Exploring Patient Perspectives on Bedside Procedures: A Mixed Methods Study

INTRODUCTION Medical procedures are often performed on patients as part of their hospital stay. Common medical procedures include paracentesis, thoracentesis, lumbar punctures, knee arthrocentesis and central line insertions. These procedures can be performed at the patient’s bedside or in Interventional Radiology (IR). Much research has been done to improve procedural education and patient outcomes. However, little is known about the patient’s perspective. We explored how patients felt about their medical procedures and compared patient satisfaction between the bedside and IR groups.   METHODS We conducted a mixed-methods study (May – August, 2014), on consenting medical inpatients that had procedures performed as part of their hospital stay. Participants completed a 13-item satisfaction survey (Cronbach’s alpha =0.99). Patients also had the option of participating in a semi-structured interview. Transcripts of the interviews were analyzed using principles of grounded theory with common themes identified using open coding.   RESULTS Of the 96 eligible participants, 29 (30%) completed the survey and 12 (13%) patients completed the interview. Participants in the bedside group reported less wait time, compared with those in the IR group (median 2 hours, IQR 1-24 versus 24 hours, IQR 24-48 hrs respectively, p =0.009).  However, participants in IR group reported higher satisfaction with the time it took to complete the procedure itself (4.91 ± 0.30 vs 4.07 ± 1.14; p = 0.02 where 5 = very satisfied and 1 = very dissatisfied). In addition, patients reported higher satisfaction with their aftercare when returning from IR (p=0.05).  Overall, survey results suggests that irrespective of group assignment, participants were satisfied with their procedure  (4.79  ± 0.42). Of those who consented to the interview (n-12), the majority of the comments were positive (92%). Predominant themes included communication, attributes of the health care professionals, procedural comfort, efficiency, outcome and timing of the procedure.  Some negative comments pertained to patients’ sense of lack of control over information and timing of the procedure, transport and pain during the procedure. Interview results suggest that patients were satisfied with their procedure, but felt a lack of control in the process.  DISCUSSION AND CONCLUSIONS Results from the survey and the interview were concordant as patients reported being satisfied with their medical procedure. We found that there are significant differences between the bedside and IR group that make a profound impact on patient experience including wait time, efficiency and aftercare. The bedside group had higher patient satisfaction with wait times while IR group scored higher on efficiency and aftercare. Both are reasonable trade offs and support the notion that overall satisfaction is similar between the bedside and IR groups. Although patients reported high satisfaction with medical procedures, they noted that transport, timing of procedures, and communication are in need of improvement. Specifically, our findings support the need for quality improvement projects surrounding communication as participant satisfaction on this item varied depending on provider. Good communication can lead to a patient’s improved understanding of their medical procedure [1]. Limitations of this study include that is a single-center study and a small sample size. Overall, patients reported being satisfied with their medical procedures.

Treatment options for pediatric patent ductus arteriosus: Systematic review and meta-analysis

BACKGROUND: Patent ductus arteriosus (PDA) in the nonpremature pediatric patient is currently treated by surgical ligation or catheter occlusion. There is no clear superiority of one technique over the other. This meta-analysis compares the clinical outcomes of the two treatment options for PDA. METHODS: We performed a literature search of MEDLINE, Embase, PubMed, and the Cochrane database of randomized controlled trials (RCTs) that took place between 1950 and February 2014 and hand-searched references from included studies. We excluded studies of adult or premature patients and those without a direct comparison between surgical and catheter-based treatments of PDAs. Outcomes of interest were reintervention, total complications, length of stay, and cost. RESULTS: One thousand three hundred thirty-three manuscripts were screened. Eight studies fulfilled the inclusion criteria (one RCT and seven observational studies [N = 1,107]). In pooled observational studies, there were significantly decreased odds (OR, 0.12; 95% CI, 0.03-0.42) for reintervention in the surgical ligation group but insignificantly higher odds for overall complications (OR, 2.01; 95% CI, 0.68-5.91). There were no complications reported in the RCT, but surgical ligation was associated with decreased odds for reintervention and a longer length of stay. Funnel plots revealed a possible publication bias and a quality review identified comparability bias. CONCLUSIONS: Both therapies have comparable outcomes. Reintervention is more common with catheter-based treatment, but overall complication rates are not higher and hospital stay is shorter. Our data span \u3e 2 decades and may not reflect current surgical and catheterization outcomes. Large, randomized, prospective studies may help determine the optimal treatment strategy

Point of care ultrasound training needs for primary care physicians: Practice setting matters

Background: Point of care ultrasound (POCUS) is increasingly used in primary care. This study seeks to determine the educational needs of primary care physicians. Methods: All primary care practitioners in Calgary, Alberta, on the electronic departmental newsletter distribution list were invited to participate in an online survey. Interests in learning 25 POCUS applications and 9 procedures were assessed using a 5-point Likert scale. Results: Of the 1394 members on the distribution list, 96 responded. Of these, 88 completed the survey. The majority of the participants (n = 69, 78%) were office-based while 19 (21%) were hospital-based. The top applications for office-based participants included: (1) confirming fetal heart rate, (2) assessing fetal lie, and (3) confirming intrauterine pregnancy. For hospital-based participants, these were: (1) assessing soft tissue/superficial abscesses, (2) looking for ascites, and (3) confirming volume status of the patient. Of the 75 participants who perform procedures, both office- and hospital-based participants were most interested in learning incision and drainage for superficial abscesses and joint aspirations/injections; other procedural interests significantly differed between the two groups. Conclusions: Interests of office-based primary care practitioners in learning POCUS differed significantly from hospital-based practitioners. We recommend that separate office vs. hospital practice streams be offered to address their educational needs

Measuring competence in central venous catheterization: a systematic-review

Article deposited according to Springer Open policy for [Measuring competence in central venous catheterization: a systematic-review]: http://www.springeropen.com/about/copyright [March 7, 2014]Funding provided by the Open Access Authors Fund.Ye