Decrease Patient Anxiety Research Articles

Effects of multimedia-based information on anxiety, discomfort and satisfaction with care among patients undergoing cerebral angiography: A quasi-experimental study.

This study investigated the effects of multimedia-based information on anxiety, discomfort and satisfaction with care among patients undergoing cerebral angiography. Cerebral angiography is the gold standard for diagnosing cerebrovascular conditions; however, patients might experience related anxiety and discomfort. For such patients, reductions in anxiety related to informational interventions have been inconsistent, and the effects on patient discomfort and satisfaction with nurses were not confirmed. This quasi-experimental study with a non-equivalent, control group, non-synchronised design was conducted using the TREND checklist. Fifty-five patients who underwent cerebral angiography at a neurosurgery ward were enrolled in this study. Twenty-seven patients in the experimental group were provided multimedia-based information on cerebral angiography, including actual on-site photographs and videos, an explanation of the benefits of cerebral angiography and introduction to medical staff. Twenty-eight in the control group were provided a printed explanation. The collected data were analysed using the χ²-test, Fisher's exact test, independent t test, paired t test or ANCOVA. In the experimental group, anxiety was significantly decreased post-intervention, and there was a significant difference in state anxiety between the experimental and control groups. Discomfort and satisfaction with care also showed significant differences between these two groups. This study confirmed that multimedia-based information decreases patient anxiety and discomfort while increasing satisfaction with care among those undergoing cerebral angiography compared with a printed explanation only. The anxiety and discomfort of patients undergoing cerebral angiography should be considered a major nursing problem. This study evaluated the effects of multimedia-based information on anxiety, discomfort and satisfaction with care among patients undergoing cerebral angiography and showed it to be an effective nursing intervention.

The effect of mandala colouringon anxiety in hospitalized COVID-19 patients: A randomized controlled clinical trial.

COVID‐19 significantly affects patients' mental health, triggering a wide range of psychological disorders, including anxiety. The aim of this study was to investigate the effect of mandala colouring on the anxiety of hospitalized COVID‐19 patients. In this randomized controlled clinical trial, 70 hospitalized patients with COVID‐19 were randomly divided between the intervention and control groups. Standard care was provided for both groups. The intervention group spent 30 min/day for six consecutive days performing mandala colouring. Patient anxiety was measured prior and subsequent to the intervention in both groups using the Spielberger State‐Trait Anxiety Inventory. Data were analysed using SPSS software version 25. The mean anxiety score was not significantly different between the two groups before the intervention (P = 0.08). Subsequent to the intervention, the mean anxiety score in the intervention and control groups was 44.05 ± 4.67 and 67.85 ± 6.25, respectively, indicating a statistically significant (P = 0.0001) decrease in the anxiety measured among the intervention group as compared with that of the control group. The results of this study show that 30 min of mandala colouring daily is an effective strategy for reducing anxiety in hospitalized COVID‐19 patients. Mandala colouring can complement routine treatment and provides a non‐pharmaceutical option for decreasing patient anxiety.

Genetic counselor use of self-involving responses in a clinical setting: A qualitative investigation.

Self-involving responses are direct expressions of genetic counselors' here-and-now feelings about/reactions to patients. Strategic, sparing use of self-involving responses may enhance practitioner genuineness, likeability, and trustworthiness, decrease patient anxiety, and increase patient trust and engagement. Conversely, they may threaten patients who are uncomfortable with emotional expression or confuse them about the counselor's intentions. Despite theorized benefits and risks, no study has explored genetic counselor self-involving responses. This study explored whether clinical genetic counselors use self-involving responses with their patients, reasons for doing so, and their perceptions of when and why the responses work well versus poorly. Two-hundred sixty-eight genetic counselors, invited via a National Society of Genetic Counselors e-blast, completed an online screening survey. Eighty-nine percent reported using self-involving responses with patients, and 17 were purposively selected to participate in semi-structured phone interviews. Thematic analysis yielded themes regarding potential benefits, risks, counselor factors and context, and patient factors related to using self-involving responses. Benefits include conveying counselor conditions for facilitating counseling process (e.g., genuineness, building rapport, focusing the session, and encouraging the patient to open-up), and counseling outcomes by validating decision-making. Risks of use include hindering counseling processes and outcomes by misperceiving patient feelings, boundary crossing, and being unduly directive. Factors, both from the counselor and the context of the session, include comfort with the technique, mastery of clinical skills, minimal knowledge of patient emotions, type of counseling session, and counselor practice specialty. Patient factors include prior rapport with the counselor, and patient emotionality and cultural background. Findings underscore the need for training about this technique. Future research could examine patients' perceptions of self-involving statements and differences in self-involvement across practice specialties and counseling modalities.

