Negative Patient Experiences Research Articles

Bowel cancer diagnosis experiences as a predictor of overall care rating: evidence from the English Cancer Patient Experience Survey

ObjectiveTo investigate whether and which negative diagnosis-related experiences of patients newly diagnosed with colorectal cancer (CRC) are associated with a poorer overall rating of care, to help prioritise interventions.MethodsA secondary...

Experience of health care utilization for inpatient and outpatient services among older adults in India

BackgroundPatient experiences have not been documented at all India level among older adults for inpatient and outpatient services. We provide all-India and sub national estimates on six domains of patient experience, namely: waiting time, respectful treatment, clarity of explanation provided, privacy during consultation, treated by provider of choice, and cleanliness of facility. MethodsUnit records of adults aged 45 years and above for their inpatient (n = 4330) or outpatient (n = 33,724) service use were assessed from the Longitudinal Ageing Survey of India (LASI), conducted in 2017-18. We identified patient experience as negative if the respondent rated it as either “Bad” or “Very Bad” on a five-point Likert scale. We computed proportion of negative experience by socio-economic status, geographic location, and type of healthcare facilities. We used binary logistic regression to estimate predictors of negative patient experience, and a three-level logistic regression model to partition the total geographic variation of patient experiences. FindingsMost individuals rated their experience in all six domains as “Good”. Negative experiences were higher among patients who used public facilities, specifically for waiting time and cleanliness of facility. Among inpatients, the higher-than-average negative experience was noted in the north and northwest, while among outpatients, it was higher in the northeast. The largest geographic variation in negative patient experience was attributable to the villages/CEBs for all domains in outpatient services and three domains of inpatient services, whereas states accounted for the other three inpatient domains. InterpretationMajority of older adults rated their experience of healthcare use positively, but less for public health facilities.

Implementation of the admission transfer unit to reduce emergency department boarding: A quality improvement initiative.

Emergency Department (ED) boarding crowds the emergency department, strains resources, leads to higher hospital costs, and is associated with increased morbidity/mortality, a negative patient experience, and patient adverse events. The time Ontario patients wait in emergency departments for inpatient beds continues to rise, with the average time admitted patients spend in the ED increasing between 2015 and 2019 from 13.8hours to 16.2hours. As reported in this quality improvement initiative, one potential solution is to repurpose short-stay medical assessment units for complex admitted medicine patients using an objective patient selection tool. Objectively selecting admitted ED patients with the highest risk for adverse events and prioritizing them to move to a transitional unit advances safe quality patient care and decreases Time-to-Inpatient Bed (TIB). Results from this quality improvement initiative include reducing the organization's TIB by 13hours.

Sex, Age, and Patient Experience in Cardiologist Reviews: A Large-Scale Artificial Intelligence-Enabled Analysis

BackgroundPatients are increasingly using online reviews to evaluate cardiologists. Online reviews can provide insights into factors driving patient satisfaction. Little is known about the effects of age and sex on the patient experience with cardiologists. ObjectivesThe purpose of this study was to apply natural language processing techniques on online reviews to determine the factors underlying positive and negative patient experiences and the effects of age and sex on the patient experience with cardiologists. MethodsMixed effects logistic regression and sentiment analysis were applied to online cardiologist reviews from Healthgrades between 1998 and 2023. The results were then analyzed by sex and age to show trends with respect to rating statistics, sentiment analysis, and frequency of 2-word phrases. ResultsThere were 100,334 online reviews of 9,461 cardiologists. Female cardiologists received lower average ratings compared to male cardiologists and were 34.5% less likely to receive a positive review (OR: 0.655; 95% CI: 0.481-0.893; P = 0.015). Older cardiologists received lower average ratings compared to younger cardiologists (4.145 ± 0.908 vs 4.348 ± 0.795; P < 0.01). Positive reviews were associated with time spent with patients (OR: 1.383; 95% CI: 1.251-1.528; P < 0.01), answering questions (OR: 2.622; 95% CI: 2.324-2.959; P < 0.01), and patients feeling they could trust their providers’ decisions (OR: 2.285; 95% CI: 2.053-2.543; P < 0.01). ConclusionsPositive reviews were associated with cardiologists being comprehensive and patients feeling a sense of trust in the relationship. There was a difference in ratings based on age and sex with female and older cardiologists receiving lower ratings.

