Methicillin-Resistant Staphylococcus aureus Infection and Hospitalization in High-Risk Patients in the Year following Detection

Many studies have evaluated methicillin-resistant Staphylococcus aureus (MRSA) infections during single hospitalizations and subsequent readmissions to the same institution. None have assessed the comprehensive burden of MRSA infection in the period after hospital discharge while accounting for healthcare utilization across institutions.We conducted a retrospective cohort study of adult patients insured by Harvard Pilgrim Health Care who were newly-detected to harbor MRSA between January 1991 and December 2003 at a tertiary care medical center. We evaluated all MRSA-attributable infections associated with hospitalization in the year following new detection, regardless of hospital location. Data were collected on comorbidities, healthcare utilization, mortality and MRSA outcomes. Of 591 newly-detected MRSA carriers, 23% were colonized and 77% were infected upon detection. In the year following detection, 196 (33%) patients developed 317 discrete and unrelated MRSA infections. The most common infections were pneumonia (34%), soft tissue (27%), and primary bloodstream (18%) infections. Infections occurred a median of 56 days post-detection. Of all infections, 26% involved bacteremia, and 17% caused MRSA-attributable death. During the admission where MRSA was newly-detected, 14% (82/576) developed subsequent infection. Of those surviving to discharge, 24% (114/482) developed post-discharge infections in the year following detection. Half (99/185, 54%) of post-discharge infections caused readmission, and most (104/185, 55%) occurred over 90 days post-discharge.In high-risk tertiary care patients, newly-detected MRSA carriage confers large risks of infection and substantial attributable mortality in the year following acquisition. Most infections occur post-discharge, and 18% of infections associated with readmission occurred in hospitals other than the one where MRSA was newly-detected. Despite gains in reducing MRSA infections during hospitalization, the risk of MRSA infection among critically and chronically ill carriers persists after discharge and warrants targeted prevention strategies

Analysis of factors affecting satisfaction in the emergency department: A survey of 1019 patients

The objective of this study was to identify factors that affect overall satisfaction of patients admitted to the emergency department (ED). All consecutive adult patients in the ED during a 14-day period who could communicate well were enrolled into this cross-sectional analytic study. Patients' demographic data, information on care, and level of satisfaction were recorded. Patients were asked to rate specific issues concerning their satisfaction (good and excellent) on a 5-point Likert scale. Response to the survey was obtained from 1019 (91.6%.) of 1113 patients for analysis during the study. Satisfaction with physician experience, physician attitude, triage, explanation of health status and treatment, and discharge instructions were found to have significant impact on satisfaction (P < .001 for each). Satisfaction with physician experience level was the most important factor affecting overall satisfaction. Patient perception of the total time spent in the ED as "short" and "very short" was not demonstrated to be significantly related to overall satisfaction (P = .162). Temporal perceptions as "long" and "very long" were shown to be significantly related to overall satisfaction (P < .001). Behavioral characteristics of the healthcare providers and the hospital itself were the factors that had the greatest impact on overall satisfaction of the ED population evaluated