2007-2009 Research

Abstract

Title
Patients who leave the Santa Clara Valley Emergency Department without being seen: what services might help them to stay?

Background
Like most county hospital emergency departments, the Santa Clara Valley Emergency Department has a relatively high left without being seen rate (the percentage of patients who leave before seeing a physician). This could reflect appropriate 'self-triaging' on the part of patients - those who use the emergency department for primary care or other non-acute medical problems may choose to leave when wait times are long. However, the medical director has observed that at least a small proportion of those who leave without being seen are categorized by the triage nurse as experiencing an acute problem which must be treated within a few hours. These patients pose a significant concern to emergency department staff, as they risk serious health deterioration upon leaving.

Objective
This study will utilize standardized open-ended interview techniques to determine what factors contributed to patients leaving without being seen (leaving factors) and what services the emergency department could have offered, if any, that might have helped patients to wait (waiting services) among patients at the emergency department of Santa Clara Valley Medical Center in San Jose, CA.

Methods
All patients presenting to the emergency department over a 24-hour period every sixth day from August 1 to December 1, 2007 were approached for consent upon registration and told that a random sample of patients will be asked to fill out an emergency department services improvement survey before they leave. Those who did not stay to the end of their visit (i.e. patients who left without being seen) were contacted for a phone interview with questions regarding leaving factors, waiting services, and general demographics. We currently have over 1000 patients enrolled in the study and have completed over 75 telephone interviews.

Analysis
Data analysis methods will include multivariate regression and econometric tools to control for confounding factors. Qualitative data will be analyzed using the NVivo program.

SRT 2007-2008 is led by Jennifer Miller, a second-year Stanford Medical Student.

Thank you to Dr. Jeff Arnold, Chair of the SCVMC Emergency Department and Dr. Robert Norris, Chair of the Stanford Emergency Department for their ongoing support.

2006-2007 Research

Abstract

Background
Patients who present to the ED with minor head injuries experience post-concussive symptoms after discharge in more than 50% of cases. Follow-up care for such patients has been shown to reduce severity of symptoms. However, a minority of patients receive follow-up care.

Hypothesis
Many patients with minor head injuries experience post-concussive symptoms that are not diagnosed or treated because patients do not seek or continue with follow-up care.

Objective
This study will identify factors that predict likelihood of sequelae and follow-up in patients who suffer minor head injuries. With this information, health care providers will be better able to identify patients at risk of sequelae and/or poor follow-up, and to take measures to improve outcomes for these patients.

Methods
We will obtain records of minor head injury patients treated by the Santa Clara Valley Medical Center trauma service, and perform chart review to collect information about demographics, hospital treatment, and follow-up. We will then conduct phone interviews with each of these patients to determine whether they have experienced sequelae, and received follow-up care.

Analysis
Data analysis methods will include multivariate regression and econometric tools to control for confounding factors.

SCOPE Research Team Members

Current members

Interpreters Edgar Flores and Ricky Villarreal are also in training to interview Spanish-speaking subjects.

Past contributors

SRT is led by Erin Palm, a second-year Stanford Medical Student.

Thank you to Dr. John Sherck and Dr. Gregg Adams of the SCVMC Dept of Surgery for their ongoing support.