Advisory Panel Guidance on Minimum Retesting Intervals for Lab Tests

What Is the Issue? Lab test overuse can contribute to further unnecessary follow-up and testing, negative patient experiences, potentially inappropriate treatments, and the inefficient use of health care resources. One review of lab testing in Canada found that around 22% of blood tests were likely unnecessary. One strategy to address lab test overuse is to establish minimal retesting intervals that can be implemented in medical laboratories to help identify and manage potentially inappropriate lab test requests. Minimum retesting intervals suggest the minimum time before a test should be repeated based on the biochemical properties of the test and the clinical situation in which it is used. They are intended to inform clinical decisions about repeat testing. The importance of lab resource stewardship is being addressed by Choosing Wisely Canada through Using Labs Wisely, a consortium of more than 150 hospitals committed to driving the appropriate use of lab testing in Canada. The hospitals participating in Using Labs Wisely identified a need for guidance on minimum retesting intervals for commonly used lab tests. What Did We Do? Choosing Wisely Canada and CADTH partnered to convene an independent time-limited advisory panel to develop consensus-based recommendations for minimum retesting intervals for 7 commonly used lab tests (antinuclear antibody [ANA], B-type natriuretic peptide [BNP] and N-terminal pro b-type natriuretic peptide [NT-proBNP], Hemoglobin A1C, lipase, lipid panel, serum protein electrophoresis [SPEP], and thyroid stimulating hormone [TSH]) in prespecified patient populations. The advisory panel included core and specialist members who were recruited from across Canada. The 7 core advisory panel members brought together expertise in laboratory medicine, family practice, and patient lived experience. Seven additional specialist members brought expertise in endocrinology, cardiology, pediatric cardiology, rheumatology, hematology oncology, gastroenterology, and general internal medicine. The Advisory Panel on Minimum Retesting Intervals considered patient group input, evidence from focused literature reviews, equity considerations, and clinical expertise. Through facilitated discussion, they reached consensus on the recommendations for minimum retesting intervals. Following external feedback, the recommendations for BNP and NT-proBNP and lipid panels were removed, and this document includes recommendations for minimum retesting intervals for 5 lab tests. These are not recommendations for repeat testing. They are recommendations that if testing is undertaken, it should not be repeated sooner than the indicated intervals. They are not intended to replace clinical judgment as there may be exceptions in which the recommendations do not apply. What Is the Potential Impact? The recommendations on minimum retesting intervals can support the hospitals participating in Choosing Wisely Canada’s Using Labs Wisely program in their effort to reduce unnecessary lab tests and their impact on patients, providers, health systems, and the environment. The recommendations may also be relevant to community and hospital lab stewardship efforts and may address the appropriate use of the 5 lab tests by enabling changes in lab test ordering in both inpatient and outpatient settings.

Provider Perceptions Toward Extended-Release Buprenorphine for Treatment of Opioid Use Disorder.

The persistence of the opioid crisis and the proliferation of synthetic fentanyl have heightened the demand for the implementation of novel delivery mechanisms of pharmacotherapy for the treatment of opioid use disorder, including injectable extended-release buprenorphine (buprenorphine-ER). The purpose of this study was to understand provider-level barriers to prescribing buprenorphine in order to facilitate targeted strategies to improve implementation for patients who would benefit from this novel formulation. Using an interview template adapted from the Consolidated Framework for Implementation Research (CFIR), we conducted structured focus group interviews with 20 providers in an outpatient addiction clinic across 4 sessions to assess providers' perceptions of buprenorphine-ER. Ninety-four unique comments were identified and deductively coded using standardized CFIR constructs. Providers expressed mixed receptivity and confidence in using buprenorphine-ER. Although providers could identify a number of theoretical advantages to the injectable formulation over sublingual buprenorphine, many expressed reservations about using it due to inexperience, negative patient experiences, uncertainties about patient candidacy, cost, and logistical constraints. Provider concerns about buprenorphine-ER may limit utilization. Some concerns may be mitigated through improved education, research, and logistical support. Given the putative benefits of buprenorphine-ER, future research should target barriers to implementation, in part based on hypotheses generated by these findings.

