Improving patients' ability to identify their physicians through the use of physician facecards and whiteboards

Administrative burden for patients in U.S. health care settings Post-Affordable Care Act: A scoping review

Administrative burdens are the costs associated with receiving a service or accessing a program. Based on the Herd & Moynihan framework, they occur in three subcategories: learning costs, compliance costs, and psychological costs. Administrative burdens manifest inequitably, more significantly impacting vulnerable populations. Administrative burdens may impact the health of those trying to access services, and in some cases block access to health-promoting services entirely. This scoping review examined studies focused on the impact on patients of administrative burden administrative burden in health care settings in the U.S. following the passage of the Affordable Care Act. We queried databases for empirical literature capturing patient administrative burden, retrieving 1578 records, with 31 articles ultimately eligible for inclusion. Of the 31 included studies, 18 used quantitative methods, nine used qualitative methods, three used mixed methods, and one was a case study. In terms of administrative burden subcategories, most patient outcomes reported were learning (22 studies) and compliance costs (26 studies). Psychological costs were the most rarely reported; all four studies describing psychological costs were qualitative in nature. Only twelve studies connected patient demographic data with administrative burden data, despite previous research suggesting an inequitable burden impact. Additionally, twenty-eight studies assessed administrative burden and only three attempted to reduce it via an intervention, resulting in a lack of data on intervention design and efficacy.

The Association of Name Recognition, Empathy Perception, and Satisfaction With Resident Physicians' Care Amongst Patients in an Academic Emergency Department

Background

Recognition of the provider's name, provider empathy, and the patient's satisfaction with their care are patient-provider rapport measures. This study aimed to determine: 1) resident physicians' name recognition by patients in the emergency department; and 2) name recognition in association with patient perception of the resident's empathy and their satisfaction with the resident's care.

Methods

This was a prospective observational study. A patient recognizing a resident physician was defined as the patient remembering a resident's name, understanding the level of training, and understanding a resident's role in patient care. A patient's perception of resident physician empathy was measured by the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE). Patient satisfaction of the resident was measured utilizing a real-time satisfaction survey. Multivariate logistic regressions were performed to determine the association amongst patient recognition of resident physicians, JSPPPE, and patient satisfaction after adjustments were made for demographics and resident training level.

Results

We enrolled 30 emergency medicine resident physicians and 191 patients. Only 26% of studied patients recognized resident physicians. High JSPPPE scores were given by 39% of patients recognizing resident physicians compared to 5% of those who were not recognized (P = 0.013). High patient satisfaction scores were recorded in 31% of patients who recognized resident physicians compared to 7% who did not (P = 0.008). The adjusted odds ratios of patient recognition of resident physicians to high JSPPPE and high satisfaction scores were 5.29 (95% confidence interval (CI): 1.33 - 21.02, P = 0.018) and 6.12 (1.84 - 20.38, P = 0.003) respectively.

Conclusions

Patient recognition of resident physicians is low in our study. However, patient recognition of resident physicians is associated with a higher patient perception of physician empathy and higher patient satisfaction. Our study suggests that resident education advocating for patient recognition of their healthcare provider's status needs to be emphasized as part of patient-centered health care.

The Gender of the Sender: Assessing Gender Biases of Greetings in Patient Portal Messages

Purpose: The purpose of the study was to determine if the use of professional titles in patient electronic health record (EHR) messages varied by gender of the physician receiving the message and gender of the patient sending the message. Methods: We conducted a retrospective observational study evaluating 285,744 messages for a patient's greeting to their physician. Logistic regression mixed effects models were fit to estimate the relationship between title use and gender. Results: Female physicians received 189,442 (66%), and female patients sent 183,579 (64%) messages. Female physicians received an average of 1754 messages each (sd = 1615, median [IQR] = 1624 [255-3040]), which was significantly more than the average 1235 messages for males (sd = 1527, median [IQR] = 385 [103-1857], Mann-Whitney-Wilcoxon p-value = 0.006). Female patients were more likely to send messages using professional titles (OR = 1.37, CI = 1.28-1.47, p < 0.001). Female physicians were no more likely than male physicians to receive professional titles (OR = 1.06, CI = 0.89-1.27, p = 0.500). Conclusions: Female physicians received significantly more EHR messages than men, and female patients were more likely to use a professional title when addressing their physician, regardless of gender. Across all patients, physician gender did not influence the rate of professional title used.

