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Article: Patient Experience With an In-Home COVID Virtual Observation Unit: An Analysis.

Hayden, Emily M / Dorner, Stephen C / Sonis, Jonathan D / White, Benjamin A

2023 Volume 10, Page(s) 23743735231171124

Abstract: We performed a retrospective cohort study of patients admitted to a novel, home-based COVID Virtual Observation Unit (CVOU) from an urban, university-affiliated emergency department with ∼112,000 annual visits. Telephone-based survey questions were ... ...

Abstract	We performed a retrospective cohort study of patients admitted to a novel, home-based COVID Virtual Observation Unit (CVOU) from an urban, university-affiliated emergency department with ∼112,000 annual visits. Telephone-based survey questions were administered by nursing staff working with the program. Of 402 patients enrolled in the CVOU, 221 (55%) were able to be contacted during the study period; 180 (45%) agreed to participate in the telephone interview. Overall, 95% (169 out of 177) of the surveyed patients reported 8 to 10 on the likelihood to recommend CVOU and 82% (100 out of 122) rated the quality of care as 10 out of 10. Over 90% of respondents reported that all role groups (nurses, paramedics, and physicians) treated them with courtesy and respect, explained things in an understandable way, and listened to them carefully. Over 80% of respondents reported that the program kept them at home. In summary, patient experiences with this novel home-based care program were highly positive. These data help underscore the importance of patient-centeredness in home-based care, and further support the concept of these innovative care models.
Language	English
Publishing date	2023-04-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2857285-3
ISSN	2374-3743 ; 2374-3735
ISSN (online)	2374-3743
ISSN	2374-3735
DOI	10.1177/23743735231171124
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Article ; Online: Optimizing Patient Experience in the Emergency Department.

Sonis, Jonathan D / White, Benjamin A

Emergency medicine clinics of North America

2020 Volume 38, Issue 3, Page(s) 705–713

Abstract: Emergency department (ED) patient experience is a growing area of focus for leaders in the ED and throughout health care. While many factors intrinsic to the ED care environment add to the challenge of providing patients with an excellent experience, ... ...

Abstract	Emergency department (ED) patient experience is a growing area of focus for leaders in the ED and throughout health care. While many factors intrinsic to the ED care environment add to the challenge of providing patients with an excellent experience, doing so holds many benefits, including improved patient compliance and health outcomes, improved workplace satisfaction and reduced provider and staff burnout, decreased malpractice risk, and increased revenue. Although wait time is a major driver of patient experience, provider and staff communication are critically important and excellent communication and perceived empathy may mitigate long waits, overcrowded environments, and other challenges.
MeSH term(s)	Emergency Service, Hospital/organization & administration ; Emergency Service, Hospital/standards ; Humans ; Patient Satisfaction ; Quality Improvement/organization & administration
Language	English
Publishing date	2020-06-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	605637-4
ISSN	1558-0539 ; 0733-8627
ISSN (online)	1558-0539
ISSN	0733-8627
DOI	10.1016/j.emc.2020.04.008
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Article ; Online: A successful campaign to increase use of the sepsis order set in the emergency department.

Berlyand, Yosef / Black, Lauren / Lee, Andy Hung-Yi / Aaronson, Emily L / Copenhaver, Martin S / Filbin, Michael R / Mort, Elizabeth A / Dutta, Sayon / Rhee, Chanu / Hibbert, Kathryn A / Turno, Douglas-Jarrett Cole / Durocher, Kara E / Aristizabal, Maria E / Sonis, Jonathan D

The American journal of emergency medicine

2023 Volume 72, Page(s) 216–218

MeSH term(s)	Humans ; Sepsis/diagnosis ; Sepsis/therapy ; Emergency Service, Hospital ; Hospital Mortality ; Shock, Septic
Language	English
Publishing date	2023-07-30
Publishing country	United States
Document type	Letter
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2023.07.052
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Article: A Conceptual Model for Emergency Department Patient Experience.

Sonis, Jonathan D / Aaronson, Emily L / Castagna, Allison / White, Benjamin

Journal of patient experience

2018 Volume 6, Issue 3, Page(s) 173–178

Abstract: Emergency department (ED) patient experience continues to be a growing area of focus for ED physicians, administrators, and regulatory agencies. Recent literature has suggested a strong correlation between positive ratings of patient experience and ... ...