Artificial Intelligence for Patient Flow

Why Is This an issue? Inefficient patient flow contributes to the overcrowding of health care settings and negative clinical outcomes and patient experiences downstream. Patient flow management aims to achieve seamless patient movement through the health care system and between acute and long-term settings, ensuring timely access to quality care. What Is the Technology? Artificial intelligence (AI)-based patient flow management tools are interventions designed to forecast and monitor patient movement from admission to discharge as they progress through different care settings. AI-driven tools can leverage big data and digital information systems (e.g., electronic health records) to facilitate effective patient flow. AI-based patient appointment scheduling tools, which can help improve patient flow, are created to automate appointment scheduling and optimize it by minimizing wait times and matching the demand for health services and hospital capacity. What Is the Potential Impact? AI tools for patient flow management can support volume forecasting of patients with various conditions, especially those experiencing chronic conditions that require different types of treatment or care in different settings over a long period of time. These AI tools can predict admissions, patient movement from the emergency department to inpatient beds, discharge, and transfers to different health care settings. Evidence for their effectiveness in patients with emergency admissions and those transferred to tertiary and quaternary care, as well as inpatients from the general, cardiology, and mental health departments, was reported. In addition, evidence suggested that AI tools can optimize appointment scheduling in general outpatient settings and operating rooms. In health care systems in Canada, AI tools are being used or investigated to enhance patient flow by predicting emergency admissions, transfers to alternate levels of care, and general inpatient discharges, as well as optimizing capacity planning for patients receiving oncology care. AI appointment scheduling tools are currently being used in some oncology care settings and operating rooms across Canada. The implementation of AI systems generally requires an upfront investment of time and other resources in addition to the financial cost of the system itself for set-up, integration, and staff training. The goal of these systems is to improve efficiency and save money, time, and human resources in the long run. What Else Do We Need to Know? Patient privacy and data security issues are concerns regarding widespread implementation of AI tools trained on electronic health records systems and patient datasets. AI algorithms trained on datasets lacking adequate representation of all relevant patients may not predict their flow accurately. Training datasets with sufficient data from all relevant patient groups can ensure the inputs and outputs of the algorithms accurately reflect patient care needs and mitigate potential bias. To accurately predict the care needs of local patients, AI algorithms, once deployed, should be retrained on site-specific datasets containing data for the patient populations that are representative of the hospital or health system in which they are being used. Not all institutions have the hardware or computing power available to adequately or efficiently process the large amounts of data that are required by these AI systems, or the infrastructure needed to use big data (e.g., from electronic health records), and may require additional resources for implementation, as well as for ongoing maintenance and updating of the systems.

Patient Safety Indicators at an Academic Veterans Affairs Hospital: Addressing Dual Goals of Clinical Care and Validity

Hospital-acquired complications add to patient morbidity and mortality, costs, length of stay, and negative patient experience. Patient Safety Indicators (PSIs) are a validated and widely used metric to evaluate hospital administrative data on preventing these events. Although many studies have addressed PSI validity, few have aimed to reduce PSI through clinical care. The authors aimed to reduce PSI events by addressing both validity and clinical care. Frontline clinicians used a deep dive template to provide input on all PSI cases, which were then reviewed by a PSI task force to identify performance gaps. After analyzing the frequency of gaps and cost-vs.-impact of potential solutions, five interventions were implemented to address the three most common, highly weighted PSIs: pressure ulcers, postoperative venous thromboembolism (VTE), and postoperative sepsis. Clinical care interventions included increasing patient mobility by creating a specialized mobility technician position, skin care audits to prevent pressure ulcers, and increasing use of pharmacologic VTE prophylaxis. Administrative interventions addressed improving clinician-coding concordance for sepsis and increasing documentation of comorbidities. After interventions, the number of PSI events for composite PSI, VTE, and sepsis decreased by 41.3% (p = 0.039), 85.2% (p = 0.0091), and 51.5% (p = 0.063), respectively, relative to the preintervention period. Pressure ulcers increased by 33.3% (p = 0.0091). Hospital complications cause substantial burden to hospitals, patients, and caregivers. Addressing administrative and clinical factors with targeted interventions led to reduction in composite PSI. Further efforts are needed locally to reduce the pressure ulcer PSI.

Nurses' Perceived Effects of Visitor Restrictions in Hospital Maternity Units.

To explore how perinatal nurses perceive the effects of visitor restrictions on patient care within a hospital setting. We distributed a cross-sectional survey online to perinatal nurses in May of 2022. Characteristics of respondents were analyzed using descriptive statistics. Responses to an open-ended question were analyzed via conventional content analysis. Among our sample of 101 nurses, we identified seven codes representing positive effects and seven codes representing negative effects. The most frequently reported positive effects were ability to provide person-centered care ( n = 36, 35.6%) and less patient stress and more rest ( n = 29, 28.7%). The most frequently reported negative effects were limited patient support ( n = 22, 21.8%) and emotional distress to the patient ( n = 15, 14.9%). Fourteen percent ( n = 14) of respondents cited both positive and negative effects. Nurses perceived that visitor restrictions resulted in both positive and negative patient experiences. Balancing clinical needs and safety considerations with emotional needs of the childbearing individual requires careful consideration by maternity care clinicians and health care systems. Subsequent research is needed to determine optimal visitation policies during intrapartum and postpartum with consideration to hospital context and patient preferences for optimal care.

