The Ability of Patients to Correctly Identify Their Hospitalist on a Patient Satisfaction Survey and the Impact of This Factor on Hospitalist Scores.

Background: Patient evaluations of their physician have been utilized to evaluate physician performance and calculate hospital reimbursement. Despite the routine use of these evaluations, little research has been done to evaluate the accuracy of these evaluations. We assessed patient's ability to correctly identify the hospitalist providing their care and whether identification of the hospitalist affected the cumulative satisfaction scores. Methods: This prospective observational study was conducted at a suburban voluntary hospital. Hospitalists were evaluated anonymously by their patients over a 4-month period on a questionnaire designed to assess patient satisfaction. Results: One hundred fifty-eight patients evaluated 16 hospitalists yielding an average of 9.9 evaluations per hospitalist. Forty Nine (31%) patients were able to identify their hospitalist. The top score (3) accounted for 76% of patient responses across all questions. Significant differences (p = .0007) existed in the distribution of these scores when patients who could identify their hospitalist was compared with those who couldn't. The variables for effective communication and hospitalist introduction were scored significantly higher by patients who could identify their hospitalist (2.77 vs 2.55; p = .027 and 2.90 vs 2.67; p = .005). Patients of younger age and female gender were more likely identify their hospitalist. Conclusions: Less than one-third of patients were able to correctly identify their hospitalist. The variables for effective communication and hospitalist introduction to the patient were scored significantly higher by patients who could identify their hospitalist. The elimination of scores by patients who could not correctly identify their provider resulted in marked changes in the percentile ranking of these providers.

The relationship between faculty performance assessment and results on the in-training examination for residents in an emergency medicine training program.

BACKGROUND: Medical knowledge (MK) in residents is commonly assessed by the in-training examination (ITE) and faculty evaluations of resident performance. OBJECTIVE: We assessed the reliability of clinical evaluations of residents by faculty and the relationship between faculty assessments of resident performance and ITE scores. METHODS: We conducted a cross-sectional, observational study at an academic emergency department with a postgraduate year (PGY)-1 to PGY-3 emergency medicine residency program, comparing summative, quarterly, faculty evaluation data for MK and overall clinical competency (OC) with annual ITE scores, accounting for PGY level. We also assessed the reliability of faculty evaluations using a random effects, intraclass correlation analysis. RESULTS: We analyzed data for 59 emergency medicine residents during a 6-year period. Faculty evaluations of MK and OC were highly reliable (κ  =  0.99) and remained reliable after stratification by year of training (mean κ  =  0.68-0.84). Assessments of resident performance (MK and OC) and the ITE increased with PGY level. The MK and OC results had high correlations with PGY level, and ITE scores correlated moderately with PGY. The OC and MK results had a moderate correlation with ITE score. When residents were grouped by PGY level, there was no significant correlation between MK as assessed by the faculty and the ITE score. CONCLUSIONS: Resident clinical performance and ITE scores both increase with resident PGY level, but ITE scores do not predict resident clinical performance compared with peers at their PGY level.

Comparison of Metallic Foreign-Body Removal between Dynamic Ultrasound and Static Radiography in a Pigs' Feet Model.

INTRODUCTION: We compared the immediate cosmetic outcome of metallic foreign-body removal by emergency medicine (EM) residents with ultrasound guidance and conventional radiography. METHODS: This single-blinded, randomized, crossover study evaluated the ability of EM residents to remove metallic pins embedded in pigs' feet. Before the experiment, we embedded 1.5-cm metallic pins into numbered pigs' feet. We randomly assigned 14 EM residents to use either ultrasound or radiography to help remove the foreign body. Residents had minimal ultrasound experience. After a brief lecture, we provided residents with a scalpel, laceration kit, a bedside portable ultrasound machine, nipple markers, paper clips, a dedicated radiograph technician, and radiograph machine 20 feet away. After removal, 3 board-certified emergency physicians, who were blinded to the study group, evaluated the soft-tissue model by using a standardized form. They recorded incision length and cosmetic appearance on the Visual Analog Scale. RESULTS: In total, 28 foreign bodies were removed. No significant difference in the time of removal (P = 0.12), cosmetic appearance (P = 0.96), or incision length (P = 0.76) was found. CONCLUSION: This study showed no difference between bedside ultrasound and radiography in assisting EM residents with metallic foreign-body removal from soft tissue. No significant difference was found in removal time or cosmetic outcome when comparing ultrasound with radiography.

