Harvey R, Igarashi S, LaChance C, Benjamin E, Lagu T. Physician communication coaching effects on patient experience. PLoS One 2017; 12:e0180294. [PMID: 28678872 PMCID: PMC5497987 DOI: 10.1371/journal.pone.0180294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 06/13/2017] [Indexed: 02/02/2023] Open
Abstract
Background Excellent communication is a necessary component of high-quality health care. We aimed to determine whether a training module could improve patients’ perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication. Study design We designed a comprehensive physician-training module focused on improving specific “etiquette-based” physician communication skills through standardized simulations and physician coaching with structured feedback. We employed a quasi-experimental pre-post design, with an intervention group consisting of internal medicine hospitalists and residents and a control group consisting of surgeons. The outcome was percent “always” scores for questions related to patients’ perceptions of physician communication using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and a Non-HCAHPS Physician-Specific Patient Experience Survey (NHPPES) administered to patients cared for by hospitalists. Results A total of 128 physicians participated in the simulation. Responses from 5020 patients were analyzed using HCAHPS survey data and 1990 patients using NHPPES survey data. The intercept shift, or the degree of change from pre-intervention percent “always” responses, for the HCAHPS questions of doctors “treating patients with courtesy” “explaining things in a way patients could understand,” and “overall teamwork” showed no significant differences between surgical control and hospitalist intervention patients. Adjusted NHPPES percent excellent survey results increased significantly post-intervention for the questions of specified individual doctors “keeping patient informed” (adjusted intercept shift 9.9% P = 0.019), “overall teamwork” (adjusted intercept shift 11%, P = 0.037), and “using words the patient could understand” (adjusted intercept shift 14.8%, p = 0.001). Conclusion A simulation based physician communication coaching method focused on specific “etiquette-based” communication behaviors through a deliberate practice framework was not associated with significantly improved HCAHPS physician communication patient experience scores. Further research could reveal ways that this model affects patients’ perceptions of physician communication relating to specific physicians or behaviors.
Collapse
Affiliation(s)
- Adrianne Seiler
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Baycare Health Partners/Pioneer Valley ACO, Springfield, Massachusetts, United States of America
- * E-mail:
| | - Alexander Knee
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Office of Research, Baystate Medical Center, Springfield, Massachusetts, United States of America
| | - Reham Shaaban
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Christine Bryson
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Jasmine Paadam
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Rohini Harvey
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Satoko Igarashi
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Christopher LaChance
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Evan Benjamin
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Department of Healthcare Quality, Baystate Medical Center, Springfield, Massachusetts, United States of America
| | - Tara Lagu
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, United States of America
- Baystate Health-University of Massachusetts Medical School, Springfield, Massachusetts, United States of America
| |
Collapse
|
7
|
Turner JS, Pettit KE, Buente BB, Humbert AJ, Perkins AJ, Kline JA. Medical student use of communication elements and association with patient satisfaction: a prospective observational pilot study. BMC MEDICAL EDUCATION 2016; 16:150. [PMID: 27209065 PMCID: PMC4875631 DOI: 10.1186/s12909-016-0671-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 05/14/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Effective communication with patients impacts clinical outcome and patient satisfaction. We measure the rate at which medical students use six targeted communication elements with patients and association of element use with patient satisfaction. METHODS Participants included fourth year medical students enrolled in an emergency medicine clerkship. A trained observer measured use of six communication elements: acknowledging the patient by name, introducing themselves by name, identifying their role, explaining the care plan, explaining that multiple providers would see the patient, and providing an estimated duration of time in the emergency department. The observer then conducted a survey of patient satisfaction with the medical student encounter. RESULTS A total of 246 encounters were documented among forty medical student participants. For the six communication elements evaluated, in 61% of encounters medical students acknowledged the patient, in 91% they introduced themselves, in 58 % they identified their role as a student, in 64% they explained the care plan, in 80% they explained that another provider would see the patient, and in only 6% they provided an estimated duration of care. Only 1 encounter (0.4%) contained all six elements. Patients' likelihood to refer a loved one to that ED was increased when students acknowledged the patient and described that other providers would be involved in patient care (P = 0.016 and 0.015 respectively, Chi Square). Likewise, patients' likelihood to return to the ED was increased when students described their role in patient care (P = 0.035, Chi Square). CONCLUSIONS This pilot study demonstrates that medical students infrequently use all targeted communication elements. When they did use certain elements, patient satisfaction increased. These data imply potential benefit to additional training for students in patient communication.
Collapse
Affiliation(s)
- Joseph S Turner
- Department of Emergency Medicine, Indiana University, 720 Eskenazi Ave, Indianapolis, IN, 46037, USA.
| | - Katie E Pettit
- Department of Emergency Medicine, Indiana University, 720 Eskenazi Ave, Indianapolis, IN, 46037, USA
| | - Bryce B Buente
- Fairbanks School of Public Health, IUPUI, Indianapolis, IN, USA
| | - Aloysius J Humbert
- Department of Emergency Medicine, Indiana University, 720 Eskenazi Ave, Indianapolis, IN, 46037, USA
| | - Anthony J Perkins
- Department of Emergency Medicine, Indiana University, 720 Eskenazi Ave, Indianapolis, IN, 46037, USA
| | - Jeffrey A Kline
- Department of Emergency Medicine, Indiana University, 720 Eskenazi Ave, Indianapolis, IN, 46037, USA
| |
Collapse
|
8
|
Patient characteristics and institutional factors associated with those who “did not wait” at a South East Queensland Emergency Department. ACTA ACUST UNITED AC 2014; 17:11-8. [DOI: 10.1016/j.aenj.2013.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 11/18/2022]
|
9
|
Vierheller CC. Evaluating Left Without Being Seen and Against Medical Advice Departures in a Rural Emergency Department. J Emerg Nurs 2013; 39:67-71. [DOI: 10.1016/j.jen.2012.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/14/2012] [Accepted: 07/21/2012] [Indexed: 11/16/2022]
|
10
|
Talking the Talk in Triage. J Emerg Nurs 2011; 37:205-6. [DOI: 10.1016/j.jen.2010.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|