Journal Reviews
October 1, 2000 4 minutes read
Journal Reviews
Wei HG, Camargo CA. Patient education in the emergency department. Acad Emerg Med 2000; 7:710-717.
Patient education in the ED is effective, yet requires specific ED-based approaches, according to this study from the Weill Medical College of Cornell University in New York City, and Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston. The researchers evaluated clinical studies that assessed patient education in the ED and comparable acute care settings.
Here are some of the findings:
• Asthma education results in significant reduction of hospitalizations, ED visits, unscheduled visits to the doctor, and days missed from work and school.
• Chronic heart failure patients who received comprehensive education had fewer readmissions for heart failure and better improvements in quality of life.
• Patients with psychiatric disorders who received educational interventions had improved medication compliance.
The researchers recommend that ED managers take the following steps:
• Target efforts toward high-risk patients for focused patient educational efforts (for example, patients intubated for asthma and substance abusers).
• Use computer-based identification of
high-risk patients.
• Customize discharge instructions according to patient age.
• Assess the reading levels of written educational materials by using validated literacy scales.
Many ED patients might not have access to formal patient education anywhere else, the researchers argue. "This becomes particularly relevant when patient education can improve outcomes in chronic illnesses with preventable acute episodes necessitating ED visits," they say and add that more research is needed to provide evidence for effective approaches designed specifically for EDs.
Boudreaux ED, Clark S, Camargo CA. Telephone follow-up after the emergency department visit: experience with acute asthma. Ann Emerg Med 2000; 35: 555-563.
Although contact rates for follow-up telephone calls to asthma patients were high, certain groups of patients were more likely to be reached, according to this study.
The researchers were from the Earl K. Long Medical Center in Baton Rouge, LA, and Massachusetts General Hospital and Brigham and Women’s Hospital, both based in Boston. They interviewed 1,874 adult and 1,184 pediatric patients in the ED. Of those, 1,308 adult patients and 1,026 pediatric patients were successfully reached for a two-week telephone follow-up.
Pediatric patients were more 2.5 times likely to be reached than adults. Patients who were black, low in socioeconomic status, lacking a primary care provider, and smokers were significantly less likely to be reached.
Because there were high contact rates overall, with
a median of two calls to reach each patient, telephone follow-up for asthmatic patients is feasible, say the researchers. National Asthma Education and Prevention Program guidelines recommend a follow-up visit with the primary care provider within three to five days of an ED visit, but that may be impractical, unnecessary, or impossible for many patients, they write.
"Telephone follow-up may represent an effective and efficient alternative means of monitoring health," they add.
The researchers recommend the following as possible options to improve contact rates:
• provide a more in-depth rationale to patients for telephone calls, such as explaining the importance of follow-up care;
• make a greater number of attempts;
• obtain a current telephone number at every visit to update registration data;
• tailor callback times to maximize
likelihood of contact;
• solicit best times to call;
• obtain alternate numbers;
• call after working hours. t
Natsch S, Kullberg BJ, Meis JF, et al. Earlier initiation of antibiotic treatment for severe infections. Arch Intern Med 2000; 160:1,317-1,320.
Delays in administering antibiotics to patients can be reduced by using educational interventions combined with clinical practice guidelines, according to this study from the departments of internal medicine and medical microbiology at the University Hospital Nijmegen in the Netherlands.
Guidelines were developed to improve timely antibiotic administration in order to speed diagnostic and therapeutic actions. Educational programs were developed, and lectures given to the medical and nursing staff. Availability of antibiotics was improved in the ED.
Together, those interventions resulted in a substantial quality improvement in the process of care, say the researchers, who recommend the following interventions:
• Keep nurses and doctors informed about delays in antibiotic administration.
• Use clinical guidelines to manage patients with presumed serious infections and on ordering immediate treatment.
• Use guidelines on obtaining cultures for microbiological analysis.
• Inservice the medical and nursing staff about the guidelines.
• Make antibiotics more available by storing them in a readily accessible place.
Groups of 50 patients were evaluated before and after the interventions were implemented. Here were key findings:
• The median time to the initial dose of antibiotics administered decreased from five hours to 3.2 hours.
• The percentage of sputum cultures obtained increased from 28% to 50%, and the percentage of urine cultures obtained increased from 50% to 100%.
• The percentage of patients whose first dose of antibiotic was delayed until a routinely scheduled drug distribution round decreased from 54% to 32%.
The researchers conclude that "coordination of care in the ED and on the inpatient unit with contributions from the pharmacy and the laboratory is needed to reduce the time to initiate antibiotic treatment."
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