Objective Assessment and Thematic Categorization of Patient‐audible Information in an Emergency Department. (1st October 2015)

• Record Type: Journal Article
• Authors: Zhang, Xiao C.; Kobayashi, Leo; Berger, Markus; Reddy, Pranav M.; Chheng, Darin B.; Gorham, Sara A.; Pathania, Shivany; Stern, Sarah P.; Icaza Milson, Elio; Jay, Gregory D.; Baruch, Jay M.; Griffey, Richard
• Is Part Of: Academic emergency medicine. Volume 22:Number 10(2015:Oct.)
• Page Start: 1222
• Page End: 1225
• Publication Date: 2015-10-01
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1111/acem.12762
• Languages: English
• ISSNs: 1069-6563

Abstract

<abstract abstract-type="main" id="acem12762-abs-0001"> <title>Abstract</title> <sec id="acem12762-sec-0001" sec-type="section"> <title>Objectives</title> <p>The objective was to assess and categorize the understandable components of patient‐audible information (e.g., provider conversations) in emergency department (ED) care areas and to initiate a baseline ED soundscape assessment.</p> </sec> <sec id="acem12762-sec-0002" sec-type="section"> <title>Methods</title> <p>Investigators at an academic referral hospital accessed 21 deidentified transcripts of recordings made with binaural in‐ear microphones in patient rooms (<italic>n</italic> = 10) and spaces adjacent to nurses' stations (<italic>n</italic> = 11), during ED staff sign‐outs as part of an approved quality management process. Transcribed materials were classified by speaker (health care provider, patient/family/friend, or unknown). Using qualitative analysis software and predefined thematic categories, two investigators then independently coded each transcript by word, phrase, clause, and/or sentence for general content, patient information, and HIPAA‐defined patient identifiers. Scheduled reviews were used to resolve any data coding discrepancies.</p> </sec> <sec id="acem12762-sec-0003" sec-type="section"> <title>Results</title> <p>Patient room recordings featured a median of 11 (interquartile range [IQR] = 2 to 33) understandable words per minute (wpm) over 16.2 (IQR = 15.1 to 18.4) minutes; nurses' station recordings featured 74 (IQR = 47 to 109) understandable wpm over 17.0 (IQR = 15.4 to 20.3) minutes. Transcript content from patient room recordings was categorized as follows: clinical, 44.8% (IQR = 17.7% to 62.2%); nonclinical, 0.0% (IQR = 0.0% to 0.0%); inappropriate (provider), 0.0% (IQR = 0.0% to 0.0%); and unknown, 6.0% (IQR = 1.7% to 58.2%). Transcript content from nurses' stations was categorized as follows: clinical, 86.0% (IQR = 68.7% to 94.7%); nonclinical, 1.2% (IQR = 0.0% to 19.5%); inappropriate (provider), 0.1% (IQR = 0.0% to 2.3%); and unknown, 1.3% (IQR = 0.0% to 7.1%). Limited patient information was audible on patient room recordings. Audible patient information at nurses' stations was coded as follows (median words per sign‐out sample): general patient history, 116 (IQR = 19 to 206); social history, 12 (IQR = 4 to 19); physical examination, 39 (IQR = 19 to 56); imaging results, 0 (IQR = 0 to 21); laboratory results, 7 (IQR = 0 to 22); other results, 0 (IQR = 0 to 3); medical decision‐making, 39 (IQR = 10 to 69); management (general), 118 (IQR = 79 to 235); pain management, 4 (IQR = 0 to 53); and disposition, 42 (IQR = 22 to 60). Medians of 0 (IQR = 0 to 0) and 3 (IQR = 1 to 4) patient name identifiers were audible on in‐room and nurses' station sign‐out recordings, respectively.</p> </sec> <sec id="acem12762-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Sound recordings in an ED setting captured audible and understandable provider discussions that included confidential, protected health information and discernible quantities of nonclinical content.</p> </sec> </abstract>