There is modest evidence supporting a range of performance improvement interventions for improving ED patient satisfaction. Further work is needed before specific, evidence-based recommendations can be made regarding which process changes are most effective. Recommendations are made for improving the quality of performance improvement efforts in the ED setting.

Background-Cancer patients take medications for coexisting disease and self medicate with overthe-counter drugs (OTCs). A complete analysis of the use of prescription drugs, OTCs and supplements during cancer treatment has never been done.

Identifying sources of variability in the response to cancer chemotherapy requires knowledge of all variables including concomitant medications, which can alter metabolism and pharmacokinetics of chemotherapy. This study investigated the accuracy of concomitant medication lists in the charts of cancer patients. Collated information from a questionnaire, patient interview and patient’s medical chart were used to obtain validated medication lists. Patients took an average of 4.8 prescription drugs, 1.6 non-prescription drugs and 1.6 other remedies within three days prior to chemotherapy. Medical records did not report 24% of prescription drugs, 84% of non-prescription drugs and 83% of other remedies. Electronic medical records were more complete than paper charts, but failed to report more than 75% of non-prescription drugs and other remedies. Potential drug interactions were noted. This study documents the extent and complexity of concomitant drugs taken by patients undergoing chemotherapy and the deficiencies in recording this information in medical charts.

There is modest evidence supporting a range of performance improvement interventions for improving ED patient satisfaction. Further work is needed before specific, evidence-based recommendations can be made regarding which process changes are most effective. Recommendations are made for improving the quality of performance improvement efforts in the ED setting.

This study demonstrates that a resident-led curriculum in palliative medicine can improve resident comfort within this still-under-represented area of medicine.