- Email: [email protected]
224: Does Providing Patients With Overestimates of Anticipated Waiting Times Improve Perception of Wait Times in the Emergency Department?
Research Forum Abstracts for 112 bedside occurrences. There was no difference in patient satisfaction based upon the presence or absence of all interruptions at the bedside. During 14 patient interactions and 23 professional discussions, multiple interruptions occurred. In 21 occurrences, multiple interruptions occurred simultaneously. Conclusion: Interruptions occurred frequently during sensitive provider activities. Patient satisfaction was not diminished by bedside interruptions. The effect on the providers has yet to be studied.
222
Reduction in Emergency Department Fast Track Length of Stay
Results: In the three month baseline period before the policy and list were implemented 128 of 246 ED (52.0%) of defined drug seeker visits resulted in inappropriate narcotic administration. In CYQ2, 55 of 137 (40.2%) received narcotics; p⬎.0125 compared to baseline. For CYQ3 81 of 185 (43.8%) received narcotics; p⬎.0125 compared to baseline. For CYQ4 89 of 191 (46.6%) received narcotics; p⬎.0125. Conclusion: In our hospital network, the development of a formal “drug seeker” policy and a readily available secure drug seeker database did not significantly decrease the dispensing of narcotics to drug-seeking patients.
Massucci JL, Farley H, Laskowski Jones L, Knox E, Alders V, Toulson K, Reed III J, Sweeney T, Jasani N, Reese IV CL/Christiana Care Health System, Newark, DE
224
Study Objectives: To determine the effect of a triage redesign process on the average length of stay (LOS) of patients treated in an emergency department (ED) fast track area. Methods: This was a prospective analytic cohort study examining the impact of a LEAN-based triage redesign effort on the average LOS of fast track patients, typically Emergency Severity Index (ESI) 4 and 5 patients, in an academic ED. The baseline average LOS of all patients seen in the fast track area between July 1, 2007 and February 1, 2008 were collected. Individual 4-8 hour rapid cycle tests (RCTs) were then conducted on nine separate days between February and April 2008 and included a total of 180 patients. Each RCT involved placing a licensed practical nurse (LPN) and a patient care technician in triage specifically for the purpose of prescreening ESI 4 and 5 patients to determine their appropriateness for treatment in the fast track area and initiating their workup. Once identified, these patients were either sent directly to fast track or had indicated radiologic studies performed and were then sent to fast track for evaluation and treatment by the physician assistant. No processes within the fast track area itself were significantly altered. LOS data were compiled from a passive electronic patient tracking system and entered into an Excel spreadsheet. Data were analyzed using analysis of variance (ANOVA) where a P value of ⱕ 0.05 was considered significant. Results: The overall ANOVA revealed a significant difference in LOS between RCTs and baseline (93.7 ⫾ 3.7 minutes vs. 144.3 ⫾ 0.8 minutes; F ⫽ 10.232, p ⬍ 0.01). Specifically, when all 9 groups were compared to baseline a 65% decrease in LOS was observed, suggesting that the triage redesign process can effectively reduce LOS. Conclusion: By implementing this simple triage redesign effort, a significant reduction in average LOS of fast track patients was achieved without the need for any substantial structural or process changes in the actual fast track area itself. Further evaluations will be necessary to determine if these LOS reductions are maintained once the new process is employed on a daily basis.