THE EFFECT OF PATIENT COOPING MECHANISM ON ANXIETY IN DEALING WITH MAJOR SURGERY IN THE SURGERY INPATIENT ROOM OF PUSKESMAS TIGA BALATA JORLANG HATARAN DISTRICT AT YEAR 2016

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Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality.

ObjectivesVirtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures.Study DesignRandomized controlled trial.SettingTertiary care center.MethodsAdult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected.ResultsEight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively (P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively (P = .770). Average pain scores were 3.53 and 2.64, respectively (P = .434).ConclusionThis pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia.Level of Evidence1

Effects of intravenous sedation on autonomic nerve activity and the psychological state during tooth extraction: A prospective non‐randomized controlled trial

AbstractPurposeIntravenous sedation is considered to decrease patient anxiety and tension during dental treatment, thereby reducing fluctuations in autonomic nerve activity and the risk of medical emergencies. We hypothesized that intravenous sedation would suppress the sympathetic nervous system during tooth extraction and relieve patient anxiety. Accordingly, the purpose of this study was to investigate the effects of intravenous sedation on autonomic nerve activity and psychological state during impacted mandibular third molar (IMTM) extraction.MethodsThis prospective study included 40 healthy women scheduled for IMTM extraction under local anesthesia alone (control group; n = 20) or local anesthesia and intravenous sedation (sedation group; n = 20); of these, 34 women were evaluated. Heart rate variability (HRV) was analyzed to evaluate autonomic nerve activity. HRV and circulatory dynamics were measured during the treatment. The Modified Dental Anxiety scale and State‐Trait Anxiety Inventory (STAI‐S and STAI‐T) scores were obtained before treatment. STAI‐S scores were also obtained after treatment. Descriptive and bivariate statistical analyses were conducted, and a P‐value <.05 was considered statistically significant.ResultsThe low‐frequency/high‐frequency ratio was lower in the sedation group than in the control group (P < .01). Compared with the control group, the sedation group showed a significantly greater decrease in post‐treatment STAI‐S scores relative to pre‐treatment scores (P < .01).ConclusionsThe findings suggest that sedation suppresses the sympathetic nervous system during IMTM extraction and decreases anxiety after the extraction. Further research should elucidate the mechanisms by which sedation suppresses the sympathetic nervous system.

Quality improvement initiative for improved patient communication in an ED rapid assessment zone

IntroductionPatient–clinician communication in the Emergency Department (ED) faces challenges of time and interruptions, resulting in negative effects on patient satisfaction with communication and failure to relieve anxiety. Our aim was...

Education-based interventions for anxiety during the treatment and management of chronic disease: a systematic review protocol.

The objective of this systematic review is to evaluate the effectiveness of education-based interventions to decrease patient anxiety during the treatment and management of a chronic disease. Anxiety is a major contributor to poor patient outcomes in self-managed chronic disease. Health care manage anxiety prior or during education can adversely affect patient outcomes. By identifying interventions that effectively decrease anxiety, clinicians may be able to consider and implement strategies as standard practice within the education-based programs. The proposed systematic review will consider studies reporting the effectiveness of any intervention aimed at decreasing participant anxiety prior to a medical procedure or prior to undertaking an education-based program to address a technical aspect of self-management in a health care setting. It will consider studies whose participants are 18 years and older and who are diagnosed with a chronic disease. The systematic review aims to find published and unpublished studies in English from 1972 onward. Databases to be searched included MEDLINE, CINAHL, Embase, ERIC, Mosby's index, Cochrane Library, and Scopus. Studies will be reviewed and data extracted by two independent reviewers. The data will include details about the interventions, populations, study methods, and outcomes of significance to the review objectives. Where possible, data will be pooled in a statistical meta-analysis. PROSPERO CRD42019142260.

The Waiting Game: How Long Are Breast Cancer Patients Waiting for Definitive Diagnosis?

