Managing patient expectations at emergency department triage

Emergency departments (ED) overcrowding, long wait, and uncomfortable waiting room conditions may lower perceived quality of the patient experience and satisfaction. This study investigates the relationship between patient satisfaction and communication of expected wait times, at the point of triage. A pre-post (11/4/ 2008 – 2/5/2009) group design with convenience sample (n=1,209) of all discharge adult ED patients was utilized for this study. A static expected wait time model (i.e., average wait time + one standard deviation) based on time of the day, day of the week and triage levels was employed to communicating expected wait time at triage while an in-house survey with five-point Likert-scale patient satisfaction questions (satisfied with wait time in triage, informed about delays, and overall rating of ED visit) was administrated at the discharge desk. The communication of delays intervention was significant for only overall rating of ED, while binary communication status was significantly associated with all three patient satisfaction questions. The patients who didn’t receive any communication about delays, were between 1.42 to 5.48 times more likely to rate the three satisfaction questions lower than very good. With communication about delays, the percentage of patients responding very good and very poor/poor were 14.6% higher and 5.9% lower, respectively, for the satisfied with wait time in triage question. Although communication of delays intervention was not significant, the patients who received wait times information were significantly more satisfied. This indicates that patients are more likely to accept longer wait times provided their expectations are managed via communication. Future studies should explore technological solutions for communication of delays and operational improvement initiatives along with alignment of incentives for ED staff to further improve the patient experience. Experience Framework This article is associated with the Culture & Leadership lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len

Cognitive Information Processing

Contains research objectives and reports on two research projects.Joint Services Electronics Program by the U. S. Army Research Office, Durham, under Contract DA 36-039-AMC-03200(E)National Science Foundation (Grant GP-2495)National Institutes of Health (Grant MH-04737-05)National Aeronautics and Space Administration (Grant NsG-496

Towards solid-state beam steering using a 7-emitter 1550 nm optical phased array

We present the preliminary design and experimental results of a 1550 nm solid-state beam pointing system based on an optical phased array (OPA) architecture. OPAs manipulate the distribution of optical power in the far-field by controlling the phase of individual emitters in an array. This allows OPAs to steer the beam in the far field without any mechanical components (e.g., steering mirrors). The beam-steering system presented here uses waveguide electro-optic modulators to actuate the phase of each element in a 7-emitter OPA, enabling kHz bandwidth steering with sub-milliradian pointing precision. The control system used to stabilize and control the phase of each emitter in the OPA exploits a technique called digitally enhanced heterodyne interferometry, allowing the phase of each emitter to be measured simultaneously at a single photodetector, dramatically simplifying the optical system. All digital signal processing is performed using a field-programmable gate-array. Applications of this technology include free-space link acquisition and tracking for satellite-to-satellite laser communications and light detection and ranging (LiDAR).This work was partially funded by the Australian Research Council Centre of Excellence for Gravitational Wave Discovery (OzGrav) (project ID CE170100004) and the Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS) (project ID CE170100009)

Let Them In: Family Presence During Intensive Care Unit Procedures

Families have for decades advocated for full access to intensive care units (ICUs) and meaningful partnership with clinicians, resulting in gradual improvements in family access and collaboration with ICU clinicians. Despite such advances, family members in adult ICUs are still commonly asked to leave the patient’s room during invasive bedside procedures, regardless of whether the patient would prefer family to be present. Physicians may be resistant to having family members at the bedside due to concerns about trainee education, medicolegal implications, possible effects on the technical quality of procedures due to distractions, and procedural sterility. Limited evidence from parallel settings does not support these concerns. Family presence during ICU procedures, when the patient and family member both desire it, fulfills the mandates of patient-centered care. We anticipate that such inclusion will increase family engagement, improve patient and family satisfaction, and may, on the basis of studies of open visitation, pediatric ICU experience, and family presence during cardiopulmonary resuscitation, decrease psychological distress in patients and family members. We believe these goals can be achieved without compromising the quality of patient care, increasing provider burden significantly, or increasing risks of litigation. In this article, we weigh current evidence, consider historical objections to family presence at ICU procedures, and report our clinical experience with the practice. An outline for implementing family procedural presence in the ICU is also presented

Gravitational Effects on Closed-Cellular-Foam Microstructure

Polyurethane foam has been produced in low gravity for the first time. The cause and distribution of different void or pore sizes are elucidated from direct comparison of unit-gravity and low-gravity samples. Low gravity is found to increase the pore roundness by 17% and reduce the void size by 50%. The standard deviation for pores becomes narrower (a more homogeneous foam is produced) in low gravity. Both a Gaussian and a Weibull model fail to describe the statistical distribution of void areas, and hence the governing dynamics do not combine small voids in either a uniform or a dependent fashion to make larger voids. Instead, the void areas follow an exponential law, which effectively randomizes the production of void sizes in a nondependent fashion consistent more with single nucleation than with multiple or combining events

Cognitive Information Processing

Contains reports on six research projects.National Institutes of Health (Grant 1 PO1 GM-14940-01)National Institutes of Health (Grant 1 PO1 GM-15006-01)Joint Services Electronics Programs (U. S. Army, U. S. Navy, and U. S. Air Force) under Contract DA 28-043-AMC-02536(E)Project MAC, an M. I. T. research programAdvanced Research Projects Agency, Department of Defense, under Office of Naval Research Contract Nonr-4102-(01

What Is the Value of Wild Bee Pollination for Wild Blueberries and Cranberries, and Who Values It?

Pollinator conservation efforts and growing interest in wild bee pollination have increased markedly in the last decade, making it increasingly important to have clear and practical estimates of the value of pollinators to agriculture. We used agricultural statistics, socio-economic producer surveys, and agronomic field research data to estimate traditional pollination value metrics and create novel approaches to the valuation of the ecosystem services provided by wild pollinators. Using two regionally important United States (USA) crops—Maine wild blueberry and Massachusetts cranberry—as models, we present the perceived values of wild bee pollinators from the perspectives of both consumers and producers. The net income attributable to wild bees was similar for wild blueberry ($613/ha) and cranberry ($689/ha). Marginal profit from incrementally adding more hives per ha was greater from stocking a third/fourth hive for cranberry ($6206/ha) than stocking a ninth/10th hive for wild blueberry ($556/ha), given the greater initial responsiveness of yield, revenue, and profit using rented honey bee hives in cranberry compared with wild blueberry. Both crops’ producers were willing to annually invest only $140–188/ha in wild pollination enhancements on their farms, justifying government financial support. Consumers are willing to pay ≈6.7 times more to support wild bees than producers, which indicates a potential source for market-based subsidies for invertebrate conservation

Cognitive Information Processing

Contains research objectives, summary of research and reports on two research projects.National Institutes of Health (Grant 5 PO1 GM-14940-02)National Institutes of Health (Grant 5 P01 GM-15006-02)Joint Services Electronics Programs (U. S. Army, U.S. Navy, and U. S. Air Force) under Contract DA 28-043-AMC-02536(E)National Institutes of Health (Grant 5 TO1 GM-01555-02