Factors related to negative feelings experienced by emergency department patients and accompanying persons: an Israeli study.

BACKGROUND: Studies on hospital violence have emphasized the importance of staff- service recipient interaction in leading to violent incidents. These incidents are the extreme result of service recipients' frustration and anger in their interaction with staff. The aim of this study was to analyze factors related to negative experiences of emergency department (ED) patients and accompanying persons in Israeli hospitals. METHODS: Structured interviews with 692 participants in seven major general Israeli hospitals: 322 patients and 370 accompanying persons. RESULTS: Negative feelings while in the ED were reported by 23.6% of patients and 20.5% of accompanying persons. Eight aggregate variables relating to staff-patients/accompanying persons interaction were identified: 1. General attitudes of staff and quality of ED experience; 2. Staff attitudes towards patients; 3. Staff attitudes towards accompanying persons; 4. Waiting; 5. Quality of perceived medical care; 6. Information provided to patients and accompanying persons; 7. Information provided to patients, as reported by accompanying persons; and 8. Severity of medical problem. Among patients, the only significant aggregate variable related to anger and frustration was perceived quality of care. Among accompanying persons, the three significant contributors to negative feelings were: 1. Staff's general attitudes; 2. Attitudes towards patients; and 3. Severity of patients' medical problem. Analysis of specific items within the variables revealed that, whereas patients' negative feelings were related to nurses' perceived negative attitudes those of accompanying persons were related to the doctors' perceived negative attitudes. In addition, patients' negative feelings were related to low severity of medical problem, whereas accompanying persons' negative feelings were related to patients' low severity of pain. CONCLUSIONS: The study reveals the importance of including both patients and accompanying persons in the analysis of staff-service recipient interactions in EDs. The results are discussed in terms of patients' and accompanying persons' different perspectives. Three practical implications of the results are put forward, aiming at reducing patients/accompanying persons-staff frictions in the EDs, thus decreasing the potential of violent outbursts against ED staff: (1) implementing a framework based on "patient-centeredness" for the restoration of patient's sense of agency and empowerment; (2) broadening the scope of laws concerning patient's rights to include their families and other accompanying persons; and (3) implementing courses on interpersonal and human service skills, as well as teaching skills of handling emotional stressors experienced by both the staff and service recipients.

Evaluation of telehealth service for patients with congestive heart failure in the north of Israel.

AIMS: This research was conducted to evaluate the impact of a telehealth service on re-hospitalization of patients with congestive heart failure at New York Heart Association II-IV. METHODS AND RESULTS: The telehealth service for congestive heart failure patients was designed to follow the patients after their daily weighing and to provide a response in cases of non-compliance or deviation from baseline weight. A weighing scale was installed in the patient's house together with a communication module connected to the telemedicine control centre through a telephone line. The control centre is staffed by skilled nurses whose responses to patients are guided by programmed algorithm. Over a year, we evaluated the changes in the frequency of hospital admission and of primary care visits, and quality of life of 141 individuals who were eligible for the telehealth service for congestive heart failure. A decline was noted in the average number of hospitalizations per patient (from 4.7 to 2.6, p < 0.001). Scores of parameters of quality of life were improved (average score for first through fourth quarterly administration: 64, 50, 16, 16, p < 0.001 by the Minnesota Living with Heart Failure Questionnaire). CONCLUSIONS: During the year of use in telehealth service for congestive heart failure parameters of hospitalization were improved, together with parameters of quality of life.

Sex differences in the epidemiology, seasonal variation, and trends in the management of patients with acute appendicitis.

BACKGROUND: Acute appendicitis is the most common indication for acute surgical abdominal intervention. In this study, we analyzed the gender correlation with demographic, epidemiologic, diurnal, and seasonal trends in relation to the incidence and management of patients with acute appendicitis in our medical center. METHODS: Data of patients, 18 years of age or older who underwent emergency appendectomies at the Rabin Medical Center during the last 13 years, were collected. The data collected included demographic parameters, hospitalization, procedures, and use of preoperative imaging. RESULTS: Data were available for 3,736 patients. Males had more appendicitis attacks than females (p < 0.0001), whereas females had more normal appendixes than males (p < 0.0001). The overall rate of normal appendixes was 19.6 %, with a decline in the past 10 years from a yearly average of 23.5 % between 1998 and 2002 to 15 % between 2003 and 2007 (p < 0.0001) with a reverse correlation with the preoperative use of abdominal CT. A distinct seasonal pattern was observed; more appendectomies for acute appendicitis occurred during the summer months (p < 0.0001). Ten percent of patients had a complicated course with a mortality rate of 0.33 %; most of them were elderly, male/female ratio 0.4. CONCLUSIONS: We found distinct gender, epidemiological, seasonal, and diurnal trends influencing the incidence of acute appendicitis. The incidence rate of false-positive surgery has been gradually declining, probably due to the increased use of preoperative abdominal CT and ultrasound. Acute appendicitis was more common in males and during the summer months.