Receiving a new breast cancer (BC) diagnosis can cause significant patient anxiety, which is amplified by delays in diagnosis. There is a lack of defined time periods for delays in the workup of BC. This study aims to evaluate national variations in timing from first abnormal mammogram to first biopsy and to determine independent predictors of delay in diagnosis. Data were derived from SEER-Medicare linked claims database from 2007 to 2013. Time intervals from abnormal mammogram, either screening or diagnostic, to biopsy were assessed. The fourth quartile for timing from first mammogram to first biopsy was utilized to define delay in diagnosis. Multivariate analyses were used to evaluate the association between clinicopathologic variables and delays in diagnosis. We analyzed 53,758 patients with stage 0-II BC who underwent upfront surgery. Significant variations in timing of care were identified, with mean times from mammogram to biopsy, surgeon visit, and breast surgery of 23.3, 31.6, and 52.6days, respectively. Over the study period, there was a decrease in delays from mammogram to biopsy. Non-White race, Northeast location, and earlier stage disease were found to be independent predictors of delays in the diagnosis of BC (p < 0.0001). The study demonstrates significant variations in time to diagnostic biopsy. More efficient processes of care to address these delays should be implemented, and further studies are needed to determine whether improved efficiency decreases patient anxiety. The large variations in time to diagnosis speak to the need for consensus guidelines to establish a standard of care.

Immediate Interpretation and Results Communication Decreases Patient Anxiety: Experience in a Private Practice Community Hospital.

OBJECTIVE. The study objectives were to evaluate the percentage of patients interested in immediate radiologic results and to measure patient anxiety and hospital loyalty with this program in a private practice community hospital setting. SUBJECTS AND METHODS. Between December 2018 and May 2019, 100 patients 18-89 years old with a primary diagnosis of abdominal pain had imaging orders for CT, ultrasound, or nuclear medicine-hepatobiliary iminodiacetic acid scans and subsequently were asked if they wanted immediate results. Those who opted for immediate results were given a two-question survey before and after results delivery that asked about their anxiety level and imaging center loyalty. Data were entered using SurveyMonkey (SVMK) and analyzed using SAS software (version 9.4, SAS Institute). RESULTS. The majority (78%) of patients wanted immediate results. There were statistically significant differences in anxiety level before and after results delivery; 37% (p < 0.001) reported decreased anxiety after receiving imaging results, whereas 57% reported no change in anxiety (p < 0.001). The decision whether to come back to this imaging center (hospital loyalty) did not change before and after test results; 85% of participants strongly agreed that they would return. CONCLUSION. It is feasible for private practice radiologists to discuss CT, ultrasound, or nuclear medicine imaging results with patients in a community hospital setting. The majority of patients preferred immediate results over traditional methods of notification. Most patients reported anxiety about their imaging results, and a statistically significant number had decreased anxiety after discussing results with radiologists.

“My Vagina Did What?”: Evaluating a 3D Mobile App of Enterocele Anatomy in Post‐Hysterectomy Women

Pelvic organ prolapses are becoming more prevalent, with the number of diagnoses projected to increase by 46% in the United States by 2050. One type of prolapse is enterocele, a condition in which a peritoneal sac containing the small intestines herniates into the vaginal wall. Secondary to weakened pelvic floor muscles, enterocele is strongly associated with hysterectomy, with 60% of women diagnosed with enterocele having a past history of hysterectomy. Healthcare providers discover prolapse during a physical exam when the vaginal wall bulges outside the vaginal opening. Despite the increasing prevalence and complicated anatomy of enterocele, there are few resources to educate women on the anatomy of a prolapse. Knowledge gaps cause patients stress and shame surrounding their condition, limiting their ability to confide in others and seek medical advice. Thus, supplementing counseling with patient education resources on enterocele anatomy may increase patient understanding and improve communication between patient and provider. Effective counseling may decrease patient anxiety by addressing patient fears, relieving humiliation, and putting an end to self‐blame. The first aim of this project was to develop an interactive three‐dimensional (3D) mobile application (app) to assist healthcare providers in educating post‐hysterectomy women on the anatomy of enterocele. The second aim was to assess the educational value of the mobile app as a visual aid during counseling and its ability to increase patient understanding and decrease anxiety. The 3D model utilized in the app was segmented using 3D Slicer from a de‐identified CT urogram and pelvic MRI of a female diagnosed with enterocele post‐hysterectomy. Artifacts were smoothed in ZBrushCore 2018, and the model was animated in Autodesk Maya 2019. The model was imported into a game engine, Unreal Engine 4, and packaged into a mobile app, which was iteratively designed to highlight relevant structures of pelvic anatomy and allow the model to be enlarged and rotated. The mobile app was revised based on surveys from healthcare providers on the app’s usability and educational value. To test the efficacy of the app, patients were randomized into two groups: (1) a control group with standard counseling and (2) an experimental group with counseling supplemented by the mobile app. Patients completed pre‐ and post‐intervention surveys assessing anatomical understanding and anxiety regarding their diagnosis. Preliminary data suggest the mobile app has a high potential to assist healthcare providers with educating patients. Complete analysis of patient and clinician data will be presented. Women’s perspectives and issues are traditionally underrepresented in medicine. By developing a mobile app to increase awareness, we intend to normalize the conversation and overcome the social stigma of female pelvic organ prolapse.

