Patient satisfaction in the emergency department and the use of business cards by physicians

From the Journal of Emergency Medicine:

BACKGROUND: Emergency departments (EDs) across the country become increasingly crowded. Methods to improve patient satisfaction are becoming increasingly important.

OBJECTIVE: To determine if the use of business cards by emergency physicians improves patient satisfaction.

METHODS: A prospective, convenience sample of ED patients were surveyed in a tertiary care, suburban teaching hospital. Inclusion criteria were limited to an understanding of written and spoken English. Excluded patients included those with altered mental status or too ill to complete a survey. Patients were assigned to receive a business card on alternate days in the ED from the treating physician(s) during their patient introductions. The business cards listed the physician’s name and position (resident or attending physician) and the institution name and phone number. Before hospital admission or discharge, a research assistant asked patients to complete a questionnaire regarding their ED visit to determine patient satisfaction.

RESULTS:  Three hundred-twenty patients were approached to complete the questionnaire and 259 patients (81%) completed it. Patient demographics were similar in both the business card and non-business-card groups. There were no statistically significant differences for patient responses to any of the study questions whether or not they received a business card during the physician introduction.

CONCLUSION: The use of business cards during physician introduction in the ED does not improve patient satisfaction.

When a health insurer won’t pay for an ER visit

From the LA Times:

According to Dr. David John, an emergency room physician in Stafford Springs, Conn., and former chair of quality and patient safety for the American College of Emergency Physicians, it’s quite typical for a patient to enter the ER with symptoms indicating a serious medical condition but leave with a diagnosis that sounds anything but urgent. Imagine, for example, the common scenario of a 50-year old man with a heart condition who comes to the ER complaining of crushing chest pain but, after a medical work up, is found to be suffering from indigestion.

By law, health plans are required to pay for emergency room visits for medical situations in which an average person believes his or her health or life is threatened (called the prudent layperson standard), according to John. Your ultimate diagnosis cannot influence whether your emergency room visit is paid for by your insurer.

ED-Hospitalist Care: The High-Impact Handover…and How to Do It Right

From the Studer Group:

Handovers are critical in healthcare. The smoothness and efficiency with which one care provider or department transitions a patient to the next care provider or department can make or break the entire patient experience.

Handovers in healthcare have been cited in the literature as times of vulnerability in safety, quality, and perception of care. One of the most important and frequent handovers happens when the patient moves from Emergency Department to hospitalist.

National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries

From the Annals of Emergency Medicine:

Study objective: We compare the association between barriers to timely primary care and emergency department (ED) utilization among adults with Medicaid versus private insurance.

Methods: We analyzed 230,258 adult participants of the 1999 to 2009 National Health Interview Survey. We evaluated the association between 5 specific barriers to timely primary care (unable to get through on telephone, unable to obtain appointment soon enough, long wait in the physician’s office, limited clinic hours, lack of transportation) and ED utilization (≥1 ED visit during the past year) for Medicaid and private insurance beneficiaries. Multivariable logistic regression models adjusted for demographics, socioeconomic status, health conditions, outpatient care utilization, and survey year.

Results: Overall, 16.3% of Medicaid and 8.9% of private insurance beneficiaries had greater than or equal to 1 barrier to timely primary care. Compared with individuals with private insurance, Medicaid beneficiaries had higher ED utilization overall (39.6% versus 17.7%), particularly among those with barriers (51.3% versus 24.6% for 1 barrier and 61.2% versus 28.9% for ≥2 barriers). After adjusting for covariates, Medicaid beneficiaries were more likely to have barriers (adjusted odds ratio [OR] 1.41; 95% confidence interval [CI] 1.30 to 1.52) and higher ED utilization (adjusted OR 1.48; 95% CI 1.41 to 1.56). ED utilization was even higher among Medicaid beneficiaries with 1 barrier (adjusted OR 1.66; 95% CI 1.44 to 1.92) or greater than or equal to 2 barriers (adjusted OR 2.01; 95% CI 1.72 to 2.35) compared with that for individuals with private insurance and barriers.

Conclusion: Compared with individuals with private insurance, Medicaid beneficiaries were affected by more barriers to timely primary care and had higher associated ED utilization. Expansion of Medicaid eligibility alone may not be sufficient to improve health care access.

Thundermist Health Center in Woonsocket

Ed. I just thought the location sounded funny…

From WRNI:

No one wants to go to the emergency room. The wait is usually long, and the care is expensive. Yet some Rhode Islanders end up in the ER more than fifty times a year. One local program is trying to offer them better, less costly treatment somewhere else.