Making bladder management a priority for multiple sclerosis

Multiple sclerosis (MS) can result in uro-neurological dysfunction, leading to a range of different urological problems that are distressing to the patient and costly for the NHS. Sue Thomas outlines why bladder management in MS needs greater focus to alleviate both negative patient experience and the financial burden of urinary dysfunction on the NHS.

Effectiveness of ligation of Inter Sphincteric Fistula Tract (LIFT) in the Management of Fistulas in ano in Maharashtra Population: Retrospective Study

Background: Anal fistula is one of the most common ano- rectal problems, resulting in very negative patientexperiences. The objectives of anal fistula treatments are to achieve healing with a low recurrence rate and preserveanal function.Method: 55 adult patients were confirmed to be competent for surgery. USG examination with 7 to 10 MHZtransducer passed into the anal canal, which is carried out with the patient in the left lateral position. Serial radialimages were taken to study the location and position of the fistula. The LIFT procedure was similar to Rojanaskulproposed method. The duration of surgery and healing time were also noted.Results: 48 (87.2%) were as per Parks classification, 5 (9.09%) intersphincteric, 2 (3.63%) suprasphincteric,Classification based on course of fistula – 20 (36.3%) anterior straight, 28 (50.9%) posterior straight, 5 (9.09%) curved,and 2 (3.63%) semi-horse shoe. Classification based on the tract – 50 (90.9%) single tracts, 5 (9.09%) multiple tracts.Conclusion: LIFT technique is simple and safe, with a high rate of healing and no risk of incontinence.

Respiratory symptoms after TB treatment completion: A qualitative study of patient and provider experiences in urban Blantyre, Malawi.

Pulmonary tuberculosis (PTB) survivors experience a high burden of residual and recurrent respiratory symptoms after TB treatment completion. However, guidelines for the investigation and care of symptomatic TB-survivors are limited. We used qualitative methods to explore patient and provider understandings, experience and practice around respiratory symptoms in the post-TB period. We conducted in-depth interviews with PTB-survivors who had experienced respiratory symptoms (cough, chest pain, breathlessness) after successful TB treatment completion in Blantyre, Malawi (n = 23). We completed focus group discussions with TB-Officers (n = 12), and in-depth interviews with health care workers (n = 18) from primary and tertiary health facilities. Interviews were conducted in Chichewa, and thematic analysis was used to identify common themes. Our data highlight that TB survivors have negative experiences of respiratory symptoms after TB treatment completion, with anxiety about the cause of symptoms, uncertainty about if and how to return to care, and fear of recurrent TB disease. Our findings suggest four critical practices which shape this experience including: limited counselling at TB treatment completion; the lack of clear health seeking pathways to return to care; the use of TB-focused investigations for those returning to care; and heterogeneous approaches to TB retreatment decisions. This study highlights that the post-TB period is a critical part of the patient's experience of TB disease. Current practices create a negative patient experience, and carry clinical and public health risks including delayed diagnosis of TB relapse, missed diagnosis of cardio-respiratory disease, and misuse of antimicrobials and TB retreatment. Formative guidelines are needed to improve the care of symptomatic TB-survivors.

FROM COMFORT TO PROFITABILITY: RELATIONSHIP BETWEEN CARE QUALITY AND FINANCIAL PERFORMANCE IN US HOSPICES

Abstract Hospice care is a critical aspect of end-of-life care in the United States, providing comfort and support to individuals with life-limiting illnesses. Quality of care is a key concern for hospice facilities, as it can impact both patient outcomes and financial sustainability. Poor quality of care can lead to negative patient experiences, increased hospitalizations, and even legal issues. It can also result in financial penalties or reduced reimbursement from payers. However, there is limited research on the relationship between quality of care and financial performance in hospice facilities. Employing a cross-sectional observational design, we examined the relationship between Hospice and Palliative Care Composite Process Measure (lagged by 1 year) and the total margin of hospice facilities across the United States. We used secondary data from Nursing Home Compare, Healthcare Cost Report Information System Dataset, and the American Community Survey for the period 2017-2021. We found a positive association between quality process measures and financial performance in hospice facilities after controlling for organizational and community factors that may influence financial performance, such as facility size and location. Specifically, a 10-unit increase in quality measure was associated with a 2% increase in total margin. The findings of this study have important implications for the management and financing of hospice facilities. Investments in quality improvement initiatives may lead to improved financial performance. Policymakers should consider these findings when designing payment systems for hospice care, and administrators of hospice facilities should prioritize quality improvement initiatives to ensure both high-quality care and financial viability.