Direct observation evaluations by emergency medicine faculty do not provide data that enhance resident assessment when compared to summative quarterly evaluations.

OBJECTIVES: The purpose of this study was to compare quarterly global evaluations with direct observation evaluations to determine if direct observation evaluations provide unique data compared to those obtained from quarterly global evaluations. METHODS: This observational, cohort study was performed at a 3-year emergency medicine (EM) residency program with 10 residents per year. Faculty used an online Web-based evaluation system to complete quarterly global evaluations and patient-specific direct observation evaluations. Two scores were collected for each resident within each quarterly evaluation period: 1) the quarterly evaluation score was the mean score across all faculty who performed a quarterly evaluation and, 2) the direct observation score was the mean score across all faculty who performed a direct observation evaluation. Pearson correlation coefficients were performed across these two groups of evaluations. RESULTS: Over the 4-year period of the study 296 complete data sets were available for the analysis. When the quarterly evaluation score was correlated with the direct observation score for each resident at the same evaluation period, we found a very high correlation for each of the eight evaluation questions (r = 0.95-0.96, p < 0.0001). When these evaluations were stratified based on the number of direct observation evaluations that were performed during the evaluation period of interest, the correlation between the quarterly evaluation and the direct observation scores increased as the number of direct observations in the evaluation period increased. The evaluation scores from the faculty who had performed both direct observation and quarterly evaluation methods during the same resident evaluation period were highly correlated even with small numbers of evaluators. CONCLUSIONS: Direct observations are highly correlated with quarterly evaluations when there are greater than three direct observation evaluations completed; however, this correlation drops significantly when the number of direct observations is lower. Direct observation evaluations provide similar data when compared with data obtained from quarterly global evaluations.

A survey of the emergency department population and their interest in preventive health education.

OBJECTIVE: To determine which preventive health information the emergency department (ED) population (patients and visitors) would be most interested in having available to them while they spend time in the waiting area. METHODS: This was a prospective survey of consecutive adults seated in the ED waiting area during a representative week on predetermined shifts. The survey asked them to indicate whether they would be interested in obtaining information about the following preventive health issues: breast cancer, prostate cancer, smoking, obesity, stress reduction, exercise programs, alcohol/drugs, HIV, blood pressure screening, immunizations, referrals to primary care physicians, Pap smears, car safety, smoke detectors, domestic and youth violence, depression, gun safety, and safe sex. RESULTS: Of the 1284 subjects approached, 878 (68%) made up the study group (56% female, mean age = 44 years, 60% white); 406 refused. The information people were most interested in obtaining was the following: 52% of the respondents were interested in referral to stress reduction programs, 51% in information about exercise programs, 42% in blood pressure screening, 40% in information about breast cancer screening, 33% in depression information/screening, 33% in prostate cancer screening, 26% in immunization against pneumococcus, 24% in immunization against tetanus, 26% in smoking cessation programs, and 26% in safe driving information. Women were most interested in breast cancer screening (64%); and men, in prostate cancer screening (55%). CONCLUSIONS: Of the 878 subjects in the study group, 96% were interested in obtaining information about one or more preventive health issues. An opportunity exists to respond to this interest by providing material for public health education in the waiting area of EDs.

Microphone array measurement system for analysis of directional and spatial variations of sound fields.

A measurement system has been developed that is capable of analyzing the directional and spatial variations in a reverberant sound field. A spherical, 32-element array of microphones is used to generate a narrow beam that is steered in 60 directions. Using an omnidirectional loudspeaker as excitation, the sound pressure arriving from each steering direction is measured as a function of time, in the form of pressure impulse responses. By subsequent analysis of these responses, the variation of arriving energy with direction is studied. The directional diffusion and directivity index of the arriving sound can be computed, as can the energy decay rate in each direction. An analysis of the 32 microphone responses themselves allows computation of the point-to-point variation of reverberation time and of sound pressure level, as well as the spatial cross-correlation coefficient, over the extent of the array. The system has been validated in simple sound fields in an anechoic chamber and in a reverberation chamber. The system characterizes these sound fields as expected, both quantitatively from the measures and qualitatively from plots of the arriving energy versus direction. It is anticipated that the system will be of value in evaluating the directional distribution of arriving energy and the degree and diffuseness of sound fields in rooms.