A retrospective study of complaint letters sent to a Swiss Emergency Department between 2009 and 2014.

OBJECTIVE: Patient complaints are a valuable resource for monitoring and improving patient safety and quality of care. The purpose of this study was to analyze the complaint letters received at a Swiss academic emergency department (ED) over six years. METHODS: A retrospective study of all complaint letters sent to a Swiss academic ED between 2009 and 2014 was conducted. The following data were extracted: epidemiology items, reasons for complaints, hospital responses, follow-up, and severity of the events mentioned in the complaints. All complaint letters related to adult patients evaluated in the ED between 2009 and 2014 were included and a qualitative evaluation was performed based on a systematic taxonomy. Context, patient characteristics, mode of resolution and clinical severity of the related adverse event were evaluated. RESULTS: A total number of 156 complaints were recorded, corresponding to an annual complaint rate of 5.5 to 8.8 per 10,000 visits. The complaints concerned mostly three domains (clinical care, management and patient or caregiver relationship) with a slight predominance for organisation and logistics (39%) compared with 31.4% for standard of care and 29.6% for communication/relational complaints. The majority of complaints were sent within one month of the ED visit. Most complaints were resolved with written apologies or explanations. The consequences of 73.5% of the events in question were considered minor or negligible, 19% moderate, and 6.5% major. Only 1% (two cases) was related to situations with catastrophic consequences. CONCLUSION: Complaint incidence in our ED was low and remained stable over the six-year observation period. Most of the complaints pertained to incidents that entailed negligible or minor consequences. As most complaints were due to inadequate communication, interventions targeting improvement of the doctor/patient communication are required.

Cost-effective follow-up of the cancer patient. Time for a new look.

Physicians are increasingly aware of their complex responsibilities in finding the difficult compromise necessary to achieve cost-effective follow-up care of cancer patients. They must consider not only the best interests of their patients but also the interests of a cost-conscious society. To meet their new societal obligations, physicians trained solely to serve the patient's best interest must now learn how to do so at the least expense. This implies knowing both the costs and the performance characteristics of the diagnostic tests ordered in follow-up. The authors analyze this dilemma as it applies to follow-up of patients following primary treatment for colon cancer or nonseminomatous testicular cancer. Principles of cost-effective patient management are reviewed.

Vincristine, cisplatin, and bleomycin with surgery in the management of advanced metastatic nonseminomatous testis tumors.

Most effective treatment regimens for advanced nonseminomatous testis tumors (NSTT) employ vinblastine (V), cisplatin (CDDP), and bleomycin (B) and adjunctive surgery. The toxicity of many of these multidrug programs, primarily from vinblastine-induced myelosuppression has resulted in significant patient morbidity and even death. Since 1978, the authors of this report have used vincristine (VCR), CDDP, and B with adjunctive surgery in patients with advanced NSTT. In the first 29 patients treated with VCR, CDDP, and B and adjunctive surgery, a complete clinical remission (CR) was achieved in 27 (93%) with 3 (11%) recurrences; 24 (83%) remain in CR 18 to 46 months (mean and median of 31 months). Twenty-six (90%) patients had either maximal abdominal tumor (Stage B3) or maximal pulmonary and/or abdominal disease (Stage C). Twenty patients had adjunctive surgery. No patient developed serious chemotoxicity. This treatment regimen is less toxic and equally effective as V, CDDP, and B combinations.

Prognostic importance of pruritus in Hodgkin's disease.

In 1971 participants in the Ann Arbor Conference on Hodgkin's disease thought that pruritus had no independent prognostic importance. We reviewed our series of patients with Hodgkin's disease and found six patients in whom severe itching was a major clinical problem. When compared with similarly treated patients without pruritus, these patients appeared to have more-aggressive disease. Severe itching, alone or with B symptoms, needs further study, since it may presage a poor prognosis.

Leukemic reticuloendotheliosis. Loss of platelet defect after splenectomy.

A 59-year-old woman with leukemic reticuloendotheliosis had pancytopenia and hypersplenism. Before splenectomy, she had an abnormal bleeding time and a severe defect of secondary-wave platelet aggregation. After splenectomy, the platelet count returned to normal, and the aggregation defect was no longer present. This response suggests that the spleen may contribute to the platelet dysfunction.