A 3D Printable model of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations (PAVMs) are vascular anomalies in which there is a direct connection between pulmonary arteries and veins, bypassing the lung capillary bed (1). The most common cause of PAVMs are congenital, resulting from an autosomal dominant disorder, hereditary hemorrhagic telangiectasia (HHT), causing mutations in proteins important in the vascular signaling pathway (2). Complications of untreated PAVM include stroke, hypoxemia, dyspnea, platypnea, infections, and anemia (1, 3). Treatment of PAVMs is most commonly done so via endovascular embolization (1). When HHT patients develop PAVMs and come to the IR clinic to obtain treatment, they are often anxious about their diagnosis and explaining the anatomy, pathology, and treatment of their disease can present challenges to the physician. The current method of patient education uses the patient’s 2D CT scans along with the physician’s narrative, which the patient may find difficult to follow because they are not trained in reading such medical datasets. We hypothesized that having a patient interact with a 3D‐printed model of PAVM would improve their understanding of the disease and anatomy involved, and decrease their anxiety regarding their diagnosis and treatment. To test this hypothesis, we first created a 3D model using the software 3D Slicer ( www.slicer.org) to segment CT scans from a single patient with multiple, untreated PAVMs. One PAVM was chosen to be segmented for its distinctive feeding artery exiting the pulmonary trunk into these fistula and distinctive vein exiting the fistula and entering the left atrium. The 3D model was then imported into Maya where it was sculpted, artistically adjusted, and enhanced to provide anatomically accurate representation of the chest anatomy applicable to this disease, to then be printed. This novel model of a disease has the potential to decrease patient anxiety prior to the treatment of their PAVM and improve their knowledge on the anatomy and pathology. The effects of HHT patient interaction with the model on the patient’s anxiety levels and understanding of the disease remains to be investigated.CT axial section of PAVM used for segmentationFigure 13D model produced in 3D SlicerFigure 2

Use of Guidance Videos to Increase Engagement and Decrease Anxiety in Patients Undergoing Pleural Tap

Use of Guidance Videos to Increase Engagement and Decrease Anxiety in Patients Undergoing Pleural Tap

Open communication and empathy during perioperative stage can ease patient anxiety

Surgical patients often experience stress, anxiety, and fear, which can result in negative effects, such as increased heart rate and blood pressure. This month's lead feature article addresses specific strategies for easing patients’ anxiety before surgery, including using music, aromatherapy, and virtual reality. Additionally, because perioperative nurses are knowledgeable about surgery, the OR environment, and the perioperative care continuum, they are uniquely positioned to address the anxiety of their patients via open communication and empathy. In one study of ambulatory surgery patients, a communication approach that encouraged patients to share their feelings and nurses to provide support and individual-specific information was shown to decrease patient anxiety. Although these nurses were trained on this specialized method, approaches like calmly answering questions and being nonjudgmental and respectful can be used in everyday interactions with patients without specialized training.1 Anxiety often stems from being unfamiliar with the environment and being unclear about what to expect.2 Therefore, it can be helpful for perioperative team members who interact with patients to introduce themselves and explain their roles, what they are doing, and why.2 Simple language should be used to guide patients through the timeline of care, including any possible changes or delays in the schedule, and what to expect with their procedure.3 Patients should be encouraged to ask questions, and if any one person is unable to answer, that person should find the team member who can provide the information.2, 3 Although perioperative nurses may only interact with patients briefly, they can still help patients feel supported by listening to their concerns and communicating with empathy.2, 4 This includes acknowledging and validating patients’ feelings; for example, during the preoperative discussion or when transferring them to the OR, nurses can ask patients how they are feeling or use observational statements like “You seem worried.”2, 4 They can then validate patients’ feelings by telling them that their feelings are understood and perhaps asking patients how they can help them relax.2, 4 Perioperative nurses also can attempt to avert patients’ focus from the upcoming procedure by asking them about their personal lives, such as where they work, where they are from, or about their families.2 This approach has the added benefit of helping nurses establish a rapport with patients and earn their trust. It also can reinforce the message that the health care team is interested in the patients as people.2 Perioperative nurses should try to be empathetic to each patient's situation, even if they are only able to communicate with the patient briefly. By imagining how patients are feeling and reacting appropriately, perioperative nurses may be able to alleviate patients’ anxiety and possibly improve their overall surgical care experience.

