Patients' sex and race are independent predictors of HEART score documentation by emergency medicine providers.

INTRODUCTION: The HEART score is a widely used clinical decision tool that provides emergency providers with objective risk stratification for patients presenting to the emergency department (ED) with undifferentiated chest pain (CP). There is no data as to which patients undergo formal risk stratification with a HEART score, and whether patient demographics influence decisions to apply the HEART score. Our objective was to determine if sex or race independently predict documentation of patients' HEART scores in CP patients. METHODS: This is a retrospective cohort study of all patients with a chief complaint of CP who presented to EDs within a single health care system (11 EDs) from September 2018-January 2021. Charts were identified via query of the electronic medical record, and patient age, race, and sex were extracted. The presence or absence of documentation of a HEART score was also recorded. Patient race was categorized as white/non-white. Sex was categorized as male/female. Age was inputted as a continuous variable. We performed logistic regression to determine which variables were associated with documentation of a HEART score. RESULTS: 38,277 patients were included in the study. The median patient age was 51 with IQR 36-64, and 18,927 (47.5%) were male. HEART scores were documented in 24,181. Younger age, female sex, and non-white race were all independent predictors of not having HEART score risk stratification documented in the medical record. CONCLUSIONS: Women and non-white patients are less likely to receive HEART score risk stratification when presenting with undifferentiated CP, even when controlling for patient age. Further studies should address whether this influences patient centered outcomes.

Satisfaction Academy: A Novel Residency Curriculum to Improve the Patient Experience in the Emergency Department.

Introduction: Patient satisfaction is a key indicator of health care value and an increasingly important metric used to assess emergency physician performance and often reimbursement. To our knowledge, there is no standardized curriculum within emergency medicine (EM) residency programs that focuses on the patient experience in EM. Methods: Our novel resident curriculum is an organized approach to enhancing patient-centered care by optimizing the patient experience. It spans the academic year, with key topics organized into a quarterly time line. Topics include physician courtesy and respect, pain management, discussion of diagnostic and therapeutic interventions, timely communication, and delivery of quality care. Each quarter has three components: introduction/didactics, an interactive workshop, and stories and reflection. The instructional methods used include didactic lectures, role-playing, and group reflection and storytelling. Results: Of 44 participants, 54.5% completed a preintervention survey, and 45.5% completed a postintervention survey. The surveys consisted of 5-point Likert scales measuring degree of agreement with statements that reflected desired behaviors and/or attitudes. On the postintervention survey, participants gave scores indicating general agreement with desired behaviors including sitting at the bedside, acknowledging all persons in the room, and giving an anticipated disposition, as well as with feeling more knowledgeable about patient satisfaction. Discussion: Our Satisfaction Academy has filled a significant gap related to enhancing the patient experience. This curriculum is generalizable to other EM residency programs, and the interactive peer-to-peer format is both engaging and customizable.