Does a waiting room video about what to expect during an emergency department visit improve patient satisfaction?

OBJECTIVE: We created an instructional waiting room video that explained what patients should expect during their emergency department (ED) visit and sought to determine whether preparing patients using this video would 1) improve satisfaction, 2) decrease perceived waiting room times and 3) increase calls to an outpatient referral line in an ambulatory population. METHODS: This serial cross-sectional study took place over a period of 2 months before (control) and 2 months after the introduction of an educational waiting room video that described a typical patient visit to our ED. We enrolled a convenience sample of adult patients or parents of pediatric patients who were triaged to the ED waiting room; a research assistant distributed and collected the surveys as patients were being discharged after treatment. Subjects were excluded if they were admitted. The primary outcome was overall satisfaction measured on a 5-point Likert scale, and secondary outcomes included perceived waiting room time, and the number of outpatient referral-line calls. RESULTS: There were 1132 subjects surveyed: 551 prevideo and 581 postvideo. The mean age was 38 years (standard deviation [SD] 18), 61% were female and the mean ED length of stay was 5.9 hours (SD 3.6). Satisfaction scores were significantly higher postvideo, with 65% of participants ranking their visit as either "excellent" or "very good", compared with 58.1% in the prevideo group (p = 0.019); however, perceived waiting room time was not significantly different between the groups (p = 0.24). Patient calls to our specialty outpatient clinic referral line increased from 1.5 per month (95% confidence interval [CI] 0.58-2.42) to 4.5 per month (95% CI 1.19-7.18) (p = 0.032). After adjusting for possible covariates, the most significant determinants of overall satisfaction were perceived waiting room time (odds ratio [OR] 0.41, 95% CI 0.34-0.48) and having seen the ED waiting room video (OR 1.41, 95% CI 1.06-1.86). CONCLUSION: Preparing patients for their ED experience by describing the ED process of care through a waiting room video can improve ED patient satisfaction and the knowledge of outpatient clinic resources in an ambulatory population. Future studies should research the implementation of this educational intervention in a randomized fashion.

Utstein style analysis of rural out-of-hospital cardiac arrest [OOHCA]: total cardiopulmonary resuscitation (CPR) time inversely correlates with hospital discharge rate.

OBJECTIVE: Survival after out-of-hospital cardiac arrest (OOHCA) in an urban environment is directly proportional to speed of defibrillation and effective bystander cardiopulmonary resuscitation (CPR). We hypothesized that the hospital discharge rate from rural OOHCA was affected by the same factors. METHODS: We studied all OOHCAs in 1998 for rural Alachua County, Florida, with one emergency medical system (EMS) transport provider and three hospitals. All EMS identified OOHCA were reviewed retrospectively, as were EMS and hospital records. The 1998 County population was 211403; 1495 deaths from all causes occurred (70.7/10(4) pop). Of 167 OOHCAs (7.9/10(4) pop), 145 were of cardiac etiology; 22 were excluded (13 scene deaths, four traumatic, one intraoperative and three respiratory arrests, one arrest during a hospital-to-hospital transfer) and in eight outcome data were not available in any form. A total of 137/145 (94.5%) OOHCA patients had analyzable data. Data were analyzed using Student's t-test and ANOVA. Alpha was set at 0.05. RESULTS: Of 25 patients (18.2% of OOHCA) with restoration of spontaneous circulation (ROSC), six survived (4.4% of total, 24% of those with ROSC) to discharge from hospital (four to a skilled nursing facility, one each home with and without assistance). Four patients were still alive at >or=1 year post arrest. Asystole as the initial rhythm (P=0.014), and emergency department (ED) CPR time (8 vs. 15.5 min, P=0.042 for survivors vs. non-survivors) were the only factors statistically affecting survival. While bystander CPR was not significantly different between groups, there was a significantly higher proportion of patients surviving in the ED who had ROSC, and a higher proportion who had ROSC after bystander CPR. Time to defibrillation in nonsurvivors, while not statistically different between city and county patient groups, was clinically different. Statistical significance would likely have been achieved with a larger study population. CONCLUSION: Our data suggest improvement in response time and bystander CPR might further improve survival in a rural setting.