Rae Jr RW, Wilson AG, Brown J, Higgins A, O’Neil BJ/William Beaumont Hospital, Royal Oak, MI
223
A Formal “Drug Seeker” Policy/Database Does Not Decrease the Dispensing of Narcotics to Drug Seekers
Patterson JW, Stockton P, Ruggles J, Murray J, Melanson S/St Luke’s Hospital, Bethlehem, PA
Study Objectives: To determine if a formal departmental drug seeker policy and an intranet drug seeker database would significantly decrease the number of narcotics dispensed to patients deemed to be drug seekers. Methods: The St Luke’s Hospital Health network consists of 4 hospitals with a combined census of 135,000. Thirty-six emergency medicine residents are trained at 2 of the sites. A drug seeker database was developed and approved by the network chief using input from attendings, nurses, and residents using pre-established criteria. Patients with patterns of frequent visits, deception (lying, altering prescriptions) or identified as receiving multiple narcotic prescriptions from multiple doctors were included. A formal drug seeking policy was developed internally and approved by outside legal counsel. An intranet drug seeker database using active server pages technology and a Microsoft sequel server database was developed. Attending physicians and residents were giving access to this list with a username and password. Departmental meetings, email, and conferences were used to inform physicians of the existence of the policy and database. A retrospective chart review was performed on all patients in the database in a 3-month period before the policy went live from November 2006 to Jan 2007. Charts were reviewed to see if patients in the database received narcotics while in the ED or were given narcotic prescriptions. A similar review was performed in the 3 subsequent 3 month periods after the policy went live in April of 2007 (CYQ2, CYQ3, and CYQ4). Separate Z tests for proportions compared the periods measured, with an adjusted p-value of .0125 denoting statistical significance.
Volume , . : October
Does Providing Patients With Overestimates of Anticipated Waiting Times Improve Perception of Wait Times in the Emergency Department?
Study Objectives: Previous research suggests that patient perception of waiting time is highly correlated with patient satisfaction in the emergency department (ED). One method of altering patient perception of wait times used in the service industries is to provide inflated estimates of expected wait times, thus improving satisfaction when expectations are met or exceeded. A recent intervention in which patients were provided overestimates of wait times at our institution showed an improvement in overall satisfaction with their ED visit. The aim of this study was to determine whether there was an improvement in patients’ perceptions of their wait times as a result of this intervention. Methods: This prospective study was performed at a 115,000 visit per year, suburban, Level I Trauma Center. Forty-five percent of patients discharged from the ED during a 6-month pre-intervention period and a 6-month post-intervention period were surveyed using the previously validated Press-Ganey (PG) instrument. During an intervening 3-month run-in period, ED staff were trained to provide patients with overestimates of wait times for each part of their ED visit(historical averages plus 20%). Per the PG standard, responses to questions about satisfaction with wait times were converted from a categorical variable with five values to a continuous variable on a scale of 0 to 100. Pre- and post-intervention groups were analyzed by student t test, the PG standard. Results: The overall response rate was 20.6%. 9 variables in our survey were related to patient perception of wait times. A statistically significant improvement in patient perception of wait times was found in 5 of the 9 variables (variable, mean improvement, P value): wait time to triage nurse (1.94, 0.034), triage nurse info on wait times (2.58, 0.027), patient kept informed of delays (3.29, 0.003), patient kept informed of treatment progress (2.14, 0.050), and time to consultant (3.39, 0.030). The other 4 variables did not reach statistical significance, but each had a trend toward improvement: time to treatment area (0.50,0.551), time to. doctor (1.22, 0.198), time to radiology test (1.89,0.099), and time to radiology results (1.45, 0.227). As reported previously, overall patient satisfaction was improved by the intervention as well: likelihood to recommend (2.18, 0.015), likelihood of using ED again (1.95, 0.050), and overall rating (2.02, 0.015). Conclusions: Providing patients with inflated estimates of wait times resulted in a statistically significant improvement in patient perception of their wait times during several parts of their ED stay and improved overall patient satisfaction. Limitations of this study include those inherent in survey-based research, the ever-present efforts to improve wait times and patient satisfaction by multiple other strategies, and difficulty in ensuring and measuring staff participation in the intervention. Of note, no substantive changes to the ED occurred during the course of this study.
225
The Effect of Wait Times and Emergency Department Length of Stay on Patient Perception of Medical Team Communication
Donlan SM, Venkatesh A, Pang PS, Mercer LM, Tanabe P, Courtney D, Engel K, Duval-Arnould J, Gisondi MA, Makoul G, Adams JG/Northwestern University, Feinberg School of Medicine, Chicago, IL
Background: Effective communication is a required core competency from educational (ACGME) and regulatory (Joint Commission) viewpoints to ensure safe, patient-centered care. ED crowding and longer wait times have been previously described as sources of patient dissatisfaction and communication breakdown. The impact of these constraints on communication and subsequent influence on curricular design has not been well explored.
