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Quality improvement initiative for improved patient communication in an ED rapid assessment zone
  1. Ahmed Taher1,2,
  2. Federico Webster Magcalas2,
  3. Victoria Woolner2,3,4,
  4. Stephen Casey2,
  5. Debra Davies2,
  6. Lucas B Chartier1,2
  1. 1Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Emergency Department, University Health Network, Toronto, Ontario, Canada
  3. 3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  4. 4Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Ahmed Taher, Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada; ahmed.taher{at}mail.utoronto.ca

Abstract

Introduction Patient–clinician communication in the Emergency Department (ED) faces challenges of time and interruptions, resulting in negative effects on patient satisfaction with communication and failure to relieve anxiety. Our aim was to improve patient satisfaction with communication and to decrease related patient anxiety.

Methods A multistage quality improvement (QI) initiative was conducted in the ED of Toronto General Hospital, a quaternary care centre in Ontario, Canada, from January to May 2018. We engaged stakeholders widely including clinicians, allied health and patients. We developed a 5-point Likert scale survey to measure patient and clinician rating of their communication experience, along with open-ended questions, and a patient focus group. Inductive analyses yielded interventions that were introduced through three Plan-Do-Study-Act (PDSA) cycles: (1) a clinician communication tool called Acknowledge-Empathize-Inform; (2) patient information pamphlets; and (3) a multimedia solution displaying patient-directed material. Our primary outcome was to improve patient satisfaction with communication and decrease anxiety by at least one Likert scale point over 6 months. Our secondary outcome was clinician-perceived interruptions by patients. We used statistical process control (SPC) charts to identify special cause variation and two-tailed Mann-Whitney U tests to compare means (statistical significance p<0.05).

Results A total of 232 patients and 104 clinicians were surveyed over baseline and three PDSA cycles. Communication about wait times, ED process, timing of next steps and directions to patient areas were the most frequently identified gaps, which informed our interventions. Measurements at baseline and during PDSA 3 showed: patient satisfaction increased from 3.28 (5 being best; n=65) to 4.15 (n=59, p<0.0001). Patient anxiety decreased from 2.96 (1 being best; n=65) to 2.31 (n=59, p<0.001). Clinician-perceived interruptions by patients changed from 4.33 (5 being highest; n=30) to 4.18 (n=11, p=0.98) and did not meet significance. SPC charts showed special cause variation temporally associated with our interventions.

Conclusions Our pragmatic low-cost QI initiative led to statistically significant improvement in patient satisfaction with communication and decreased patient anxiety while narrowly missing our a priori improvement aim of one full Likert scale point.

  • quality improvement
  • emergency department
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Footnotes

  • Handling editor Simon Smith

  • Twitter @ak_taher

  • Contributors AT: study concept and design, data acquisition, analysis and interpretation of the data, drafting of the manuscript and critical revision of the manuscript for important intellectual content. FWM: data acquisition and critical revision of the manuscript. VW: data analysis and critical revision of the manuscript. SC and DD: acquisition of the data and critical revision of the manuscript. LBC: study concept and design, acquisition of the data, analysis and interpretation of the data and critical revision of the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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