Using AIDET® Education Simulations to Improve Patient Experience Scores

The acronym AIDET stands for Acknowledge, Introduce, Duration, Explanation, and Thank You. Created by the Studer Group as a communication framework for health care professionals, AIDET is aimed at enhancing communication with patients, thereby decreasing patient anxiety, increasing compliance, and improving clinical outcomes. Its use has also been shown to improve patients' satisfaction and perceptions of care. Staff at a large urban academic medical center were trained on the use of AIDET. However, patient engagement scores on the Heart and Vascular Center unit remained low in certain domains. Simulation-based re-education is an effective strategy regarding retention of skills. Thus, we developed and implemented a series of in situ AIDET simulations, hypothesizing that staff training of AIDET could positively impact patient engagement scores. The in situ simulations provided an effective learning opportunity for Heart and Vascular Center staff to practice their AIDET communication skills in a familiar environment and receive real-time feedback. There was a slight increase for all questions of interest in the Consumer Assessment of Healthcare Providers and Systems program survey.

Communicating the External Beam Radiation Experience (CEBRE): Perceived Benefits of a Graphic Narrative Patient Education Tool

PurposeCurrent radiation oncology patient education materials exceed national readability recommendations. A graphic narrative educational tool, the Communicating the External Beam Radiation Experience (CEBRE) discussion guide, was developed to facilitate patient–provider communication. A pilot study evaluated perceived benefits of CEBRE for patients and physicians. Methods and MaterialsCEBRE was designed through a collaboration between physicians and designers. Designers interviewed patients, family members, and the clinical team. Interviews were coded for themes, leading to the design principles that drove the design of CEBRE, including a graphic narrative component. CEBRE explains the radiation therapy care path. Readability was measured using the Flesch-Kincaid test. Patients receiving radiation therapy or in follow-up and practicing radiation oncologists reviewed CEBRE and completed independent surveys. Each survey included modified versions of the Systems Usability Score (SUS) and Spielberger State-Trait Anxiety Inventory (STAI) short form, along with questions unique to CEBRE. Likert-type scores are reported as median (interquartile range). ResultsCEBRE scores at a 5.4 Flesch-Kincaid grade level. Thirty-four patients and 15 radiation oncologists completed surveys. Patients had completed a high school/general equivalency degree (18%), a 2-year degree or some college (50%), or at least 4 years of college (32%). Patient and physician responses were concordant. On a scale of 1 to 5 for modified SUS and 1 to 4 for modified STAI (“strongly disagree” to “strongly agree”) the SUS scores were 4 (4-5) and 4 (4-5) and STAI scores were 3 (3-4) and 3 (3-3.5) for patients and providers, respectively. This indicates CEBRE is usable and would decrease anxiety. Compared with text, the graphic narrative component of CEBRE was rated as “quite helpful” (4 [4-5]). ConclusionsCEBRE, a graphic narrative education tool developed through a novel collaboration between designers and radiation therapy stakeholders, is accessible for patients and practical to facilitate patient–provider discussion. Perceived benefits demonstrating high usability and the potential to decrease patient anxiety warrant further prospective investigation of CEBRE in the clinical setting.

Effect on nurse and patient experience: overnight use of blue-depleted illumination

BackgroundTypical hospital lighting is rich in blue-wavelength emission, which can create unwanted circadian disruption in patients when exposed at night. Despite a growing body of evidence regarding the effects of...

Effect of Consent and Educational Adjuncts to Consent on Patient Perceptions About Colonoscopy.

Informed consent is a vital preprocedural step for endoscopy but there are substantial variations in its delivery. We therefore sought to assess a multifaceted intervention to improve the consent process. Gastroenterologists at a tertiary center were educated on the recommended components of informed consent. Following this, 3 cohorts of patients undergoing colonoscopy were surveyed before and after consent. In one cohort, the effect of optimized verbal consent alone was assessed. In the second and third groups, the effects of the addition of either a handout or a video describing colonoscopy and its risks were evaluated. The primary outcomes were the changes between preconsent and postconsent survey responses regarding confidence in understanding the procedure's purpose, likelihood of adverse events, and levels of anxiety. In total, 240 patients were included with 79 to 81 patients per group. There were no significant differences among the groups' survey responses. Compared with patients receiving verbal consent alone, fewer patients in the handout and video groups increased their perceived risk of adverse events following consent, but this difference did not reach significance (P=0.08). Examining all groups together, anxiety levels changed significantly after consent (P=0.003), with 31% of patients reducing their anxiety level, 8% increasing it, and 62% having no change. The consent process appears to decrease patient anxiety about colonoscopy. When used in conjunction with a high-quality verbal consent, written or video educational adjuncts provided on the day of colonoscopy likely have no effect on patient perceptions.