Annals of Emergency Medicine S111
222
Reduction in Emergency Department Fast Track Length of Stay
Results: In the three month baseline period before the policy and list were implemented 128 of 246 ED (52.0%) of defined drug seeker visits resulted in inappropriate narcotic administration. In CYQ2, 55 of 137 (40.2%) received narcotics; p⬎.0125 compared to baseline. For CYQ3 81 of 185 (43.8%) received narcotics; p⬎.0125 compared to baseline. For CYQ4 89 of 191 (46.6%) received narcotics; p⬎.0125. Conclusion: In our hospital network, the development of a formal “drug seeker” policy and a readily available secure drug seeker database did not significantly decrease the dispensing of narcotics to drug-seeking patients.
Massucci JL, Farley H, Laskowski Jones L, Knox E, Alders V, Toulson K, Reed III J, Sweeney T, Jasani N, Reese IV CL/Christiana Care Health System, Newark, DE
224
Study Objectives: To determine the effect of a triage redesign process on the average length of stay (LOS) of patients treated in an emergency department (ED) fast track area. Methods: This was a prospective analytic cohort study examining the impact of a LEAN-based triage redesign effort on the average LOS of fast track patients, typically Emergency Severity Index (ESI) 4 and 5 patients, in an academic ED. The baseline average LOS of all patients seen in the fast track area between July 1, 2007 and February 1, 2008 were collected. Individual 4-8 hour rapid cycle tests (RCTs) were then conducted on nine separate days between February and April 2008 and included a total of 180 patients. Each RCT involved placing a licensed practical nurse (LPN) and a patient care technician in triage specifically for the purpose of prescreening ESI 4 and 5 patients to determine their appropriateness for treatment in the fast track area and initiating their workup. Once identified, these patients were either sent directly to fast track or had indicated radiologic studies performed and were then sent to fast track for evaluation and treatment by the physician assistant. No processes within the fast track area itself were significantly altered. LOS data were compiled from a passive electronic patient tracking system and entered into an Excel spreadsheet. Data were analyzed using analysis of variance (ANOVA) where a P value of ⱕ 0.05 was considered significant. Results: The overall ANOVA revealed a significant difference in LOS between RCTs and baseline (93.7 ⫾ 3.7 minutes vs. 144.3 ⫾ 0.8 minutes; F ⫽ 10.232, p ⬍ 0.01). Specifically, when all 9 groups were compared to baseline a 65% decrease in LOS was observed, suggesting that the triage redesign process can effectively reduce LOS. Conclusion: By implementing this simple triage redesign effort, a significant reduction in average LOS of fast track patients was achieved without the need for any substantial structural or process changes in the actual fast track area itself. Further evaluations will be necessary to determine if these LOS reductions are maintained once the new process is employed on a daily basis.
Rae Jr RW, Wilson AG, Brown J, Higgins A, O’Neil BJ/William Beaumont Hospital, Royal Oak, MI
223
A Formal “Drug Seeker” Policy/Database Does Not Decrease the Dispensing of Narcotics to Drug Seekers
Patterson JW, Stockton P, Ruggles J, Murray J, Melanson S/St Luke’s Hospital, Bethlehem, PA
Study Objectives: To determine if a formal departmental drug seeker policy and an intranet drug seeker database would significantly decrease the number of narcotics dispensed to patients deemed to be drug seekers. Methods: The St Luke’s Hospital Health network consists of 4 hospitals with a combined census of 135,000. Thirty-six emergency medicine residents are trained at 2 of the sites. A drug seeker database was developed and approved by the network chief using input from attendings, nurses, and residents using pre-established criteria. Patients with patterns of frequent visits, deception (lying, altering prescriptions) or identified as receiving multiple narcotic prescriptions from multiple doctors were included. A formal drug seeking policy was developed internally and approved by outside legal counsel. An intranet drug seeker database using active server pages technology and a Microsoft sequel server database was developed. Attending physicians and residents were giving access to this list with a username and password. Departmental meetings, email, and conferences were used to inform physicians of the existence of the policy and database. A retrospective chart review was performed on all patients in the database in a 3-month period before the policy went live from November 2006 to Jan 2007. Charts were reviewed to see if patients in the database received narcotics while in the ED or were given narcotic prescriptions. A similar review was performed in the 3 subsequent 3 month periods after the policy went live in April of 2007 (CYQ2, CYQ3, and CYQ4). Separate Z tests for proportions compared the periods measured, with an adjusted p-value of .0125 denoting statistical significance.
