Emergency management of chest pain: patient satisfaction with an emergency department based six hour rule out myocardial infarction protocol

Abstract

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...

Patient satisfaction with chest pain unit care: findings from the Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions (ESCAPE) cluster randomised trial

“…This contrasts with previous studies in the UK, which both reported significant improvements in patient satisfaction with CPU care 13 14…”

“…At Manchester Royal Infirmary, Richards et al 13 reported high levels of patient satisfaction with the protocol in the ED. The study by Goodacre et al 14 at the Northern General Hospital in Sheffield also found that CPU care was associated with significant improvements in patient satisfaction.…”

Implementation of the Guidelines for the Management of Patients With Chest Pain Through a Critical Pathway Approach Improves Length of Stay and Patient Satisfaction But Not Anxiety

“…Length of stay (LOS): a shorter LOS would result in a more efficient use of resources, both medical and economical; 2. Patient satisfaction: a multifaceted parameter influencing outcome and quality of care 8,9 ; 3. Anxiety: highly prevalent among chest pain unit (CPU) patients and associated with increased morbidity and mortality.…”

View From the United Kingdom

“…Since then evidence has accumulated that CPC care in the UK is safe, practical, effective, cost-effective, and acceptable to patients. 15,20 Despite this, development has been sporadic. A variety of different approaches to CPC care have been implemented, often poorly funded, and with variable use of diagnostic tests and protocols.…”