Objective:To measure the level of patient satisfaction with an emergency department based chest pain assessment unit. Design: Structured patient satisfaction surveys. Setting: Inner city university hospital emergency department Participants: 383 consecutive patients aged over 25 years with probable cardiac chest pain of less than 12 hours duration at moderate to low risk of acute myocardial infarction. Intervention: Two structured questionnaires-the first addressing satisfaction with different aspects of the health care process, the second designed to assess global satisfaction outcomes. Results: 274 patients (74%) fully or partly answered the first questionnaire. There were high levels of satisfaction with all process of care issues (waiting time, information, discussion, explanation, pain management, personal needs, family needs, and discharge preparation). Altogether 258 patients fully or partly answered the second questionnaire. Global satisfaction was high. Subgroup data analysis showed white patients significantly more satisfied than non-white patients (p<0.0001), and over 45s significantly more satisfied than under 45s (p<0.01). A number of issues were raised in the free comment section of the second questionnaire. The lack of a definitive diagnosis at discharge was a recurring theme. Conclusion: Chest pain assessment units are acceptable from a patient perspective. C hest pain assessment units (CPAUs) are an innovative approach to the problem of chest pain in emergency departments, and have been shown to be clinically and cost effective in the United States. 1-4Any new clinical intervention should now provide some evidence of patient acceptability in addition to clinical and cost effectiveness. The importance of incorporating the patients' point of view into quality assurance procedures has been emphasised in many United Kingdom government documents, 5-8 which aim to rebuild public confidence in the NHS by making it accountable to the patients and shaped by their views. As part of the strategy to assess the quality of NHS care A first class service: quality in the new NHS 8 stated that a national survey of patient and user experience would be conducted in order to trigger improvement of services that consistently fail to deliver patient satisfaction. This patient satisfaction movement ties in with cultural changes within the health service and the shift towards patient centred medicine and quality management systems.However, patient satisfaction is important in its own right and should be taken seriously for a number of reasons.9 Firstly, it can be an important outcome measure determining compliance with the recommended treatment, re-attendance and so on. Secondly, it can be a useful way of assessing consultations and patterns of communication, identifying key areas for improvement. Thirdly, it enables choice between alternatives in organising or providing health care.CPAUs were first established in the United States. The only published paper on patient satisfaction in such units 10 concluded that patien...

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Best evidence topic reports (BETS) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. The BETS published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary. 1 Each BET has been constructed in the four stages that have been described elsewhere. 2 The four topics covered in this issue of the journal are:

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Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study weaknesses Sloan JP et al, 1987, UK 1 85 adult patients with recent (<6 h) open fractures of the distal phalanges Controlled clinical trial Infection rate 30% v <3% No antibiotic v cephradine Suprock MD et al, 1990, USA 2 91 patients with open fractures of the finger Controlled clinical trial Number of infections 4 in each group Surgical irrigation and debridement with or without antibiotics