Abstract A030: Identifying LGBTQ+-related barriers and gaps in patient and workplace environments: An LGBTQ+ environmental needs assessment at Perlmutter Cancer Center

Abstract Background: The LGBTQ+ community faces disproportionately higher cancer-related health disparities compared to the general population. Lack of access, knowledge, and cultural attitudes are known factors attributing to lower rates of receiving cancer-preventative services, as well as higher rates of later-stage cancer diagnoses. Many factors contribute to these disparities, including finding a trusted provider, poor visual representation at clinics, missing sexual orientation and gender identity (SOGI) data, and negative patient experiences. To address these issues and to promote equitable care it is important to identify gaps and barriers that present in patient and healthcare staff environments. The LGBTQ+ Staff Task Force (STF) at NYU Langone Health Perlmutter Cancer Center (PCC) will utilize the Exploration, Planning, Implementation, Sustainment (EPIS) framework to address these inequities. Methods: As part of the “Exploratory” phase, the STF will deploy an environmental needs assessment survey, to evaluate patient and employee areas. The assessment includes the following LGBTQ+ domains to evaluate the environments: Policy; Visualization and Safety; Knowledge and awareness education; Complaint and Feedback Reporting; Workplace Inclusions and Non-discrimination; Resources. The survey will be administered to all clinical and non-clinical departments of PCC and will be completed by STF members from their respective departments and by managers or supervisors from each department location. Surveys will be submitted electronically via REDCap Data will be analyzed by the research team and discussed in small focus groups. Discussion: The LGBTQ+ Needs Assessment will be carried out across all PCC departments and locations within an 8-week period between May and July 2023. The findings from utilizing the EPIS framework will enable the identification of gaps and barriers to inclusive patient care and evaluate the efficacy of current processes and resources in place for LGBTQ+ patients and employees. Findings will inform strategies and planning to decrease identified factors impacting access to equitable healthcare. Citation Format: Alexandr Trifonov, Rachel Monahan, Megan C. Haseltine, Kevin Moore, Gwendolyn P. Quinn, Rachel Nelson, Abraham Chachoua, Jason Domogauer. Identifying LGBTQ+-related barriers and gaps in patient and workplace environments: An LGBTQ+ environmental needs assessment at Perlmutter Cancer Center [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A030.

Demographics and Social Factors Associated With Persistent Nonuse of Video Appointments at a Multisite Health Care Institution: Cross-Sectional Study.

During the COVID-19 outbreak, video appointments became a popular method for health care delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (F2F) appointments to prevent the spread of the virus, some patients continued seeing their health care providers in person. In the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, a subset of patients continued to avoid video appointments. It is not yet clear what sociodemographic factors may be associated with this group of patients. This cross-sectional study aimed to examine demographic and social determinant of health (SDoH) factors associated with persistent nonusers of video appointments among a sample of patients within a multistate health care organization. We also explored patient beliefs about the use of video for health care appointments. We conducted a 1-time cross-sectional paper survey, mailed between July and December 2022, of patients matching the eligibility criteria: (1) aged ≥18 years as of April 2020, (2) Mayo Clinic Midwest, Florida, or Arizona patient, (3) did not use video appointment services during April-December 2020 but attended F2F appointments in the departments of primary care and psychiatry/psychology. The survey asked patients, "Have you ever had a video appointment with a healthcare provider?" "Yes" respondents were defined as "users" (adapted to video appointments), and "no" respondents were defined as "persistent nonusers" of video appointments. We analyzed demographics, SDoH, and patient beliefs toward video appointments in 2 groups: persistent nonusers of video appointments and users. We used chi-square and 2-tailed t tests for analysis. Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent nonusers of video appointments. Only 1 SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent nonuse of video appointments. Persistent nonusers of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting nonverbal cues, and personal preference for F2F appointments over video. Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients' decisions to choose between video versus F2F appointments for health care delivery. Health care institutions should assess patients' negative attitudes toward technology prior to introducing them to digital health care services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a "digital health coordinator" could be assigned to assist with various digital health solutions.