Abstract	Emergency department (ED) patient experience continues to be a growing area of focus for ED physicians, administrators, and regulatory agencies. Recent literature has suggested a strong correlation between positive ratings of patient experience and important health system goals, including improved clinical outcomes and care quality, increased staff satisfaction, and reduced medicolegal risk. However, given the myriad of factors driving ED patient experience, identifying effective and synergistic interventions can present a challenge, especially in the setting of limited ED resources. Utilizing the themes identified in a recent systematic review of the ED patient experience literature, we developed a conceptual "logic model" of ED patient experience in order to provide a broadly applicable framework for practical intervention and to guide further study of ED patient experience interventions. The logic model was modified in an iterative fashion through review by local patient and staff groups as well as a national interest group until arriving at the current, comprehensive version. Here, we describe the creation of the logic model and, with the aim of providing a framework for readers to develop similar models for their practice settings, provide a case discussion of its use by an ED medical director.
Language	English
Publishing date	2018-08-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2857285-3
ISSN	2374-3743 ; 2374-3735
ISSN (online)	2374-3743
ISSN	2374-3735
DOI	10.1177/2374373518795415
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Article ; Online: Keeping pace: An ED communications strategy for COVID-19.

Baugh, Joshua J / Sonis, Jonathan D / Wittbold, Kelley A / White, Benjamin A / Raja, Ali S / Aaronson, Emily L / Biddinger, Paul D / Yun, Brian J

The American journal of emergency medicine

2020 Volume 38, Issue 12, Page(s) 2735–2736

MeSH term(s)	COVID-19/epidemiology ; Communication ; Electronic Mail ; Emergency Service, Hospital/organization & administration ; Humans ; Personnel Staffing and Scheduling ; Workflow
Keywords	covid19
Language	English
Publishing date	2020-04-14
Publishing country	United States
Document type	Letter
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2020.04.033
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Article ; Online: Design and Implementation of a Real-time Monitoring Platform for Optimal Sepsis Care in an Emergency Department: Observational Cohort Study.

Lee, Andy Hung-Yi / Aaronson, Emily / Hibbert, Kathryn A / Flynn, Micah H / Rutkey, Hayley / Mort, Elizabeth / Sonis, Jonathan D / Safavi, Kyan C

Journal of medical Internet research

2021 Volume 23, Issue 6, Page(s) e26946

Abstract: Background: Sepsis is the leading cause of death in US hospitals. Compliance with bundled care, specifically serial lactates, blood cultures, and antibiotics, improves outcomes but is often delayed or missed altogether in a busy practice environment.: ...

Abstract	Background: Sepsis is the leading cause of death in US hospitals. Compliance with bundled care, specifically serial lactates, blood cultures, and antibiotics, improves outcomes but is often delayed or missed altogether in a busy practice environment. Objective: This study aims to design, implement, and validate a novel monitoring and alerting platform that provides real-time feedback to frontline emergency department (ED) providers regarding adherence to bundled care. Methods: This single-center, prospective, observational study was conducted in three phases: the design and technical development phase to build an initial version of the platform; the pilot phase to test and refine the platform in the clinical setting; and the postpilot rollout phase to fully implement the study intervention. Results: During the design and technical development, study team members and stakeholders identified the criteria for patient inclusion, selected bundle measures from the Center for Medicare and Medicaid Sepsis Core Measure for alerting, and defined alert thresholds, message content, delivery mechanisms, and recipients. Additional refinements were made based on 70 provider survey results during the pilot phase, including removing alerts for vasopressor initiation and modifying text in the pages to facilitate patient identification. During the 48 days of the postpilot rollout phase, 15,770 ED encounters were tracked and 711 patient encounters were included in the active monitoring cohort. In total, 634 pages were sent at a rate of 0.98 per attending physician shift. Overall, 38.3% (272/711) patients had at least one page. The missing bundle elements that triggered alerts included: antibiotics 41.6% (136/327), repeat lactate 32.4% (106/327), blood cultures 20.8% (68/327), and initial lactate 5.2% (17/327). Of the missing Sepsis Core Measures elements for which a page was sent, 38.2% (125/327) were successfully completed on time. Conclusions: A real-time sepsis care monitoring and alerting platform was created for the ED environment. The high proportion of patients with at least one alert suggested the significant potential for such a platform to improve care, whereas the overall number of alerts per clinician suggested a low risk of alarm fatigue. The study intervention warrants a more rigorous evaluation to ensure that the added alerts lead to better outcomes for patients with sepsis.
MeSH term(s)	Aged ; Cohort Studies ; Emergency Service, Hospital ; Humans ; Medicare ; Prospective Studies ; Sepsis/diagnosis ; Sepsis/drug therapy ; United States
Language	English
Publishing date	2021-06-24
Publishing country	Canada
Document type	Journal Article ; Observational Study
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1439-4456
ISSN (online)	1438-8871
ISSN	1439-4456
DOI	10.2196/26946
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Article ; Online: Impact of Emergency Department Crowding on Discharged Patient Experience