Impact of Bundled Care on Outcomes Following Elective Primary Total Hip or Total Knee Arthroplasty.

Standardized approaches to care and care pathways for patients with joint replacement have been shown to decrease length of stay (LOS), improve patient participation in education, decrease patient anxiety while improving perception of care, and lead to overall efficiency and improved care and outcomes. The purpose of this study was to determine whether implementation of a standardized bundle approach to care influenced the outcomes after total hip or total knee arthroplasty (THA or TKA). A retrospective, quasi-experimental before- and after-design study was used to evaluate the impact of the intervention. Two hospitals implemented a standardized bundle of care for patients undergoing THA or TKA that included preoperative patient education, day of surgery mobilization, and a total joint group physical therapy session (Full Bundle). Data analyses were completed on a convenience sample of 2,200 patients who underwent THA or TKA. Outcomes data measured were LOS, discharge disposition, costs, and readmission rate. Patients receiving the Full Bundle had significant reduction in LOS of roughly 1 day (OR = 1.687, 95% CI [1.578, 1.797]) versus group not receiving all elements (OR = 2.706; 95% CI [2.623, 2.789]). Full Bundle patients were 6 times more likely to be discharged home compared with the Partial Bundle group (OR = 6.01, 95% CI [4.01, 9.03]). Full Bundle group had significantly lower total direct costs, F(1) = 4.06, p = .046, partial η = 0.003. There were no differences in readmission rates between the 2 groups. Patients who had all elements of the THA/TKA bundle had the best outcomes. By improving efficiencies of care through the use of the bundle, the 2 hospitals positively impacted the care and outcomes of THA and TKA patients.

LO92: Improving patient communication in an emergency department's rapid assessment zone

Background: Emergency Department (ED) communication between patients and clinicians is fraught with challenges. A local survey of 65 ED patients revealed low patient satisfaction with ED communication and resultant patient anxiety. Aim Statement: To increase patient satisfaction with ED communication and to decrease patient anxiety related to lack of ED visit information (primary aims), and to decrease clinician-perceived patient interruptions (secondary aim), each by one point on a 5-point Likert scale over a six-month period. Measures &amp;amp; Design: We performed wide stakeholder engagement, surveyed patients and clinicians, and conducted a patient focus group. An inductive analysis followed by a yield-feasibility-effort grid led to three interventions, introduced through sequential and additive Plan-Do-Study-Act (PDSA) cycles. PDSA 1: clinician communication tool (Acknowledge-Empathize-Inform [AEI] tool), based on survey themes and a literature review, and introduced through a multi-modal education approach. PDSA 2: patient information pamphlets developed with stakeholder input. PDSA 3: new waiting room TV screen with various informational ED-specific videos. Measures were conducted through anonymous surveys: Primary aims towards the end of the patient ED stay, and the secondary aim at the end of the clinician shift. We used Statistical Process Control (SPC) charts with usual special cause variation rules. Two-tailed Mann-Whitney tests were used to assess for statistical significance between means (significance: p &amp;lt; 0.05). Evaluation/Results: Over five months, 232 patient and 104 clinician surveys were collected. Wait times, ED processes, timing of typical steps, and directions were reported as the most important communication gaps, they and were included in the interventions. Patient satisfaction improved from 3.28 (5 being best, all means; n = 65) to 4.15 (n = 59, p &amp;lt; 0.0001). Patient anxiety improved from 2.96 (1 being best; n = 65) to 2.31 (n = 59, p &amp;lt; 0.01). Clinician-perceived interruptions went from 4.33 (1 being best; n = 30) to 4.18 (n = 11, p = 0.98). SPC charts using Likert scales did not show special cause variation. Discussion/Impact: A sequential, additive approach undertaken with pragmatic and low-cost interventions based on both clinician and patient input led to increased patient satisfaction with communication and decreased patient anxiety due to lack of ED visit information after PDSA cycles. These approaches could easily be replicated in other EDs to improve the patient experience.