Cultural Competence and the Postoperative Experience: Pain Control and Rehabilitation

Healthcare inequities exist across healthcare and have been shown to influence patient care and outcomes. In the field of orthopaedic surgery, healthcare disparities have been shown to manifest in the realms of postoperative pain management and rehabilitation. Previous literature has demonstrated that socioeconomic status, sex, gender, race, and ethnicity influence postoperative pain management and can precipitate a negative patient experience, manifesting as poorly managed pain and undertreatment of minorities and patients of lower socioeconomic status. A similar body of literature has revealed similar barriers in postoperative rehabilitation, particularly with regard to accessibility, language, rapport, and culture. These disparities impact patients, ranging from diminished surgical satisfaction to postoperative morbidity. As the United States becomes increasingly diverse, cultural competence plays a major role in combating these disparities. This article presents methods to promote cultural competence, including greater diversity in the medical field, a greater emphasis on cultural competency in education and training programs at all levels of healthcare, increased resources allocated to researching healthcare inequities, and more effective mechanisms of patient education.

Patients' negative experiences with health care settings brought to light by formal complaints: A qualitative metasynthesis.

Narratives of negative patient experiences expressed in complaints can help health care professionals reflect on their practices. To synthesise evidence from qualitative primary studies on patients' negative experiences with different health care settings and to obtain a detailed picture of what patients find problematic while receiving health care. Metasynthesis inspired by Sandelowski and Barroso. A protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO). A systematic search was conducted in CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycInfo (Ovid) and Scopus, on 20.04.2021. Backward and forward citations of included reports were searched for relevant studies and the search was completed in March 2022. Two researchers independently screened and appraised the included reports. A metasynthesis using reflexive thematic analysis and a metasummary were conducted. Twenty-four reports were included, and four main themes were extracted from the metasynthesis: (1) problems with access to health care services; (2) failure to acquire information about diagnosis, treatment and the expected patient role; (3) experiencing inappropriate care and bad treatment; (4) problems with trusting health care service providers. Negative patient experiences impact patients' physical and psychological health, leading to suffering and hampering patients from involving themselves in their health care. Narratives of negative patient experiences aggregated from the findings provide knowledge about what patients need and expect from health care providers. These narratives can help health care professionals reflect on the way they interact with patients and improve their practice. Health care organisations need to prioritise patient participation. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Findings were presented and discussed in a meeting with a reference group representing patients, health care professionals and the public.

Impact of Emergency Department Crowding on Discharged Patient Experience.

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. 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. 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 0.657-0.690]; P<0.001), with the same three care areas having significant differences in detractor likelihood based on patient census changes. Length of stay (OR 1.71, CI 1.50-1.95), leaving against medical advice/without being seen (OR 5.15, CI 3.84-6.89), and the number of ED care areas a patient visited (OR 1.16, CI 1.01-1.33) was associated with an increase in detractor likelihood. Patients arriving to a crowded ED and ultimately discharged are more likely to have negative patient experience. Future studies should characterize which variables most impact patient experience of discharged ED patients.

Access, relationships, quality and safety (ARQS): a qualitative study to develop an Indigenous-centred understanding of virtual care quality

BackgroundAmong Indigenous peoples in Canada, access to high-quality healthcare remains an important determinant of health. The shift to virtual and remote-based approaches, expedited during the COVID-19 pandemic, influenced the ways...

Online Patient Reviews of Breast Reconstruction: RealSelf Analysis.

The breast reconstruction category from RealSelf.com was analyzed using a web crawler-based application built from Python and Selenium. Reviews were collected from May 2009 to November 2021. Information including RealSelf's inherent "worth it" ranking system, review text, the number of submitted photographs, and the number of readers who found the review helpful was captured. The content of the review was then independently reviewed by the authors and was categorized with key factors that determined positive or negative reviews. A total of 3451 breast reconstruction reviews were collected. After the authors analyzed each review, 3225 (94.33%) were identified as positive reviews. The most common factors associated with positive reviews were physician demeanor (n = 2600, 31.7%), aesthetic outcome (n = 1955, 23.8%), or staff (n = 1543, 18.8%), while negative reviews were associated with unfavorable aesthetic outcome (n = 94, 28.9%), physician demeanor (n = 82, 25.2%), or postoperative complications (n = 75, 23.1%). Although there are surveys that analyze patient satisfaction for breast reconstruction, there has not been a study that analyzed a large online review database. Predominating factors in both positive and negative reviews were physician demeanor and aesthetic outcome.