Yosef Berlyand / Martin S. Copenhaver / Benjamin A. White / Sayon Dutta / Joshua J. Baugh / Susan R. Wilcox / Brian J. Yun / Ali S. Raja / Jonathan D. Sonis

Western Journal of Emergency Medicine, Vol 24, Iss

2023 Volume 2

Abstract: Introduction: While emergency department (ED) crowding has deleterious effects on patient care outcomes and operational efficiency, impacts on the experience for patients discharged from the ED are unknown. We aimed to study how patient-reported ... ...

Abstract	Introduction: While emergency department (ED) crowding has deleterious effects on patient care outcomes and operational efficiency, impacts on the experience for patients discharged from the ED are unknown. We aimed to study how patient-reported experience is affected by ED crowding to characterize which factors most impact discharged patient experience. Methods: This institutional review board-exempt, retrospective, cohort study included all discharged adult ED patients July 1, 2020–June 30, 2021 with at least some response data to the the National Research Corporation Health survey, sent to most patients discharged from our large, academic medical center ED. Our query yielded 9,401 unique encounters for 9,221 patients. Based on responses to the summary question of whether the patient was likely to recommend our ED, patients were categorized as “detractors” (scores 0–6) or “non-detractors” (scores 7–10). We assessed the relationship between census and patient experience by 1) computing percentage of detractors within each care area and assessing for differences in census and boarder burden between detractors and non-detractors, and 2) multivariable logistic regression assessing the relationship between likelihood of being a detractor in terms of the ED census and the patient’s last ED care area. A second logistic regression controlled for additional patient- and encounter-specific covariates. Results: Survey response rate was 24.8%. Overall, 13.9% of responders were detractors. There was a significant difference in the average overall ED census for detractors (average 3.70 more patients physically present at the time of arrival, 95% CI 2.33–5.07). In unadjusted multivariable analyses, three lower acuity ED care areas showed statistically significant differences of detractor likelihood with changes in patient census. The overall area under the curve (AUC) for the unadjusted model was 0.594 (CI 0.577–0.610). The adjusted model had higher AUC (0.673, CI 0.657–.690]; P<0.001), with the same three care areas ...
Keywords	Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
Subject code	310
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	eScholarship Publishing, University of California
Document type	Article ; Online
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Article ; Online: Using Design Thinking to Improve Patient-Provider Communication in the Emergency Department.

Aaronson, Emily L / White, Benjamin A / Black, Lauren / Sonis, Jonathan D / Mort, Elizabeth A

Quality management in health care

2019 Volume 29, Issue 1, Page(s) 30–34

Abstract: Quality issue: Emergency department overcrowding has been identified as a quality and patient safety concern.: Initial assessment: The need for a project focused on mitigating risk in the setting of overcrowding was identified.: Choice of solution!# ...

Abstract	Quality issue: Emergency department overcrowding has been identified as a quality and patient safety concern. Initial assessment: The need for a project focused on mitigating risk in the setting of overcrowding was identified. Choice of solution: Design thinking is an improvement methodology that uses a process that prioritizes empathy for end users and is optimal for abstract problems. Implementation: The team leveraged design thinking to walk through a 5-step process. In the empathize phase, inputs were collected and safety themes identified. In the define phase, optimal communication was identified as the focus area of the project. During the ideate phase, the team looked both internally and externally to identify tactics that existed to improve communication. Next, the team prototyped different solutions. In the testing phase, 33 trainings with 289 clinicians were conducted. Evaluation: The evaluation of this program demonstrated that it was positively received by clinicians. Although only 72% of clinicians believed the course would be a valuable use of their time before taking it, 97% reported it was a valuable use of their time following completion (P < .001). Precourse self-evaluation of knowledge, skill, and ability was high. Despite this, postcourse self-efficacy improved significantly in all 4 domains studied. Lessons learned: Design thinking offers an agile method for process improvement that was ideal for our relatively abstract problem. Although likely not an optimal method for a problem that is well understood, design thinking holds promise for many of the increasingly patient-centered initiatives that are underway in health care.
MeSH term(s)	Communication ; Emergency Service, Hospital ; Empathy ; Health Personnel ; Humans ; Patient Safety ; Program Development ; Quality Improvement ; Thinking
Language	English
Publishing date	2019-12-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1162319-6
ISSN	1550-5154 ; 1063-8628
ISSN (online)	1550-5154
ISSN	1063-8628
DOI	10.1097/QMH.0000000000000239
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Article ; Online: Humanism in the Age of COVID-19: Renewing Focus on Communication and Compassion.

