Background Improving patients' ability to identify their inpatient physicians and understand their roles is vital to safe patient care. We designed picture cards to facilitate physician introductions. We assessed the effect of Feedback Care and Evaluation (FACE™) cards on patient: (1) ability to correctly identify their inpatient physicians, and (2) understanding of their roles. Methods In October 2006, team members introduced themselves with FACE™ cards, which included a photo and an explanation of their roles. During an inpatient interview research assistants asked patients to name their inpatient physicians and trainees, and rate their understanding of their physicians' roles. Results 1686 (80%) patients in the baseline period and 857 (67%) in the intervention period participated in the evaluation. With the FACE™ intervention, patients were significantly more likely to correctly identify at least one inpatient physician (attending, resident, or intern) [baseline 12.5% vs. intervention 21.1%; p<0.001]. Of the 181 patients who were able to correctly identify at least one inpatient physician in the intervention period, research assistants noted that 59% (n=107) had FACE™ cards visible in their rooms. Surprisingly, fewer patients rated their understanding of their physicians' roles as excellent or very good in the intervention period (45.6%) compared to the baseline period (55.3%) (p<0.001). Conclusions Although FACE™ cards improved patients' ability to identify their inpatient physicians, many patients still cannot identify their inpatient doctors. The FACE™ cards also served to highlight patients' misunderstanding of their physicians' roles.

IntroductionMedical professionalism is a core competency for emergency medicine (EM) trainees; but defining professionalism remains challenging, leading to difficulties creating objectives and performing assessment. Because professionalism is dynamic, culture-specific, and often taught by modeling, an exploration of trainees’ perceptions can highlight their educational baseline and elucidate the importance they place on general conventional professionalism domains. To this end, our objective was to assess the relative value EM residents place on traditional components of professionalism.MethodsWe performed a cross-sectional, multi-institutional survey of incoming and graduating EM residents at four programs. The survey was developed using the American Board of Internal Medicine’s “Project Professionalism” and the Accreditation Council of Graduate Medical Education definition of professionalism competency. We identified 27 attributes within seven domains: clinical excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data to assess variance across attributes as well as differences between residents at different training levels or different institutions.ResultsOf the 114 residents eligible, 100 (88%) completed the survey. The relative value assigned to different professional attributes varied considerably, with those in the altruism domain valued significantly lower and those in the “respect for others” and “honor and integrity” valued significantly higher (p<0.001). Significant differences were found between interns and seniors for five attributes primarily in the “duty and service” domain (p<0.05). Among different residencies, significant differences were found with attributes within the “altruism” and “duty and service” domains (p<0.05).ConclusionResidents perceive differences in the relative importance of traditionally defined professional attributes and this may be useful to educators. Explanations for these differences are hypothesized, as are the potential implications for professionalism education. Because teaching professional behavior is taught most effectively via behavior modeling, faculty awareness of resident values and faculty development to address potential gaps may improve professionalism education.

Use of a tablet computer application to engage patients in updating their medication list Purpose. Failure to obtain an accurate medication history can adversely affect patient care in the emergency department (ED) and propagate errors into the inpatient and outpatient settings. Obtaining an accurate medication history in the ED is challenging, however, due to limited time, a suboptimal environment for patient interaction, and inadequate information in the electronic health record (EHR). This article describes the development and initial evaluation of the PictureRx Medication History Application, a tablet computer-based program that queries patients' prescription fill data from the Surescripts Medication History service and renders it graphically for review and editing at the point of care.Methods. A quasi-experimental trial of PictureRx was performed in a large academic ED. Adult patients taking at least 1 prescription medication were prospectively eligible for the intervention. Usual care control patients were retrospectively matched 1:1. The main outcomes were updates to the patients' existing pre-visit medication list in the EHR and patient perceptions of the application.Results. The medication list was updated for 101/244 (41.4%) of the intervention group and for 43/244 (17.6%) of the control group (difference 23.8%, 95% confidence interval, 16.0-31.6%). Similar differences were observed for medication additions, removals, and corrections in dose. Approximately 80% of intervention patients "strongly agreed" that the application was easy to use, aided medication list accuracy, and the graphical features assisted with recall. Conclusion.A novel tablet computer-based medication history application was feasible to implement in a busy academic ED. Use of the tool was associated with more updates to patients' EHR medication list.

crowding levels. We then compared the adoption of crowding measure across quartiles and compared differences using linear regression using 2010 data. All analyses were adjusted for complex survey design and weighting to provide national estimates (SAS 9.3); P<.05 was significant. Results: There was a significant increase for seven crowding interventions from 2007 to 2010 including use of bedside registration (66.3% in 2007 to 79.2% in 2010, P¼.0019), electronic dashboards (35.2% to 51.9%, P¼.0024), radio frequency identification tracking (9.8% to 20.7%, P¼.0216), full capacity protocol (21.0% to 45.6%, P<.001), boarding patients on inpatient hallways (14.8% to 23.8%, P¼.027), immediate bed census availability (66.1% to 83.4%, P<.0001), and use of pooled nurses (33.2% to 60.0%, P<.0001). The total number of interventions rose from 5.2 to 6.6 from 2007 to 2010 (P<.0001). Several crowding interventions demonstrated no change over the study period, such as computer-assisted triage, presence of fast-track, increased number of standard ED treatment spaces, physical expansion of the ED, zone nursing, use of a bed czar, avoiding admissions when on ambulance diversion, presence of a separate OR for ED cases, or surgical schedule smoothing. The use of an ED observation unit decreased (35.7% to 21.1%, P<.0001). In 2010, six specific interventions showed greater use in more crowded EDs (Table). By comparison, use of bed census availability and avoiding admissions of elective cases during ambulance diversion were inversely related to ED crowding. Adoption of the remainder of the interventions was not associated with ED crowding levels. Conclusion: There has been a growth in the number of interventions to reduce ED crowding across U.S. hospitals from 2007-2010, several which reflect technological advances. However, interventions that required a change in hospital-level protocols demonstrate relatively low adoption rates and have not grown in use, potentially because of difficulties in accomplishing hospital-wide interventions or priorities. In general, EDs that were more crowded have adopted more strategies, demonstrating that interventions are being used in hospitals with the greatest need.