Improving patients' ability to identify their physicians through the use of physician facecards and whiteboards.

Background: Hospitalised patients are often not able to correctly identify members of their physician team. Identifying physicians is a critical component of developing the patient-physician relationship and visual aids have been shown to improve physician identification and overall patient satisfaction. Objectives: The aim of this quality improvement study was to assess the impact of implementation of a physician facecard on the ability of patients to identify their attending physician and other members of the physician team, as well as to evaluate current use of patient whiteboards for physician team identification. Methods: We prospectively studied 149 patients admitted to the medicine teaching service, who were randomised to receive a physician facecard or usual care. Patients were surveyed to determine their ability to identify physician team members. Observational data was also collected regarding use of patient whiteboards. Additionally, all hospitalists were surveyed to assess their perception of these visual aids. Results: Patients who received the facecard were more likely to recall the name of the attending physician as compared with the control group (63% vs 32%, p<0.01). Additionally, 68% of patients with the attending name correctly listed on their whiteboard were able to correctly identify the attending physician (p<0.01). Ninety per cent of patients who both received a facecard and had their whiteboard correctly filled out were able to identify the attending physician. Eighty per cent of hospitalists surveyed agreed that use of the facecard added value and 90% disagreed that routine use of the facecard was burdensome. Conclusion: The use of physician facecards improves the ability of hospitalised patients to identify their attending physicians, and the combined use of facecards and whiteboards may provide additive benefits.

Grading the severity of obstruction in mixed obstructive-restrictive lung disease.

BACKGROUND: The severity of obstructive pulmonary disease is determined by the FEV(1) % predicted based on the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. In patients with coexisting restrictive lung disease, the decrease in FEV(1) can overestimate the degree of obstruction. We hypothesize that adjusting the FEV(1) for the decrease in total lung capacity (TLC) results in a more appropriate grading of the severity of obstruction. METHODS: We examined a large pulmonary function test database and identified patients with both restrictive (TLC < 80% predicted) and obstructive (FEV(1)/FVC < the lower limit of normal) lung disease. FEV(1) % predicted was adjusted for the degree of restriction by dividing it by TLC % predicted. We compared the distribution of severity grading between adjusted and unadjusted values according to ATS/ERS criteria and determined how the distribution of severity would change based on asthma and COPD guidelines. RESULTS: We identified 199 patients with coexisting restrictive and obstructive lung disease. By ATS/ERS grading, the unadjusted data categorized 76% of patients as having severe or very severe obstruction and 11% as having mild or moderate obstruction. The adjusted data classified 33% with severe or very severe obstruction and 44% with mild or moderate obstruction. Of the corrected values, 83% resulted in a change to less severe obstruction by ATS/ERS guidelines, and 44% and 70% of patients, respectively, would be reclassified as having less severe obstruction by current asthma and COPD guidelines. CONCLUSIONS: This method results in a more appropriate distribution of severity of obstruction, which should lead to more accurate treatment of obstruction in these patients.