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Randomized clinical trial of bedside ultrasound among patients with abdominal pain in the emergency department: impact on patient satisfaction and health care consumption.

ABSTRACT: Previous research shows that surgeon-performed ultrasound for patients presenting with abdominal pain in the emergency department leads both to higher diagnostic accuracy and to other benefits. We have evaluated the level of patient satisfaction, health condition and further health care consumption after discharge from the emergency department.A total of 800 patients who attended the emergency department for abdominal pain were randomized to surgeon-performed ultrasound or not as a complement to standard examination. All patients were interviewed by telephone six weeks after the visit to the emergency department using a structured questionnaire including information about health condition, satisfaction and medical examinations. A regional health register was used to check health care consumption over two years and mortality was checked for in the personal data register.We found a higher self-rated patient satisfaction in the ultrasound group when leaving the emergency department. After six weeks the figures were equal. There were fewer patients in the ultrasound group with completed or planned complementary examinations after six weeks (31.1%) compared with the control group (41.4%), p=0.004. There was no difference found in the two-year health care consumption or mortality between the groups.For patients with acute abdominal pain, bedside ultrasound examination is related to higher satisfaction and decreased short-term health care consumption. No major effects were revealed when evaluating effects on a long-term basis, including mortality. The previously proven benefit together with the lack of adverse effects from the method makes ultrasound well worth considering for implementation in emergency departments.The study has been registered in ClinicalTrials.gov ID NCT00550511.

SUBMITTER: Lindelius A

PROVIDER: S-EPMC2794249 | biostudies-literature | 2009 Nov

REPOSITORIES: biostudies-literature

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Randomized clinical trial of bedside ultrasound among patients with abdominal pain in the emergency department: impact on patient satisfaction and health care consumption.

Lindelius Anna A Törngren Staffan S Nilsson Laila L Pettersson Hans H Adami Johanna J

Scandinavian journal of trauma, resuscitation and emergency medicine 20091127

<h4>Background</h4>Previous research shows that surgeon-performed ultrasound for patients presenting with abdominal pain in the emergency department leads both to higher diagnostic accuracy and to other benefits. We have evaluated the level of patient satisfaction, health condition and further health care consumption after discharge from the emergency department.<h4>Methods</h4>A total of 800 patients who attended the emergency department for abdominal pain were randomized to surgeon-performed u ...[more]

PMID: 19941671

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Project description:ObjectivesPoint-of-care ultrasound (POCUS) may facilitate the diagnosis and management of children for various conditions. Integration of POCUS into clinical care requires hands-on training; however, providers may be reluctant to perform educational ultrasounds to improve their skills, as it is a procedure without direct clinical benefit to the patient and due to concerns that it may lower a family's overall satisfaction. We sought to evaluate whether the use of POCUS changed overall patient/caregiver satisfaction in a pediatric emergency department (ED) visit.MethodsWe performed a prospective cohort study of children presenting to a single children's hospital ED. We evaluated overall satisfaction for three groups: 1) children undergoing POCUS for educational purposes, 2) children undergoing POCUS for a specific diagnostic indication, and 3) controls who did not receive POCUS. Overall satisfaction was measured using a 100-point visual analog scale (VAS). We performed a noninferiority test between patients receiving POCUS and controls using a delta of 10 points to determine significance. We also examined satisfaction among patients receiving diagnostic ultrasound and sought to determine patient/caregiver satisfaction with specific elements of the POCUS experience.ResultsWe surveyed 159 patients who presented between April 2016 and August 2016 (53 in each group). The three groups did not differ with respect to patient age, sex, or Emergency Severity Index level. The median VAS scores for both the educational and the diagnostic POCUS groups (94 and 94, respectively) were not inferior to the VAS score for the control group (91) with a median (95% confidence interval [CI]) difference of 3.0 (-2.2 to 8.2) for educational and control groups and 3.0 (-1.6 to 7.6) for diagnostic and control groups. No patients/caregivers in the educational POCUS group would refuse an educational ultrasound during a future medical encounter.ConclusionEducational POCUS does not decrease patient/caregiver satisfaction among children presenting to the ED.

Project description:IntroductionMany emergency department (ED) patients with acute pulmonary embolism (PE) who meet low-risk criteria may be eligible for a short length of stay (LOS) (<24 hours), with expedited discharge home either directly from the ED or after a brief observation or hospitalization. We describe the association between expedited discharge and site of discharge on care satisfaction and quality of life (QOL) among patients with low-risk PE (PE Severity Index [PESI] Classes I-III).MethodsThis phone survey was conducted from September 2014 through April 2015 as part of a retrospective cohort study across 21 community EDs in Northern California. We surveyed low-risk patients with acute PE, treated predominantly with enoxaparin bridging and warfarin. All eligible patients were called 2-8 weeks after their index ED visit. PE-specific, patient-satisfaction questions addressed overall care, discharge instruction clarity, and LOS. We scored physical and mental QOL using a modified version of the validated Short Form Health Survey. Satisfaction and QOL were compared by LOS. For those with expedited discharge, we compared responses by site of discharge: ED vs. hospital, which included ED-based observation units. We used chi-square and Wilcoxon rank-sum tests as indicated.ResultsSurvey response rate was 82.3% (424 of 515 eligible patients). Median age of respondents was 64 years; 47.4% were male. Of the 145 patients (34.2%) with a LOS<24 hours, 65 (44.8%) were discharged home from the ED. Of all patients, 89.6% were satisfied with their overall care and 94.1% found instructions clear. Sixty-six percent were satisfied with their LOS, whereas 17.5% would have preferred a shorter LOS and 16.5% a longer LOS. There were no significant differences in satisfaction between patients with LOS<24 hours vs. ≥24 hours (p>0.13 for all). Physical QOL scores were significantly higher for expedited-discharge patients (p=0.01). Patients with expedited discharge home from the ED vs. the hospital had no significant difference in satisfaction (p>0.20 for all) or QOL (p>0.19 for all).ConclusionED patients with low-risk PE reported high satisfaction with their care in follow-up surveys. Expedited discharge (<24 hours) and site of discharge were not associated with differences in patient satisfaction.

Dataset Information

Randomized clinical trial of bedside ultrasound among patients with abdominal pain in the emergency department: impact on patient satisfaction and health care consumption.

Publications

Randomized clinical trial of bedside ultrasound among patients with abdominal pain in the emergency department: impact on patient satisfaction and health care consumption.

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