Aaron W. Bernard

Postal survey methodology to assess patient satisfaction in a suburban emergency medical services system: an observational study

BackgroundPatient satisfaction is of growing importance to providers of emergency medical services (EMS). Prior reports of patient satisfaction have frequently used resource-intensive telephone follow-up to assess satisfaction. We determine the feasibility of using a single mailing, anonymous postal survey methodology for collecting patient satisfaction data from a suburban EMS system.MethodsPatients transported between January 2001 and December 2004 were mailed a brief satisfaction questionnaire. The questionnaire was printed on a pre-addressed, postage paid postcard and consisted of five questions that used a five-point Likert scale to assess satisfaction with EMS personnel and services provided. Three open-ended questions assessed concerns, the most important service provided, and methods for improving service. Survey response rate was the primary outcome of interest. The Chi-square test was used to compare rates between years.ResultsThe survey required about 6 man hours and cost about

Full blood count and reticulocyte count in painful sickle crisis

70 per month. Overall response rate was 32.0% (857/2764; 95CI 30.3% – 33.9%). During the first year, response rate was 42.6% (95CI 38.5% – 46.8%), but was significantly lower in subsequent years (29.0% in year 2, 30.8% in year 3, and 27.6% in year 4, p < 0.05). There were 847/851 respondents (99.5%) who were satisfied or very satisfied with their EMS experience. Three patients felt the service was adequate and one was very unsatisfied. Open-ended questions suggested that interpersonal communications were the single most important contributor to patient satisfaction. Patients also reported that response times and technical aspects of care were important to them.ConclusionPostal surveys for assessing patient satisfaction following EMS transport can achieve comparable response rates to similar surveys in other health care settings. Response rates did not decline after the second year of patient surveys, suggesting some stability after the initial year. Interpersonal communication was determined to be the single most important contributor to patient satisfaction.

Derivation of a risk assessment tool for emergency department patients with sickle cell disease

Report by Aaron W Bernard, Arvind Venkat, Emergency Physicians Checked by Michael S Lyons, Emergency Physician Department of Emergency Medicine, University of Cincinnati, Cincinnati, USA ### Abstract A short cut review was carried out to establish whether routine haematological testing is useful in patients with painful sickle crisis. 21 papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. It is concluded that routine haematological testing does not alter management decisions in these patients. ### Three part question In a [patient with painful sickle crisis] does a [complete blood count or reticulocyte cell count] alter …

Recording Out-of-Hospital Cardiac Arrest Treatment via a Mobile Smartphone Application: A Feasibility Simulation Study

Introduction: Sickle cell patients commonly present to the emergency department (ED). Identifying those requiring admission and those who can safely be discharged is difficult. It was hypothesised that ED variables predictive of 96-h adverse sickle cell patient outcomes are identifiable. Methods: This observational cohort study included all adult sickle cell patient visits (1 June 2004–31 May 2005) to two ED. Patients were identified by ICD-9 codes of vaso-occlusive crisis and lists from treating haematologists. ED charts were abstracted for history, physical examination, laboratory/imaging data and outcomes. Outcomes were hospitalisation within 96 h of ED presentation for transfusion/antibiotic treatment, acute chest syndrome, or aplastic or sequestration crisis. Logistic regression was used to derive a risk score, which was tested in a validation cohort. The area under the receiver operating curve (AUC) was used to measure score performance. Results: There were 884 ED visits by 125 patients (mean age 36 years/55% female/58% homozygous sickle cell disease). 199 ED visits had one or more outcome (197 transfusion/antibiotic treatment, 71 acute chest syndrome, and one aplastic crisis). The risk score included sickle variant, chest pain, chills, pain dissimilar to past, temperature (<36°C/>38°C), oxygen saturation (<95%), haemoglobin (<10 g/dl), urine nitrites and chest x ray abnormality. The score had an AUC of 0.816 (95% CI 0.778 to 0.854) in the derivation cohort, 0.824 (95% CI 0.760 to 0.889) in the validation cohort. Conclusion: Those ED variables predictive of 96-h adverse sickle cell patient outcomes can be identified and combined into a risk score. Prospective validation is necessary before any clinical decision-making based on this score.

Acute Chest Syndrome of Sickle Cell Disease

Abstract Background: Given the demanding nature of out-of-hospital cardiac arrest (OHCA) resuscitations, recordings of the times of interventions in EMS patient care reports (PCRs) are often inaccurate. The American Heart Association developed Full Code Pro (FCP), a smartphone application designed to assist EMS personnel in recording the timing of interventions performed. Through OHCA simulations, this study assessed the group size necessary to use the FCP recording functions accurately and safely without compromising patient care. Program evaluation was based on participant feedback surveys, data accuracy, delays between recording and performing interventions, and delays in care attributed to using the application, stratified by group size. Methods: Simulations of a standard OHCA scenario using the Gaumard TraumaHal mannequin and a dedicated iPhone 5 preloaded with FCP version 3.4 were run with group sizes of 2–6 participants, with group sizes determined by participant availability. Participants included Connecticut certified paramedics and paramedic students who had completed the appropriate coursework. A 7-item feedback survey using a Likert scale established participant feedback on the application. Videos of the simulations were analyzed to assess for delays. One-way analysis of variance with trend analysis was used to test whether outcomes differed by group size and whether differences tended in one direction in parallel with group size. Results: There were 37 simulations, including 142 participants. The feedback survey questions achieved a Cronbach’s alpha of 0.91, signifying high reliability, and demonstrated a linear trend supporting greater satisfaction with FCP as group size increases (p < 0.001). Similarly, increasing group size displayed linear trends with greater numbers of interventions recorded (p = 0.009) and fewer missed and false recordings (p = 0.002). Delays revealed significant linear trends (p = 0.018 for delays in recording and p < 0.001 for delays in care), as increasing group size corresponded with lesser delays. Greatest improvement was noted to be between groups of 3 and 4 participants. Conclusions: OHCA simulations using FCP demonstrate increased provider comfort, increased recording accuracy, and decreased delays as the group size increased. While the application may improve recordings for PCRs and future research, the data suggest a sufficient number of EMS personnel (>3) should be present to achieve reliable data without compromising patient care.