Volume , . : October
Does Providing Patients With Overestimates of Anticipated Waiting Times Improve Perception of Wait Times in the Emergency Department?
Study Objectives: Previous research suggests that patient perception of waiting time is highly correlated with patient satisfaction in the emergency department (ED). One method of altering patient perception of wait times used in the service industries is to provide inflated estimates of expected wait times, thus improving satisfaction when expectations are met or exceeded. A recent intervention in which patients were provided overestimates of wait times at our institution showed an improvement in overall satisfaction with their ED visit. The aim of this study was to determine whether there was an improvement in patients’ perceptions of their wait times as a result of this intervention. Methods: This prospective study was performed at a 115,000 visit per year, suburban, Level I Trauma Center. Forty-five percent of patients discharged from the ED during a 6-month pre-intervention period and a 6-month post-intervention period were surveyed using the previously validated Press-Ganey (PG) instrument. During an intervening 3-month run-in period, ED staff were trained to provide patients with overestimates of wait times for each part of their ED visit(historical averages plus 20%). Per the PG standard, responses to questions about satisfaction with wait times were converted from a categorical variable with five values to a continuous variable on a scale of 0 to 100. Pre- and post-intervention groups were analyzed by student t test, the PG standard. Results: The overall response rate was 20.6%. 9 variables in our survey were related to patient perception of wait times. A statistically significant improvement in patient perception of wait times was found in 5 of the 9 variables (variable, mean improvement, P value): wait time to triage nurse (1.94, 0.034), triage nurse info on wait times (2.58, 0.027), patient kept informed of delays (3.29, 0.003), patient kept informed of treatment progress (2.14, 0.050), and time to consultant (3.39, 0.030). The other 4 variables did not reach statistical significance, but each had a trend toward improvement: time to treatment area (0.50,0.551), time to. doctor (1.22, 0.198), time to radiology test (1.89,0.099), and time to radiology results (1.45, 0.227). As reported previously, overall patient satisfaction was improved by the intervention as well: likelihood to recommend (2.18, 0.015), likelihood of using ED again (1.95, 0.050), and overall rating (2.02, 0.015). Conclusions: Providing patients with inflated estimates of wait times resulted in a statistically significant improvement in patient perception of their wait times during several parts of their ED stay and improved overall patient satisfaction. Limitations of this study include those inherent in survey-based research, the ever-present efforts to improve wait times and patient satisfaction by multiple other strategies, and difficulty in ensuring and measuring staff participation in the intervention. Of note, no substantive changes to the ED occurred during the course of this study.
225
The Effect of Wait Times and Emergency Department Length of Stay on Patient Perception of Medical Team Communication
Donlan SM, Venkatesh A, Pang PS, Mercer LM, Tanabe P, Courtney D, Engel K, Duval-Arnould J, Gisondi MA, Makoul G, Adams JG/Northwestern University, Feinberg School of Medicine, Chicago, IL
Background: Effective communication is a required core competency from educational (ACGME) and regulatory (Joint Commission) viewpoints to ensure safe, patient-centered care. ED crowding and longer wait times have been previously described as sources of patient dissatisfaction and communication breakdown. The impact of these constraints on communication and subsequent influence on curricular design has not been well explored.
Annals of Emergency Medicine S111