Interventions to Improve Patient-centered Care During Times of Emergency Department Crowding

Authors

  • Julius Cuong Pham MD, PhD,

    1. From the Department of Emergency Medicine and Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine (JCP), Baltimore, MD; the Department of Emergency Medicine, Mount Sinai School of Medicine (NST), New York, NY; the Department of Emergency Medicine, University of Pennsylvania (JH), Philadelphia, PA; the Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine (RKK), Chicago, IL; the Department of Emergency Medicine, George Washington University (JPS), Washington, DC; and the Department of Emergency Medicine, Yale School of Medicine (SLB) New Haven, CT.
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  • N. Seth Trueger MD,

    1. From the Department of Emergency Medicine and Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine (JCP), Baltimore, MD; the Department of Emergency Medicine, Mount Sinai School of Medicine (NST), New York, NY; the Department of Emergency Medicine, University of Pennsylvania (JH), Philadelphia, PA; the Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine (RKK), Chicago, IL; the Department of Emergency Medicine, George Washington University (JPS), Washington, DC; and the Department of Emergency Medicine, Yale School of Medicine (SLB) New Haven, CT.
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  • Joshua Hilton MD,

    1. From the Department of Emergency Medicine and Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine (JCP), Baltimore, MD; the Department of Emergency Medicine, Mount Sinai School of Medicine (NST), New York, NY; the Department of Emergency Medicine, University of Pennsylvania (JH), Philadelphia, PA; the Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine (RKK), Chicago, IL; the Department of Emergency Medicine, George Washington University (JPS), Washington, DC; and the Department of Emergency Medicine, Yale School of Medicine (SLB) New Haven, CT.
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  • Rahul K. Khare MD, MS,

    1. From the Department of Emergency Medicine and Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine (JCP), Baltimore, MD; the Department of Emergency Medicine, Mount Sinai School of Medicine (NST), New York, NY; the Department of Emergency Medicine, University of Pennsylvania (JH), Philadelphia, PA; the Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine (RKK), Chicago, IL; the Department of Emergency Medicine, George Washington University (JPS), Washington, DC; and the Department of Emergency Medicine, Yale School of Medicine (SLB) New Haven, CT.
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  • Jeffrey P. Smith MD, MPH,

    1. From the Department of Emergency Medicine and Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine (JCP), Baltimore, MD; the Department of Emergency Medicine, Mount Sinai School of Medicine (NST), New York, NY; the Department of Emergency Medicine, University of Pennsylvania (JH), Philadelphia, PA; the Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine (RKK), Chicago, IL; the Department of Emergency Medicine, George Washington University (JPS), Washington, DC; and the Department of Emergency Medicine, Yale School of Medicine (SLB) New Haven, CT.
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  • Steven L. Bernstein MD

    1. From the Department of Emergency Medicine and Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine (JCP), Baltimore, MD; the Department of Emergency Medicine, Mount Sinai School of Medicine (NST), New York, NY; the Department of Emergency Medicine, University of Pennsylvania (JH), Philadelphia, PA; the Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine (RKK), Chicago, IL; the Department of Emergency Medicine, George Washington University (JPS), Washington, DC; and the Department of Emergency Medicine, Yale School of Medicine (SLB) New Haven, CT.
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  • Breakout Session Participants: Felix Ankel, Michelle Blanda, Mike Carter, Meher Chaudhry, David Cone, Linda Davis-Moon, Nicole DeIorio (observing), Susan Duffy, Heather Farley, Ula Hwang, Melissa McCarthy, Mark McClelland, Brian Rowe, Kirsten Rounds, Peter Samuel, Jeffrey Smith, Bob Solomon, Seth Trieger, and Adrian Tyndall.

  • This manuscript represents a component of the 2011 Academic Emergency Medicine Consensus Conference entitled “Interventions to Assure Quality in the Crowded Emergency Department (ED)” held in Boston, MA.

  • Funding for this conference was made possible (in part) by 1R13HS020139-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. This issue of Academic Emergency Medicine is funded by the Robert Wood Johnson Foundation.

  • The authors have no potential conflicts of interest to disclose.

  • Supervising Editor: James Miner, MD.

Address for correspondence and reprints: Julius Cuong Pham, MD, PhD; e-mail: jpham3@jhmi.edu.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:1289–1294 © 2011 by the Society for Academic Emergency Medicine

Abstract

Patient-centered care is defined by the Institute of Medicine (IOM) as care that is responsive to individual patient needs and values and that guides treatment decisions. This article is the result of a breakout session of the 2011 Academic Emergency Medicine consensus conference “Interventions to Assure Quality in the Crowded Emergency Department” and focuses on three broad domains of patient-centered care: patient satisfaction, patient involvement, and care related to patient needs.The working group provided background information and an overview of interventions that have been conducted in the domains of patient satisfaction, patient involvement (patients’ preferences and values in decision-making), and patient needs (e.g., comfort, information, education). Participants in the breakout session discussed interventions reported in the medical literature as well as initiated at their institutions, discussed the effect of crowding on patient-centered care, and prioritized, in a two-step voting process, five areas of focus for establishing a research agenda for studying patient-centered care during times of crowding. The research priorities for enhancing patient-centered care in all three domains during periods of crowding are discussed. These include assessing the effect of other quality domains on patient satisfaction and determining the effects of changes in ED operations on patient satisfaction; enhancing patient involvement by determining the effect of digital records and health information technology (HIT); rapid assessment areas with focused patient–provider communication; and meeting patients’ needs through flexible staffing, use of HIT to enhance patient communication, discharge instructions, and postdischarge telephone calls.

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