Use of a tablet computer application to engage patients in updating their medication list.

PURPOSE: Failure to obtain an accurate medication history can adversely affect patient care in the emergency department (ED) and propagate errors into the inpatient and outpatient settings. Obtaining an accurate medication history in the ED is challenging, however, due to limited time, a suboptimal environment for patient interaction, and inadequate information in the electronic health record (EHR). This article describes the development and initial evaluation of the PictureRx Medication History Application, a tablet computer-based program that queries patients' prescription fill data from the Surescripts Medication History service and renders it graphically for review and editing at the point of care. METHODS: A quasi-experimental trial of PictureRx was performed in a large academic ED. Adult patients taking at least 1 prescription medication were prospectively eligible for the intervention. Usual care control patients were retrospectively matched 1:1. The main outcomes were updates to the patients' existing pre-visit medication list in the EHR and patient perceptions of the application. RESULTS: The medication list was updated for 101/244 (41.4%) of the intervention group and for 43/244 (17.6%) of the control group (difference 23.8%, 95% confidence interval, 16.0-31.6%). Similar differences were observed for medication additions, removals, and corrections in dose. Approximately 80% of intervention patients "strongly agreed" that the application was easy to use, aided medication list accuracy, and the graphical features assisted with recall. CONCLUSION: A novel tablet computer-based medication history application was feasible to implement in a busy academic ED. Use of the tool was associated with more updates to patients' EHR medication list.

Emergency Medicine Resident Perceptions of Medical Professionalism.

INTRODUCTION: Medical professionalism is a core competency for emergency medicine (EM) trainees; but defining professionalism remains challenging, leading to difficulties creating objectives and performing assessment. Because professionalism is dynamic, culture-specific, and often taught by modeling, an exploration of trainees' perceptions can highlight their educational baseline and elucidate the importance they place on general conventional professionalism domains. To this end, our objective was to assess the relative value EM residents place on traditional components of professionalism. METHODS: We performed a cross-sectional, multi-institutional survey of incoming and graduating EM residents at four programs. The survey was developed using the American Board of Internal Medicine's "Project Professionalism" and the Accreditation Council of Graduate Medical Education definition of professionalism competency. We identified 27 attributes within seven domains: clinical excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data to assess variance across attributes as well as differences between residents at different training levels or different institutions. RESULTS: Of the 114 residents eligible, 100 (88%) completed the survey. The relative value assigned to different professional attributes varied considerably, with those in the altruism domain valued significantly lower and those in the "respect for others" and "honor and integrity" valued significantly higher (p<0.001). Significant differences were found between interns and seniors for five attributes primarily in the "duty and service" domain (p<0.05). Among different residencies, significant differences were found with attributes within the "altruism" and "duty and service" domains (p<0.05). CONCLUSION: Residents perceive differences in the relative importance of traditionally defined professional attributes and this may be useful to educators. Explanations for these differences are hypothesized, as are the potential implications for professionalism education. Because teaching professional behavior is taught most effectively via behavior modeling, faculty awareness of resident values and faculty development to address potential gaps may improve professionalism education.

Improving inpatients' identification of their doctors: use of FACE cards.

BACKGROUND: Improving patients' ability to identify their inpatient physicians and understand their roles is vital to safe patient care. Picture cards were designed to facilitate physician introductions. The effect of Feedback Care and Evaluation (FACE) cards on patients' ability to correctly identify their inpatient physicians and on patients understanding of physicians roles was assessed. METHODS: In October 2006, team members introduced themselves with FACE cards, which included a photo and an explanation of their roles. During an inpatient interview, research assistants asked patients to name their inpatient physicians and trainees and to rate their understanding of their physicians' roles. RESULTS: Of 2,100 eligible patients, 1,686 (80%) patients participated in the baseline period, and 857 (67%) of the 1,278 patients in the intervention period participated in the evaluation. With the FACE intervention, patients were significantly more likely to correctly identify at least one inpatient physician (attending, resident, or intern; baseline 12.5% versus intervention 21.1%; p < .001). Of the 181 patients who were able to correctly identify at least one inpatient physician in the intervention period, research assistants noted that 59% (107) had FACE cards visible in their rooms. Surprisingly, fewer patients rated their understanding of their physicians' roles as excellent or very good in the intervention period (45.6%) compared with the baseline period (55.3%; p < .001). DISCUSSION: Although FACE cards improved patients ability to identify their inpatient physicians, many patients still could not identify their inpatient doctors. FACE cards may have served as a reminder to physicians to introduce themselves to their patients. The FACE cards also served to highlight patients' misunderstanding of their physicians' roles.