Sonis, Jonathan D / Kennedy, Maura / Aaronson, Emily L / Baugh, Joshua J / Raja, Ali S / Yun, Bryan J / White, Benjamin A

The western journal of emergency medicine

2020 Volume 21, Issue 3, Page(s) 499–502

MeSH term(s)	Aged ; Betacoronavirus ; COVID-19 ; Communication ; Coronavirus Infections/psychology ; Coronavirus Infections/therapy ; Emergency Service, Hospital/organization & administration ; Empathy ; Hospitalization ; Humanism ; Humans ; Medical Staff, Hospital/psychology ; Pandemics ; Patient Admission ; Patient Discharge ; Patient Isolation/psychology ; Pneumonia, Viral/psychology ; Pneumonia, Viral/therapy ; Professional-Family Relations ; Professional-Patient Relations ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-04-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-900X
ISSN (online)	1936-9018
ISSN	1936-900X
DOI	10.5811/westjem.2020.4.47596
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Article ; Online: Effect of Automated Real-Time Feedback on Early-Sepsis Care: A Pragmatic Clinical Trial.

Leisman, Daniel E / Deng, Hao / Lee, Andy H / Flynn, Micah H / Rutkey, Hayley / Copenhaver, Martin S / Gay, Elizabeth A / Dutta, Sayon / McEvoy, Dustin S / Dunham, Lisette N / Mort, Elizabeth A / Lucier, David J / Sonis, Jonathan D / Aaronson, Emily L / Hibbert, Kathryn A / Safavi, Kyan C

Critical care medicine

2023 Volume 52, Issue 2, Page(s) 210–222

Abstract: Objectives: To determine if a real-time monitoring system with automated clinician alerts improves 3-hour sepsis bundle adherence.: Design: Prospective, pragmatic clinical trial. Allocation alternated every 7 days.: Setting: Quaternary hospital ... ...

Abstract	Objectives: To determine if a real-time monitoring system with automated clinician alerts improves 3-hour sepsis bundle adherence. Design: Prospective, pragmatic clinical trial. Allocation alternated every 7 days. Setting: Quaternary hospital from December 1, 2020 to November 30, 2021. Patients: Adult emergency department or inpatients meeting objective sepsis criteria triggered an electronic medical record (EMR)-embedded best practice advisory. Enrollment occurred when clinicians acknowledged the advisory indicating they felt sepsis was likely. Intervention: Real-time automated EMR monitoring identified suspected sepsis patients with incomplete bundle measures within 1-hour of completion deadlines and generated reminder pages. Clinicians responsible for intervention group patients received reminder pages; no pages were sent for controls. The primary analysis cohort was the subset of enrolled patients at risk of bundle nonadherent care that had reminder pages generated. Measurements and main results: The primary outcome was orders for all 3-hour bundle elements within guideline time limits. Secondary outcomes included guideline-adherent delivery of all 3-hour bundle elements, 28-day mortality, antibiotic discontinuation within 48-hours, and pathogen recovery from any culture within 7 days of time-zero. Among 3,269 enrolled patients, 1,377 had reminder pages generated and were included in the primary analysis. There were 670 (48.7%) at-risk patients randomized to paging alerts and 707 (51.3%) to control. Bundle-adherent orders were placed for 198 intervention patients (29.6%) versus 149 (21.1%) controls (difference: 8.5%; 95% CI, 3.9-13.1%; p = 0.0003). Bundle-adherent care was delivered for 152 (22.7%) intervention versus 121 (17.1%) control patients (difference: 5.6%; 95% CI, 1.4-9.8%; p = 0.0095). Mortality was similar between groups (8.4% vs 8.3%), as were early antibiotic discontinuation (35.1% vs 33.4%) and pan-culture negativity (69.0% vs 68.2%). Conclusions: Real-time monitoring and paging alerts significantly increased orders for and delivery of guideline-adherent care for suspected sepsis patients at risk of 3-hour bundle nonadherence. The trial was underpowered to determine whether adherence affected mortality. Despite enrolling patients with clinically suspected sepsis, early antibiotic discontinuation and pan-culture negativity were common, highlighting challenges in identifying appropriate patients for sepsis bundle application.
MeSH term(s)	Adult ; Humans ; Shock, Septic ; Prospective Studies ; Feedback ; Hospital Mortality ; Sepsis ; Anti-Bacterial Agents/therapeutic use ; Guideline Adherence
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-12-13
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000006057
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