- Email: [email protected]
274 Development and Testing of a Patient-Reported Outcome Measure for Use With Emergency Department Patients Who Are Discharged Home
Research Forum Abstracts addressed interventions were imaging studies (11 items; 29%) and use of antibiotics (9 items; 24%). Recommendations with the 10 highest overall ratings are shown in the Table; due to a 4-way tie for 10th place, 13 items are included. Within this group, six items address imaging studies, including four that address imaging in children. Another five items focus on antibiotic use, including two regarding respiratory infections and another two regarding asymptomatic bacteruria. Conclusions: 38 CW recommendations from other specialties are highly relevant to emergency care. Imaging studies and antibiotic use are heavily represented among them.
median and interquartile range [IQR]. Mann-Whitney U test was used to compare median values between groups. Results: A total of 434 patients were electronically identified. One-hundred eighty-seven (187) patients, transferred from 40 unique referring EDs with triage SBP161 mm Hg and received EVD during hospitalization, were included in analysis. Median Glasgow Coma Scale (GCS) at ED presentation was 13 [7-15]. Median SBPs at ED triage and departure were 199 [IQR 175-221] and 163 [IQR 138-176], p<0.001, respectively. One-hundred one (54%) patients had transfer SBP (tSBP) 161 mmHg, while 86 (46%) patients had tSBP 160mmHg. Median time from triage to SBP <160 was 142 [70-236] minutes while median time from triage to EVD placement at academic referral hospital was 426 [320678] minutes. Intracranial pressure for patients with tSBP161mmHg, comparing to patients with tSBP160 mm Hg respectively, was 20[15-25] vs 24 [15-30] mm Hg, p¼0.437. Conclusions: Emergency providers’ management of hypertensive patients with sICH and suspected intracranial hypertension was inadequate with only 46% of patients’ SBP at time of transfer meeting recommended treatment guidelines. Further education opportunities exist to encourage emergency providers to treat critically ill patients with spontaneous intracranial hemorrhage more effectively.
274
Development and Testing of a PatientReported Outcome Measure for Use With Emergency Department Patients Who Are Discharged Home
Vaillancourt S, Dainty K, Seaton MB, Linton D, McGowan M, Maybee A, Inrig T, Schull M, Laupacis A, Beaton D/St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada; St. Michael’s Hospital, Toronto, ON, Canada; Independent Peer Researcher, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
273
Emergency Providers Did Not Adequately Manage Patients With Spontaneous Intracranial Hemorrhage and Suspected Intracranial Hypertension
Strong J, Gatz JD, Al Rebh H, Kersey J, Jenkins R, Pope K, Tuteja G, Nguyen T, Chang W-T, Tran QK/University of Maryland, Baltimore, MD
Study Objectives: Spontaneous intracranial hemorrhage (sICH) often presents with markedly elevated blood pressure. Systolic blood pressure (SBP) above 140 to 150 mmHg has been found to be associated with higher morbidity and mortality. The 2010 American Heart Association and American Stroke Association (AHA/ASA) guideline recommends reduction of SBP among these patients to less than 160 mmHg if presenting SBP160mm Hg. However, a retrospective study in 2013 of 78 patients with non-traumatic subarachnoid hemorrhage showed that emergency providers treated only 71% of patients with SBP 160mmHg. Therefore, we hypothesized that more than 50% of patients with hypertensive sICH will not have SBP<160 mmHg at ED departure. Our study objective was to assess the effectiveness of emergency providers’ blood pressure management among critically ill patients with sICH and suspected high intracranial pressure (ICP). Methods: We performed a retrospective study of adult patients with diagnosis of sICH transferred from referring EDs to a quaternary academic center between 01/01/2011 and 09/30/2015 and received external ventricular drains (EVD) during hospitalization. Patients were identified by International Classification of Disease, version 9 (ICD-9 codes of 430.XX, 431.XX) and procedure code 02.21. Patients were excluded if a) not transferred directly from an ED; b) ED triage SBP 160 mmHg; c) no ED records available. Primary outcome was percentage of patients with SBP160 mm Hg at ED departure; secondary outcome was ICP at time of EVD placement. Data was expressed in
S108 Annals of Emergency Medicine
Study Objectives: Patient-reported outcome measures (PROM) are sophisticated questionnaires that are increasingly used to elicit care outcome information from patients. We sought to develop and validate the first PROM for use with general patients receiving emergency department (ED) care and not hospitalized. Methods: PROM development required an extensive multi-phase process based on national and international organizations guidelines (FDA, NQF, ISPOR). Phase 1: Definition of Outcome Concepts - Qualitative research with ED patients post-discharge was used to develop a conceptual framework of ED care outcomes. Phase 2: Item generation - A review of the literature and existing instruments identified candidate questions relevant for each domain; Phase 3: Cognitive debriefing - Existing and newly written questions were tested for understandability problems and wording preference for understandability of questions with ED patients; Phase 4: Field and validity testing - Pilot testing on large cohort of discharged ED patients through a survey panel; Phase 5: Final item reduction Based on Delphi process involving ED clinicians, researchers, patients and system administrators. Results: We completed qualitative interviews with a diverse group of 46 patients within days of their care in the ED to define core outcome domains to ED care. Four core outcome domains were conceptualized: (1) Understanding; (2) Symptom relief; (3) Reassurance and (4) Having a plan. The conceptual framework of ED care outcome informed a review of existing relevant questionnaires and instruments and the writing of additional questions that formed an initial long-form questionnaire. Eight patients participated in cognitive debriefing of the questionnaire within days of their ED visit to test for understanding and wording. Expert clinicians, researchers and patient partners provided input on item refinement and reduction. Over 400 patients completed a second version of the long-form questionnaire which informed the final item reduction process by a modified Delphi method to create PROM-ED version 1.0. Conclusions: Using instrument development methodology, we have developed the first PROM instrument for use with ED patients who are not hospitalized. Such a questionnaire could be used to systematically gather care outcome information from patients that could support and inform improvement work in ED care.
