Improving patient satisfaction for patients with acute neurological symptoms by increased flow from the front door of hospital and more specific documentation in medical record notes: a quality improvement project.

Patient experience is considered essential in evaluating healthcare quality. One of the most important parameters that influence patient satisfaction is perception of throughput time, defined as the time from hospital entrance to time of discharge. Throughput issues often start in the emergency department. This often contributes to waiting time for patients and task accumulation for staff. Our overall aim was to optimise throughput in a patient-centred manner for acute neurological patients arriving in the emergency department. We found two primary drivers for change: faster admission to the neurological subunit of the emergency department and improved documentation of three specific topics in the medical records (specific tentative diagnosis, specific treatment plan after CT/MRI and specifically addressing time of expected discharge). Using the plan-do-study-act method, we facilitated successfully changes through education, one-to-one talks, feedback, checklists and by drawing attention to the project. Patients admitted to the hospital after telephonic contact between admitting physician and neurologist arrived in the subunit with a delay of 34 min after arriving at the hospital compared with 89 min before the interventions. Patients unknown to the neurologist before arrival to the hospital arrived at the subunit with a delay of 107 min compared with 130 min before the intervention. The compliance with addressing each of three topics in the medical records showed a significant increase from a median of, respectively, 62%-100%, 45%-82% and 28%-72%. The project goal was achieved, as an increase in patient satisfaction of 27% from the baseline survey was seen, as well as a reduction in the proportion of patients mentioning waiting time in a negative way from 45% to 10%. This demonstrates that a low-cost structured approach can change the way doctors work, for the benefit of patients and staff in the emergency department.

Rescue of ligand binding of a mutant IGF-I receptor by complementation.

The IGF-I receptor binds IGF-I with complex kinetics characterized by a curvilinear Scatchard plot, suggesting receptor heterogeneity and apparent negative cooperativity. To explore the molecular mechanisms underlying these properties, we have characterized the binding of a hybrid receptor formed from a wild-type receptor monomer and a mutant receptor monomer devoid of binding activity. Receptor hybrids were generated by transient co-transfection of cDNAs encoding wild-type and mutant receptors with unique epitope tags. Hybrid receptors were purified from transfected cells by sequential immuno-affinity chromatography and their ligand-binding properties were determined. Complementation produced a hybrid with near wild-type affinity. Dissociation studies demonstrated that the hybrid did not exhibit negative cooperativity.