The Effect of Standardized Hospitalist Information Cards on the Patient Experience: a Quasi-Experimental Prospective Cohort Study

BACKGROUND

Communication with clinicians is an important component of a hospitalized patient's experience.

OBJECTIVE

To test the impact of standardized hospitalist information cards on the patient experience.

DESIGN

Quasi-experimental study in a U.S. tertiary-care center.

PARTICIPANTS

All-comer medicine inpatients.

INTERVENTIONS

Standardized hospitalist information cards containing name and information on a hospitalist's role and availability vs. usual care.

MAIN MEASURES

Patients' rating of the overall communication as excellent ("top-box" score); qualitative feedback summarized via inductive coding.

KEY RESULTS

Five hundred sixty-six surveys from 418 patients were collected for analysis. In a multivariate regression model, standardized hospitalist information cards significantly improved the odds of a "top-box" score on overall communication (odds ratio: 2.32; 95% confidence intervals: 1.07-5.06). Other statistically significant covariates were patient age (0.98, 0.97-0.99), hospitalist role (physician vs. advanced practice provider, 0.56; 0.38-0.81), and hospitalist-patient gender combination (female-female vs. male-male, 2.14; 1.35-3.40). Eighty-seven percent of patients found the standardized hospitalist information cards useful, the perceived most useful information being how to contact the hospitalist and knowing their schedule.

CONCLUSIONS

Hospitalized patients' experience of their communication with hospitalists may be improved by using standardized hospitalist information cards. Younger patients cared for by a team with an advanced practice provider, as well as female patients paired with female providers, were more likely to be satisfied with the overall communication. Assessing the impact of information cards should be studied in other settings to confirm generalizability.

Physician Identification Badges: A Multispecialty Quality Improvement Study to Address Professional Misidentification and Bias

OBJECTIVE

To evaluate whether providing resident physicians with "DOCTOR" role identification badges would impact perceptions of bias in the workforce and alter misidentification rates.

PARTICIPANTS AND METHODS

Between October 2019 and December 2019, we surveyed 341 resident physicians in the anesthesiology, dermatology, internal medicine, neurologic surgery, otorhinolaryngology, and urology departments at Mayo Clinic in Rochester, Minnesota, before and after an 8-week intervention of providing "DOCTOR" role identification badges. Differences between paired preintervention and postintervention survey answers were measured, with a focus on the frequency of experiencing perceived bias and role misidentification (significance level, α=.01). Free-text comments were also compared.

RESULTS

Of the 159 residents who returned both the before and after surveys (survey response rate, 46.6% [159 of 341]), 128 (80.5%) wore the "DOCTOR" badge. After the intervention, residents who wore the badges were statistically significantly less likely to report role misidentification at least once a week from patients, nonphysician team members, and other physicians (50.8% [65] preintervention vs 10.2% [13] postintervention; 35.9% [46] vs 8.6% [11]; 18.0% [23] vs 3.9% [5], respectively; all P<.001). The 66 female residents reported statistically significantly fewer episodes of gender bias (65.2% [43] vs 31.8% [21]; P<.001). The 13 residents who identified as underrepresented in medicine reported statistically significantly less misidentification from patients (84.6% [11] vs 23.1% [3]; P=.008); although not a statistically significant difference, the 13 residents identifying as underrepresented in medicine also reported less misidentification with nonphysician team members (46.2% [6] vs 15.4% [2]; P=.13).

CONCLUSION

Residents reported decreased role misidentification after use of a role identification badge, most prominently improved among women. Decreasing workplace bias is essential in efforts to improve both diversity and inclusion efforts in training programs.

