Postal survey methodology to assess patient satisfaction in a suburban emergency medical services system: an observational study.

BACKGROUND: Patient satisfaction is of growing importance to providers of emergency medical services (EMS). Prior reports of patient satisfaction have frequently used resource-intensive telephone follow-up to assess satisfaction. We determine the feasibility of using a single mailing, anonymous postal survey methodology for collecting patient satisfaction data from a suburban EMS system. METHODS: Patients transported between January 2001 and December 2004 were mailed a brief satisfaction questionnaire. The questionnaire was printed on a pre-addressed, postage paid postcard and consisted of five questions that used a five-point Likert scale to assess satisfaction with EMS personnel and services provided. Three open-ended questions assessed concerns, the most important service provided, and methods for improving service. Survey response rate was the primary outcome of interest. The Chi-square test was used to compare rates between years. RESULTS: The survey required about 6 man hours and cost about $70 per month. Overall response rate was 32.0% (857/2764; 95CI 30.3% - 33.9%). During the first year, response rate was 42.6% (95CI 38.5% - 46.8%), but was significantly lower in subsequent years (29.0% in year 2, 30.8% in year 3, and 27.6% in year 4, p < 0.05). There were 847/851 respondents (99.5%) who were satisfied or very satisfied with their EMS experience. Three patients felt the service was adequate and one was very unsatisfied. Open-ended questions suggested that interpersonal communications were the single most important contributor to patient satisfaction. Patients also reported that response times and technical aspects of care were important to them. CONCLUSION: Postal surveys for assessing patient satisfaction following EMS transport can achieve comparable response rates to similar surveys in other health care settings. Response rates did not decline after the second year of patient surveys, suggesting some stability after the initial year. Interpersonal communication was determined to be the single most important contributor to patient satisfaction.

Evaluating an emergency medical services-initiated nontransport system.

OBJECTIVE: To evaluate both factors predicting nontransport and mortality rates in an emergency medical services system with a nontransport policy. METHODS: We reviewed data from 1,581 transported and nontransported patients from October 2001 to July 2003. Patients who refused transport against medical advice were excluded. Extracted data included demographics, run characteristics, chief complaint, and clinical impression. Transported and nontransported patients were compared using Mann-Whitney U or chi-square tests. Logistic regression identified factors predictive of nontransport. A Social Security Death Index search determined 30-day mortality. RESULTS: A total of 1,501 runs involving 1,059 patients were included. Median age was 60 years (range, 0-97 years). A total of 427 (40.4%) were male; 107 (10.2%) were nonwhite. Older patients were more likely to be transported (odds ratio, 1.03; confidence interval, 1.02-1.03). Race, frequency of calls, mutual aid, or time of day did not significantly influence probability of transport. Patients with cardiovascular, respiratory, and gastrointestinal complaints were more likely to be transported than those with other conditions (P < 0.005); patients with endocrine, trauma, and miscellaneous complaints were less likely to be transported (P < 0.003). Patients with renal, obstetrics/gynecology, and hema matology/oncology were complaints all transported. Mortality was 4.9% (confidence interval, 3.9%-6.2%) for transported patients and 1.0% for those not transported (confidence interval, 0.2%-3.7%). CONCLUSIONS: Age is a determinant when deciding on transporting patients. Patients with complaints with potentially higher acuity were transported most often. Only two nontransported patients died within 30 days, although it is unknown whether initial transport would have changed their mortality. Our data suggest that emergency medical services-initiated nontransport is influenced only by age and chief complaint and may not result in significant mortality.

Prehospital cardiac arrest in a paramedic first-responder system using the Utstein style.

OBJECTIVES: To describe the characteristics of patients found to have cardiac arrest and to evaluate the characteristics predictive of survival after cardiac arrest in a paramedic first-responder model. METHODS: All patients who suffered out-of-hospital cardiac arrest in the city of Reading, Ohio, from January 1998 to December 2003 were recorded in the Utstein style. The number and incidence rate of witnessed arrests, initial rhythms, rate of bystander cardiopulmonary resuscitation (CPR), and 30-day mortality rate were retrospectively collected. Demographics, time to hospital, and response times were evaluated as predictors of survival. RESULTS: Of those patients initially found to be in cardiac arrest, 14.3% were discharged alive. Witnessed arrests were more likely to result in live discharge of the patient. Whether bystander CPR was performed was not found to affect survival, nor was initial rhythm, although no patients initially found in asystole were discharged alive. No demographic characteristics or response times were predictive of survival. CONCLUSION: The rates of survival in this paramedic first-response system are favorable compared with basic emergency medical technician first-response systems. Further study using direct comparison methodology is warranted to confirm these findings.

Regional pharmaceutical preparation for biological and chemical terrorism.

BACKGROUND: The United States National Office of Domestic Preparedness has determined that the threat of a biological or chemical attack is very real. As an active participant of a 13-county regional task force, one of the roles of the poison center was to determine the pharmaceutical needs of the community in the event of a terrorist action and develop a financially responsible method of acquisition and storage. METHODS: Working with local health officials, an extensive literature review was conducted to identify possible biological and chemical poisons. Treatment recommendations were identified and an estimated amount to treat 5,000 people for 24hrs was determined. Instead of purchasing the medications, a unique solution utilizing a regional pharmacy wholesaler was used. DISCUSSION: An important element in a biological or chemical terrorist event is the availability of the pharmaceuticals and the capability of delivering them rapidly. The poison center is the ideal agency to help coordinate this endeavor since it is familiar with contemporary therapy and will be aware of the number, location, and status of casualties. Based on the expense involved in the purchase and storage of a large quantity of medications, utilizing a local pharmaceutical distribution company is fiscally responsible. Rotation through normal stock and being readily accessible is another benefit. CONCLUSION: The poison center serves a number of roles in the surveillance, recognition, and treatment of biological and chemical terrorism. Assisting in the development, implementation, and procurement of a pharmaceutical cache is yet another role.