The Use of Performance Improvement Methods to Enhance Emergency Department Patient Satisfaction in the United States: A Critical Review of the Literature and Suggestions for Future Research

Objectives: The authors reviewed the evidence on performance improvement methods for increasing emergency department (ED) patient satisfaction to provide evidence-based suggestions for clinical practice.
Methods: Data sources consisted of searches through MEDLINE, CINAHL, PSYCHINFO, Cochrane Library, and Emergency Medicine Abstracts and a manual search of references. Articles were included if they reported a performance improvement intervention targeting patient satisfaction in the ED setting. Articles on studies not conducted in the United States or that failed to provide enough details to allow critical evaluation of the study were excluded. Two authors used structured evaluation criteria to independently review each retained study.
Results: Nineteen articles met all selection criteria. Three studies found varying levels of support for multicomponent interventions, predominantly focused on implementation of clinical practice guidelines for specific presenting complaints and process redesign. Sixteen studies evaluated single-component interventions, with the following having at least one supportive study: using alternating patient assignment to provider teams rather than "zone"-based assignment, enhancing provider communication and customer service skills, incorporating information delivery interventions (e.g., pamphlets, video) that target patient expectations, using preformatted charts, and establishing ED-based observation units for specific conditions such as asthma and chest pain.
Conclusions: 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.     

Influence of Electromagnetic Fields on Function of Automated External Defibrillators

Objectives: In this study, the authors tested whether electromagnetic interference (EMI) is able to impair correct electrocardiogram analysis and produce false‐positive shock advice from automated external defibrillators (AEDs) when the true rhythm is sinus. Methods: Nineteen healthy subjects were used to test five AEDs available on the Austrian market in a prospective, open, and sequence‐randomized study. The primary outcome variable was the absolute number of shocks advised in the presence of EMI. The secondary outcome was the number of impaired analyses caused by incorrectly detected patient movements or electrode failure. Results: Of 760 tests run, 18 (2.37%) cases of false‐positive results occurred, and two of five AEDs recommended shocks in the presence of sinus rhythm. Of 760 tests run, no electrode failures occurred. There were 27 occurrences (3.55%) of motion detected by an AED in the presence of strong electromagnetic fields. Conclusions: AED models differ in their response to EMI; it may be useful to consider specific safety requirements for areas with such fields present. Working personnel and emergency medical services staff should be informed about potential risks and the possible need for patient evacuation before AEDs are attached and shock recommendations are followed.     

甲磺酸帕珠沙星注射液治疗急性细菌性感染有效性和安全性的多中心临床研究

目的评价甲磺酸帕珠沙星注射液治疗急性细菌性呼吸系统、泌尿生殖系统感染的有效性、安全性。方法采用随机单盲平行对照多中心试验方法。选择急性细菌性呼吸系统、泌尿生殖系统感染患者213例，可评价病例209例，随机编人试验组或对照组。试验组101例．每日1次给予甲磺酸帕珠沙星注射液300mg，iv，gtt，bid；对照组108例，每日1次给予加替沙星注射液200mg，iv，gtt，bid。疗程7～10d。结果甲磺酸帕珠沙星组、加替沙星组有效率分别为94．06％（95／101）和90．74％（98／108）；痊愈率分别为67．33％（68／101）和70．37％（76／108）；细菌清除率分别为94．62％（88／93）和93．62％（88／94）；不良反应发生率分别为7，69％（8／104）和5．50％（6／109）。两组有效性、安全性相似（P〉0．05）。结论甲磺酸帕珠沙星注射液治疗急性细菌性呼吸系统、泌尿生殖系统感染有效、安全，与加替沙星相当。     

继续医学教育管理工作的几点思考

继续医学教育作为医护人员从业后获取新知识、新理论、新技术和新方法的终身性医学教育，发展至今已有十几年了。期间通过继续医学教育管理工作者的不懈努力，不仅充分调动了广大卫生专业技术人员的学习热情，使其不断提高专业技能和业务水平，同时继续医学教育管理工作也得到了飞速发展，已经形成了良好的运行机制，但在具体实践中也存在不少问题。     

民生五官:对话大医院

主动挑战大医院,占领专科医疗至高点,尽量在其它社会资本大举涌入前让自己变得强壮:5年内做成10家专科连锁医院,与知名大医院的耳鼻喉科隔岸对峙、一比高低——这是今年32岁的陈然最重要的“理想”。虽然现在他手里只握着一张牌——运作还不足两个月的武汉民生五官医院。     

财从才出--四川康骨医院的人才增值路径

只要是投资就要有收益并伴随着风险，人才资本投资自然也不例外。但如何衡量并有效利用人才的资本属性?传统的方法一般是使用标准的HR(人力资源)衡量指标：雇佣成功率和员工维持率。然而一些医院并不满足于这些古板的方法，他们希望走得更远一些，即在保证这两个条件的基础上，进一步控制人才资本的投资风险和成本，提高收益率——这决定了人才资本的真正回报。然而，在人才资本投资测算和收益掌控面前，人们听到更多的是“知易行难”的感叹。如何设置切实有效的人才资本增值路径?四川康骨医院给出了一种回答。