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Thesis (Ed. D.)--Virginia Polytechnic Institute and State University, 1993. / Vita. Abstract. Includes bibliographical references (leaves 105-112). Also available via the Internet.

The correlation between social style and career satisfaction among emergency physicians was investigated. An e-mail survey was sent to a random sample of 1,000 members of the American College of Emergency Physicians in practice for at least three years; 707 had valid e-mail addresses. A twenty-item behavioral style survey instrument and a five-item career satisfaction scale were used. The study incorporated prenotification and reminder e-mails. Valid responses were obtained from 329 physicians (46.5%). No correlation was shown between social style and career satisfaction. Problems with both survey instruments were discovered. Survey respondents were unhappy with their careers, with an average satisfaction of 4.03, 1 being very satisfied, 5 very dissatisfied. Areas for future study include redoing the study using different survey instruments.

aThesis (doctoral)--Universität Regensberg. / Includes bibliographical references and index.

This study examined patient behavior in the emergency department and trained physicians to respond to that behavior. It demonstrated that physicians can increase patient satisfaction by responding to the thoughts, feelings and actions which the patients are experiencing. The literature provided variables for patient satisfaction and physician counseling techniques. These variables provided the base for a Patient Satisfaction Inventory (PSI) and a training module for the physicians. Patient behavior was evaluated through the clinical Thinking, Feeling and Acting interview, given to patients, before and after each patient was seen by the physician. This information was then provided to the physicians. For half of the patients, physicians responded according to patients thinking. feeling and acting components of behavior. For the others, physicians received no information other than the generic summary card summarizing thoughts, feelings and actions of the patients as a group. The PSI was completed by all patients after discharge from the emergency department. Pre and post training scores were compared on the PSI to determine if there was a difference in patient satisfaction. An increase in patient satisfaction was experienced after the physicians were trained to purposefully respond to patient behavior. On the PSI, patients perceived greater compassion, understood and communicated with the physician better, and perceived more accurate diagnoses and treatments. These increases in patient satisfaction were significant (p < .01) regardless of whether the physician had the actual patient information from the clinical TF A interview or just the generic summary. The physicians seemed to become sensitized to the patients needs by organizing the data they already had about the patients. Implications for the counseling field and training physicians to better serve their patients were discussed. / Ed. D.

Indiana University-Purdue University Indianapolis (IUPUI) / Reducing medical error remains in the forefront of healthcare reform. The use of health information technology, specifically the electronic health record (EHR) is one attempt to improve patient safety. The implementation of the EHR in the Emergency Department changes physician workflow, which can have negative, unintended consequences for patient safety. Inaccuracies in clinical documentation can contribute, for example, to medical error during transitions of care. In this quasi-experimental comparison study, we sought to determine whether there is a difference in document quality, error rate, error type, cognitive load and time when Emergency Medicine (EM) residents use paper charts versus the EHR to complete physician documentation of clinical encounters. Simulated patient encounters provided a unique and innovative environment to evaluate EM physician documentation. Analysis focused on examining documentation quality and real-time observation of the simulated encounter. Results demonstrate no change in document quality, no change in cognitive load, and no change in error rate between electronic and paper charts. There was a 46% increase in the time required to complete the charting task when using the EHR. Physician workflow changes from partial documentation during the patient encounter with paper charts to complete documentation after the encounter with electronic charts. Documentation quality overall was poor with an average of 36% of required elements missing which did not improve during residency training. The extra time required for the charting task using the EHR potentially increases patient waiting times as well as clinician dissatisfaction and burnout, yet it has little impact on the quality of physician documentation. Better strategies and support for documentation are needed as providers adopt and use EHR systems to change the practice of medicine.