The recent evolution of patient care rounds in pediatric teaching hospitals in the United States and Canada

Introduction: National trends toward empowering and enabling patients and families to take a bigger role in their own medical care and enhanced collaboration between rounding stakeholders have effectuated a new rounding model in the pediatric inpatient setting known as 'Patient- and Family-Centered Rounds/I-PASS,' which has shown to decrease safety events and to improve stakeholders' experience with rounding. Other enhancements to the new model, such as the use of whiteboards, rounding checklists, and facecards, have all been applied to the new model to good effect. Another major enhancement to rounding of late has been the application of a schedule to rounds, which has increased the presence of the nurse and the family during rounds and has improved rounding efficiency without a negative effect on teaching.Objective:  We provide a review of the literature regarding this new rounding model and its effects in the pediatric inpatient setting, as well as a review of the enhancements that have been applied to the new model, the recognized barriers to the implementation of these rounding alterations and the ways in which those barriers have been overcome. Conclusions:  In the pediatric inpatient setting, the 'Patient and Family-Centered Rounds/IPASS' rounding model, as well as enhancements to this new model such as rounding schedules, whiteboards, checklists and facecards, have had a positive effect on stakeholders' experience with rounding, increased patient safety and improved rounding efficiency.  Given these positive effects, these alterations to rounding should be promoted and sustained.PLAIN LANGUAGE SUMMARYRounding is when a medical care provider, or a team of providers, visits patients in the hospital in order to determine a plan of care and discuss that care with the patient and the patient's family. In teaching hospitals, this involves staff physicians, medical trainees and advanced practice providers. Rounding has changed in the recent past as evolving pressures have increasingly led these teams of providers to talk and make decisions about patients outside the patient's room, which lessens the patient's ability to contribute to decision-making. This also lessens the ability of the patient's nurse to contribute. The recognition of this problem has led to big changes in rounding in children's teaching hospitals, the biggest of which is called 'family-centered rounding.' This involves performing the entirety of rounds in the patients' rooms, directing the discussion toward them in language that they understand, with the active participation of everyone present, including the patient's nurse. Other changes in rounding, designed to improve patients' experiences and decrease medical errors, have made this new rounding model even better. Structured communication during rounds, communication aids such as whiteboards and checklists, and planned times for rounding on each patient ('scheduled rounding') have all successfully been used to improve patients' care and experience in the hospital. This article aims to inform the reader about family-centered rounds and other recent rounding transformations that have proven to increase patient safety and improve their experience while in the hospital, also noting barriers to these changes and how they have been overcome.

Electronic Paper Displays in Hospital Operations: Proposal for Deployment and Implementation

BACKGROUND

Display signage is ubiquitous and essential in hospitals to serve several clerical, operational, and clinical functions, including displaying notices, providing directions, and presenting clinical information. These functions improve efficiency and patient engagement, reduce errors, and enhance the continuity of care. Over time, signage has evolved from analog approaches such as whiteboards and handwritten notices to digital displays such as liquid crystal displays, light emitting diodes, and, now, electronic ink displays. Electronic ink displays are paper-like displays that are not backlit and show content by aligning microencapsulated color beads in response to an applied electric current. Power is only required to generate content and not to retain it. These displays are very readable, with low eye strain; minimize the emission of blue light; require minimal power; and can be driven by several data sources, ranging from virtual servers to electronic health record systems. These attributes make adapting electronic ink displays to hospitals an ideal use case.

OBJECTIVE

In this paper, we aimed to outline the use of signage and displays in hospitals with a focus on electronic ink displays. We aimed to assess the advantages and limitations of using these displays in hospitals and outline the various public-facing and patient-facing applications of electronic ink displays. Finally, we aimed to discuss the technological considerations and an implementation framework that must be followed when adopting and deploying electronic ink displays.

METHODS

The public-facing applications of electronic ink displays include signage and way-finders, timetables for shared workspaces, and noticeboards and bulletin boards. The clinical display applications may be smaller form factors such as door signs or bedside cards. The larger, ≥40-inch form factors may be used within patient rooms or at clinical command centers as a digital whiteboard to display general information, patient and clinician information, and care plans. In all these applications, such displays could replace analog whiteboards, noticeboards, and even other digital screens.

RESULTS

We are conducting pilot research projects to delineate best use cases and practices in adopting electronic ink displays in clinical settings. This will entail liaising with key stakeholders, gathering objective logistical and feasibility data, and, ultimately, quantifying and describing the effect on clinical care and patient satisfaction.

