- Email: [email protected]
269 Impact of an Asthma Care Pathway on the Emergency Department Management of Asthma
Research Forum Abstracts less. Per NVS, 50% of patients had limited health literacy. There was no significant difference in LOS between the 2 groups. Comparison between adequate and limited health literacy subjects are shown in the table. Patients at risk for limited health literacy had higher odds of having EKGs performed (OR¼2.0, 95%CI¼1.1, 3.6) and of having prior ED visits (OR¼1.7, 95%CI¼1.0, 2.8) compared to patients with adequate health literacy. Conclusions: We found no significant difference in ED LOS or overall ED testing between patients with limited health literacy and adequate health literacy in an academic urban ED setting. Limited health literacy subjects were more likely to have had EKGs done and more likely to have had prior ED visits.
performed (23% vs 45%), CXR performed (30% vs 23%), median time-toinhaled beta-agonist (44 minutes, 233) vs 38 minutes, 505), median time to inhaled anticholinergic therapy (40 minutes, 233) vs 30 minutes, 266), median time to steroid administration (105 minutes, 414 vs 91.5 minutes, 502), and median LOS (206 minutes, 1320 vs 184.5 minutes, 884). PPO use in the post-intervention group was 4.4%. Conclusion: The implementation of an asthma care pathway, despite infrequent use of the PPO component of the pathway at our institution, appears to have led to an improvement in quality measures of ED asthma care. Opportunities for further improvements may be attained through ongoing provider education and increased protocol adherence.
270
Patients’ Attitudes Regarding Tattooed Physicians: The ART Study
Cohen M, Jeanmonod D, Stankewicz H, Coppersmith V, Berrios M, Habeeb K, Jeanmonod R/St. Luke’s University Health Network, Bethlehem, PA
269
Impact of an Asthma Care Pathway on the Emergency Department Management of Asthma
Wood B, Toma A, McGowan M/University of Toronto, Toronto, ON, Canada; St Michael’s Hospital, Toronto, ON, Canada
Study Objective: Introduction of care pathways has been theorized to improve adherence to evidence-based guidelines and improve quality of care metrics. In 2014, an interprofessional team developed and implemented an evidence-based asthma care pathway, including a nursing medical directive and pre-printed order set, supported with education. We sought to assess performance in quality markers of asthma care such as time to corticosteroids and the rational use of diagnostic studies in line with published national and international guidelines for emergency department (ED) management of asthma. Methods: A retrospective review of ED patients greater than 16 years of age with a discharge diagnosis of asthma was conducted pre- (September 2013 through March 2014) and post-intervention (April 2014 through January 2015). Measures were: use of peak-expiratory flow rate testing (PEFR), chest x-ray (CXR) performance, and timebased outcomes from triage: time to inhaled beta-agonist therapy, time to inhaled anticholinergic therapy, time to steroid administration, length-of-stay (LOS) and use of pre-printed orders (PPO). Results: A total of 495 cases met criteria (pre-intervention N¼290 and postintervention N¼205). Improvements were seen for both time based metrics (median, range) and percent utilization of diagnostic testing after the intervention. Pre- and post-intervention groups showed respectively; PEFR
Volume 66, no. 4s : October 2015
Study Objectives: Many health care institutions have policies prohibiting physicians from having exposed tattoos and facial piercings. Several non-clinical studies have demonstrated that patients feel that medical providers with exposed body art are less competent, approachable, and professional than their traditional counterparts. We sought to determine if the presence of exposed body art had any impact on patients’ perceptions of their physician in actual practice. Methods: This prospective cohort study utilized a survey-based approach to investigate patients’ perceptions of professionalism, caring, and approachability of the physician providing them care in the emergency department (ED). Physicians in the study served as their own controls. Both male and female resident and attending physicians participated. Physicians had control shifts as well as shifts wearing temporary standardized tattoos (black tribal arm band) and/or nontraditional piercings (any piercing in men, nose stud in women). Patients were surveyed during these shifts, but were not informed that the survey was to evaluate the physicians’ appearance. Patients were surveyed during all shifts and on all days of the week. The survey utilized previously published validated items as well as Press-Ganey questions, and was reviewed by a committee of experts for face and content validity. The questions were on a 5-point Likert scale, and both positively and negatively worded questions were used for internal validity. English-speaking patients over the age of 18 were approached by nurses to complete the survey. The surveys were anonymous, but demographic information and triage acuity were collected. Given the high response percentage based on Press Ganey and prior studies at our institution, with a goal confidence level of 90% and a 5% margin of error, our sample size for our primary research question was 97. The study was IRB exempt. Results: A total of 292 patients were surveyed during the course of the study. One hundred thirty-four encounters involved providers with no exposed body art (45.9%). For the 4 providers in the study, there were no baseline differences in perceived professionalism (P ¼ .79) or skills (P ¼ .52). Patients found all providers equally comfortable to talk with about their problems (P ¼ .72). There were no differences in these same measures for any individual provider comparing presence of exposed body art to no exposed body art (P values ranging from .16-1.0). Patients were generally satisfied with their care, with greater than 90% of patients stating they strongly agree with the statement “the doctor was professional” and more than 80% strongly agreeing with the statement “I felt comfortable talking to the doctor about my problem.” Conclusion: In this study, we found no statistical difference in perception of patient care by patients who were treated by physicians with or without exposed body art. Physician tattoos and facial piercings were not factors in patient’s evaluation of physician competence, professionalism, or approachability.
