QUESTION UNDER STUDY: Elderly patients represent an increasing proportion of emergency department (ED) admissions. When no specific complaint is identified, the reason for referral is commonly called "home care impossible". The aim of this study was to describe a population of elderly patients who present to the ED of a 1200-bed university hospital without specific complaint, and to assess how they were evaluated in the ED. METHODS: Data on triage, mode of admission and discharge were collected. After the initial evaluation in the ED, patients were classified in two categories: (1) patients identified with a medical problem requiring rapid care or investigation, (2) patients without a medical problem considered as true "home care impossible". These latter patients underwent a complete assessment using the Minimal Data Set-Home Care (MDS-HC). RESULTS: During the 10-week study period 253 patients (mean age 81 years) were referred because of "home care impossible". An acute medical problem was identified in 129 of those patients (51%). All these patients were triaged in lower acuity categories. 33 (26%) were undertriaged due to (1) absence of vital signs measurement, (2) poor recognition of neurological symptoms, (3) atypical clinical presentation. The remaining patients were considered as true "home care impossible". The MDS-HC evaluation revealed a high level of biopsychosocial comorbidities. CONCLUSIONS: Frail elderly patients admitted without specific complaints are at risk of inappropriate or delayed evaluation due to undertriage at the door of the ED. A more specific geriatric assessment should be integrated early in the triage process of these patients.

Activities of Daily Living↗

PubMed2005

[Confidence in the drug industry].

Explore the source record for details and available documents.

Drug Approval↗

PubMed2005

How do patients define "good" and "bad" doctors?

QUESTIONS UNDER STUDY: Knowledge of hospital patients' perceptions of doctors' qualities is limited. The purpose of this study was to explore hospital patients' definitions of "good" and "bad" doctors. METHODS: Semi-structured interviews conducted with 68 consecutive hospital patients. The questions explored the characteristics of good/bad doctors. Responses were subjected to content analysis. RESULTS: The patients' mean age was 72.7 (+/- 15) years; 61% were female. Content analysis produced 9 categories connoted positively/negatively; the mean number of categories/patient response was 2.4 (+/- 1.3), ranging from 1-6. Sensitivity/insensitivity to feelings were in the forefront, together with the importance of the relational dimension and the need to provide treatment tailored to the patient's needs. Patients' responses emphasised "bad" doctors' use of medicine as self-serving and not serving the patient. CONCLUSION: This qualitative enquiry made it possible to gather information on the patients' expectations or beliefs outside physicians' or health researchers' pre-established categories. It emphasised that acknowledging possible areas of uncertainty may be less threatening for the doctor's image than exhibiting scientific proficiency unadapted to the patient's expectations and needs.

Age Distribution↗

PubMed2004

Exploring the major difficulties perceived by residents in training: a pilot study.

OBJECTIVES: To assess residents' difficulties during the first year of residency. In contrast to previous studies that mainly used structured questionnaires, a qualitative procedure was applied. METHODS: Twenty-four consecutive first-year residents in internal medicine were asked to "Please identify two to three major difficulties or concerns related to your practice of medicine within this hospital". The answers were submitted to content analysis performed by three independent researchers. Inter-rater agreement was high (kappa coefficient = 0.92). Disagreements were solved by consensus. RESULTS: Physicians' characteristics: female 37%, mean age 28 +/- 2.2 years, mean duration of postgraduate training 2.5 +/- 1.3 years. Total number of answers: 122, average answers/resident 5.1 +/- 1.3. Nine categories were extracted from content analysis: communication problems at the workplace, feelings of not being respected, constraints of collaborative work, experiencing the gap between medical school and clinical care, work overload, responsibility towards and emotional investment in patients, worries about career plans, and lack of theoretical knowledge. Residents expressed major difficulties in communicating with and being respected by seniors and peers in particular, and hospital staff in general. They also voiced problems in coping with emotions, either their own or those of their patients. CONCLUSIONS: The residents' responses stressed the complexity of blending the requirements of the physician's role when instrumental/cognitive knowledge is not sufficient to deal with problems requiring personal and relational dimensions. Learning to combine medical knowledge and practice necessitates helping students/residents identify and deal with the constraints of these requirements.

Adult↗

PubMed2003

Hospitalisation process seen by patients and health care professionals.

Appropriate use of hospitalisation is an important concern in most countries. Previous studies have relied on professional opinion regarding the appropriateness of hospital stays, neglecting the patients' point of view. The purpose of this cross-sectional study was to assess the patients' point of view about the appropriateness of their hospital stay and to evaluate agreement with health care providers' opinions. It was undertaken in a medical rehabilitation division of the University Hospitals of Geneva in Switzerland. Patients reported their opinion on the justification of their hospital stay on the day of the interview, the reason why they judged their stay to be appropriate, and the place where they should be if not. The patients' health care providers answered the same questions. Two-hundred and fifty-four patients contributed to the evaluation of 314 days of hospitalisation. Only 20 hospital days (6%) were considered unjustified by patients, compared to 63 (20%) by health care providers (p<0.001). There was no agreement between these two judgements (Kappa=0.00,95% CI: -0.09 to +0.09). Similarly, there was little or no agreement concerning the reasons justifying the stay (Kappa=0-0.47) and concerning discharge planning. These results suggest that the definition of an appropriate hospital stay is complex and depends upon each actor's point of view. Better communication between patients and health care providers about decisions related to the hospitalisation process would be desirable.

Attitude of Health Personnel↗