CONCLUSIONS

There are several use cases in a clinical setting that may lend themselves perfectly to electronic ink display use. The main considerations to be studied in this adoption are network connectivity, content management, privacy and security robustness, and detailed comparison with existing modalities. Electronic ink displays offer a superior opportunity to future-proof existing practices. There is a need for theoretical considerations and real-world testing to determine if the advantages outweigh the limitations of electronic ink displays.

Mitigating the gender gap: How "DOCTOR" badges affect physician identity

OBJECTIVES

Patients and their families frequently misclassify female physicians in the Emergency Department (ED) as non-physicians. Physician misidentification impacts the environment of care on multiple levels; including patient satisfaction and physician well-being. Implementing "DOCTOR" badges may be a low-cost tool to rectify these problems.

METHODS

The study was conducted in a large urban academic medical center. Badges with the title "DOCTOR" was distributed to 83 Emergency Medicine (EM) residents and 28 EM Attendings in the department. After 3 months, the residents and Attendings were surveyed to assess the efficacy of the intervention. Descriptive data, univariable, and multivariable analyses were conducted.

RESULTS

There were 98 respondents to the pre-intervention survey and 87 respondents to the post-intervention survey. 91% of EM physicians reported that they were misidentified by the patients and their families. Compared to male EM physicians, female EM physicians were disproportionately more likely to be misidentified as a non-physician 43% vs 97%, respectfully, 95% CI: [37,66], p < 0.0001. After wearing the "DOCTOR" badges, a postintervention survey showed decrease in misidentification of female EM physicians by patients and their families to 81.6%, a 15.4% decrease, p = 0.03. Being more valued was reported by 73.7% female physicians vs. 44.9% male physicians, 95% CI [7.9,46], p = 0.007. Similarly, 64.3% EM physicians felt less frustration with misclassification, 81.6% female physicians vs. 51% male physicians, 95% CI [10.5,47], p = 0.0033.

CONCLUSIONS

Female EM physicians are disproportionately misidentified by patients and their families and are more likely to feel undervalued when clarifying their roles. In only a span of 3 months, we found that the use of "DOCTOR" badges decreased misidentification and improved outcomes that may enhance physician wellness. Having EM physicians wear a "DOCTOR" badge may be a simple and effective long-term solution to this issue.

Introducing physician associates to hospital patients: Development and feasibility testing of a patient experience-based intervention

Background

Physician associates (PAs) are one of many new mid‐level health practitioner roles being introduced worldwide. They are a recent innovation in English hospitals. Patient confusion with novel mid‐level practitioner titles and roles is well documented, alongside evidence of a positive association between patients’ ability to identify practitioners and patient satisfaction. No prior research developed an intervention to introduce PAs or any other new practitioner role to hospital patients.

Objective

To develop, with patient and public involvement and engagement (PPIE), an intervention for introducing the PA role to hospital patients, and to test feasibility.

Methods

Intervention development was underpinned by an experience‐based co‐design approach. Workshop participants generated ideas for introducing PAs, subsequently explored in semi‐structured interviews with hospital patients (n = 13). Interview findings were used by participants in a second workshop to design the intervention. Feasibility of the intervention was assessed in relation to its acceptability and efficacy using semi‐structured interviews with hospital patients (n = 20) and PAs (n = 3).

Results

The intervention developed was a patient information leaflet. It was considered feasible to use in the hospital setting, helpful to patients in understanding the PA role and acceptable to both patients and PAs. The intervention was also appreciated by patients for providing reassurance of care and support.

Conclusions

An experience‐based co‐design approach enabled development of an intervention tailored to patients’ experiential preferences. Positive evidence of feasibility and utility is encouraging, supporting future larger‐scale testing.

Patient and public contribution

PPIE representatives were involved in the study design, intervention development and data interpretation.

Stress and Fear: Clinical Implications for Providers and Patients (in the Time of COVID-19 and Beyond)

In light of the coronavirus disease 2019 pandemic, we explore the role of stress, fear, and the impact of positive and negative emotions on health and disease. We then introduce strategies to help mitigate stress within the health care team, and provide a rationale for their efficacy. Additionally, we identify strategies to optimize patient care and explain their heightened importance in today's environment.