271
Qualitative Study: Cost of Emergency Care From the Providers’ Perspective
Gilbert SK, Wen L/George Washington University, Washington, DC
Study Objectives: It is well known that health care spending in the United States is increasing at a rapid rate, including emergency care. Less clear, however, is how the
Annals of Emergency Medicine S97
performed (23% vs 45%), CXR performed (30% vs 23%), median time-toinhaled beta-agonist (44 minutes, 233) vs 38 minutes, 505), median time to inhaled anticholinergic therapy (40 minutes, 233) vs 30 minutes, 266), median time to steroid administration (105 minutes, 414 vs 91.5 minutes, 502), and median LOS (206 minutes, 1320 vs 184.5 minutes, 884). PPO use in the post-intervention group was 4.4%. Conclusion: The implementation of an asthma care pathway, despite infrequent use of the PPO component of the pathway at our institution, appears to have led to an improvement in quality measures of ED asthma care. Opportunities for further improvements may be attained through ongoing provider education and increased protocol adherence.
270
Patients’ Attitudes Regarding Tattooed Physicians: The ART Study
Cohen M, Jeanmonod D, Stankewicz H, Coppersmith V, Berrios M, Habeeb K, Jeanmonod R/St. Luke’s University Health Network, Bethlehem, PA
269
Impact of an Asthma Care Pathway on the Emergency Department Management of Asthma
Wood B, Toma A, McGowan M/University of Toronto, Toronto, ON, Canada; St Michael’s Hospital, Toronto, ON, Canada
Study Objective: Introduction of care pathways has been theorized to improve adherence to evidence-based guidelines and improve quality of care metrics. In 2014, an interprofessional team developed and implemented an evidence-based asthma care pathway, including a nursing medical directive and pre-printed order set, supported with education. We sought to assess performance in quality markers of asthma care such as time to corticosteroids and the rational use of diagnostic studies in line with published national and international guidelines for emergency department (ED) management of asthma. Methods: A retrospective review of ED patients greater than 16 years of age with a discharge diagnosis of asthma was conducted pre- (September 2013 through March 2014) and post-intervention (April 2014 through January 2015). Measures were: use of peak-expiratory flow rate testing (PEFR), chest x-ray (CXR) performance, and timebased outcomes from triage: time to inhaled beta-agonist therapy, time to inhaled anticholinergic therapy, time to steroid administration, length-of-stay (LOS) and use of pre-printed orders (PPO). Results: A total of 495 cases met criteria (pre-intervention N¼290 and postintervention N¼205). Improvements were seen for both time based metrics (median, range) and percent utilization of diagnostic testing after the intervention. Pre- and post-intervention groups showed respectively; PEFR
Volume 66, no. 4s : October 2015
Study Objectives: Many health care institutions have policies prohibiting physicians from having exposed tattoos and facial piercings. Several non-clinical studies have demonstrated that patients feel that medical providers with exposed body art are less competent, approachable, and professional than their traditional counterparts. We sought to determine if the presence of exposed body art had any impact on patients’ perceptions of their physician in actual practice. Methods: This prospective cohort study utilized a survey-based approach to investigate patients’ perceptions of professionalism, caring, and approachability of the physician providing them care in the emergency department (ED). Physicians in the study served as their own controls. Both male and female resident and attending physicians participated. Physicians had control shifts as well as shifts wearing temporary standardized tattoos (black tribal arm band) and/or nontraditional piercings (any piercing in men, nose stud in women). Patients were surveyed during these shifts, but were not informed that the survey was to evaluate the physicians’ appearance. Patients were surveyed during all shifts and on all days of the week. The survey utilized previously published validated items as well as Press-Ganey questions, and was reviewed by a committee of experts for face and content validity. The questions were on a 5-point Likert scale, and both positively and negatively worded questions were used for internal validity. English-speaking patients over the age of 18 were approached by nurses to complete the survey. The surveys were anonymous, but demographic information and triage acuity were collected. Given the high response percentage based on Press Ganey and prior studies at our institution, with a goal confidence level of 90% and a 5% margin of error, our sample size for our primary research question was 97. The study was IRB exempt. Results: A total of 292 patients were surveyed during the course of the study. One hundred thirty-four encounters involved providers with no exposed body art (45.9%). For the 4 providers in the study, there were no baseline differences in perceived professionalism (P ¼ .79) or skills (P ¼ .52). Patients found all providers equally comfortable to talk with about their problems (P ¼ .72). There were no differences in these same measures for any individual provider comparing presence of exposed body art to no exposed body art (P values ranging from .16-1.0). Patients were generally satisfied with their care, with greater than 90% of patients stating they strongly agree with the statement “the doctor was professional” and more than 80% strongly agreeing with the statement “I felt comfortable talking to the doctor about my problem.” Conclusion: In this study, we found no statistical difference in perception of patient care by patients who were treated by physicians with or without exposed body art. Physician tattoos and facial piercings were not factors in patient’s evaluation of physician competence, professionalism, or approachability.
271
Qualitative Study: Cost of Emergency Care From the Providers’ Perspective
Gilbert SK, Wen L/George Washington University, Washington, DC
Study Objectives: It is well known that health care spending in the United States is increasing at a rapid rate, including emergency care. Less clear, however, is how the
Annals of Emergency Medicine S97