Volume 70, no. 4s : October 2017
median and interquartile range [IQR]. Mann-Whitney U test was used to compare median values between groups. Results: A total of 434 patients were electronically identified. One-hundred eighty-seven (187) patients, transferred from 40 unique referring EDs with triage SBP161 mm Hg and received EVD during hospitalization, were included in analysis. Median Glasgow Coma Scale (GCS) at ED presentation was 13 [7-15]. Median SBPs at ED triage and departure were 199 [IQR 175-221] and 163 [IQR 138-176], p<0.001, respectively. One-hundred one (54%) patients had transfer SBP (tSBP) 161 mmHg, while 86 (46%) patients had tSBP 160mmHg. Median time from triage to SBP <160 was 142 [70-236] minutes while median time from triage to EVD placement at academic referral hospital was 426 [320678] minutes. Intracranial pressure for patients with tSBP161mmHg, comparing to patients with tSBP160 mm Hg respectively, was 20[15-25] vs 24 [15-30] mm Hg, p¼0.437. Conclusions: Emergency providers’ management of hypertensive patients with sICH and suspected intracranial hypertension was inadequate with only 46% of patients’ SBP at time of transfer meeting recommended treatment guidelines. Further education opportunities exist to encourage emergency providers to treat critically ill patients with spontaneous intracranial hemorrhage more effectively.
274
Development and Testing of a PatientReported Outcome Measure for Use With Emergency Department Patients Who Are Discharged Home
Vaillancourt S, Dainty K, Seaton MB, Linton D, McGowan M, Maybee A, Inrig T, Schull M, Laupacis A, Beaton D/St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada; St. Michael’s Hospital, Toronto, ON, Canada; Independent Peer Researcher, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
273
Emergency Providers Did Not Adequately Manage Patients With Spontaneous Intracranial Hemorrhage and Suspected Intracranial Hypertension
Strong J, Gatz JD, Al Rebh H, Kersey J, Jenkins R, Pope K, Tuteja G, Nguyen T, Chang W-T, Tran QK/University of Maryland, Baltimore, MD
Study Objectives: Spontaneous intracranial hemorrhage (sICH) often presents with markedly elevated blood pressure. Systolic blood pressure (SBP) above 140 to 150 mmHg has been found to be associated with higher morbidity and mortality. The 2010 American Heart Association and American Stroke Association (AHA/ASA) guideline recommends reduction of SBP among these patients to less than 160 mmHg if presenting SBP160mm Hg. However, a retrospective study in 2013 of 78 patients with non-traumatic subarachnoid hemorrhage showed that emergency providers treated only 71% of patients with SBP 160mmHg. Therefore, we hypothesized that more than 50% of patients with hypertensive sICH will not have SBP<160 mmHg at ED departure. Our study objective was to assess the effectiveness of emergency providers’ blood pressure management among critically ill patients with sICH and suspected high intracranial pressure (ICP). Methods: We performed a retrospective study of adult patients with diagnosis of sICH transferred from referring EDs to a quaternary academic center between 01/01/2011 and 09/30/2015 and received external ventricular drains (EVD) during hospitalization. Patients were identified by International Classification of Disease, version 9 (ICD-9 codes of 430.XX, 431.XX) and procedure code 02.21. Patients were excluded if a) not transferred directly from an ED; b) ED triage SBP 160 mmHg; c) no ED records available. Primary outcome was percentage of patients with SBP160 mm Hg at ED departure; secondary outcome was ICP at time of EVD placement. Data was expressed in
S108 Annals of Emergency Medicine
Study Objectives: Patient-reported outcome measures (PROM) are sophisticated questionnaires that are increasingly used to elicit care outcome information from patients. We sought to develop and validate the first PROM for use with general patients receiving emergency department (ED) care and not hospitalized. Methods: PROM development required an extensive multi-phase process based on national and international organizations guidelines (FDA, NQF, ISPOR). Phase 1: Definition of Outcome Concepts - Qualitative research with ED patients post-discharge was used to develop a conceptual framework of ED care outcomes. Phase 2: Item generation - A review of the literature and existing instruments identified candidate questions relevant for each domain; Phase 3: Cognitive debriefing - Existing and newly written questions were tested for understandability problems and wording preference for understandability of questions with ED patients; Phase 4: Field and validity testing - Pilot testing on large cohort of discharged ED patients through a survey panel; Phase 5: Final item reduction Based on Delphi process involving ED clinicians, researchers, patients and system administrators. Results: We completed qualitative interviews with a diverse group of 46 patients within days of their care in the ED to define core outcome domains to ED care. Four core outcome domains were conceptualized: (1) Understanding; (2) Symptom relief; (3) Reassurance and (4) Having a plan. The conceptual framework of ED care outcome informed a review of existing relevant questionnaires and instruments and the writing of additional questions that formed an initial long-form questionnaire. Eight patients participated in cognitive debriefing of the questionnaire within days of their ED visit to test for understanding and wording. Expert clinicians, researchers and patient partners provided input on item refinement and reduction. Over 400 patients completed a second version of the long-form questionnaire which informed the final item reduction process by a modified Delphi method to create PROM-ED version 1.0. Conclusions: Using instrument development methodology, we have developed the first PROM instrument for use with ED patients who are not hospitalized. Such a questionnaire could be used to systematically gather care outcome information from patients that could support and inform improvement work in ED care.
Volume 70, no. 4s : October 2017