Background: As the US healthcare system is becoming a more outcomes based system, increasing emphasis is being paid to improving all aspects of health care delivery. Interpersonal and communication skills, an ACGME (Accreditation Council for Graduate Medical Education) core competency in resident education, play a fundamental role in this effort. This aspect of healthcare delivery is also part of Medicare hospital reviews. In our hospital, the administration has introduced AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank you) as a communication strategy which promises to improve exchange of information between healthcare professionals as well as with patients and their families. Objective: Determine if the AIDET strategy used in our facility has improved patient satisfaction. Methods: This study was done using pretest post test experimental design. Patient satisfaction was measured using scores from the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) quarterly reports from the 3 rd quarter of 2010 to the 2 nd quarter of 2013. Pre and post AIDET implementation results were statistically analysed using a paired t-test.Results are reported as a p-value with < .05 being statistically significant. Results: There were a total of 1,811 patient responses sampled from the 3 rd quarter of 2010 to the 2 nd quarter of 2013. A significant change < .05 was seen in the way Nurses Explain, Doctors Explain and Nurses listen in the pre and post AIDET implementation comparison. The change in percentage of patients that believed doctors and nurses explained things to them in a way they could understand showed a p-value of .02. The trend in percentage of patients that perceived that nurses always listened carefully to them showed a p-value of .02 as well. On the other hand, the data evaluating how doctors listened carefully to them did not reach statistical significance with a p-value of .08. The remaining categories of "Told About Medication" and "Help after Discharge" were both found not have changed significantly either. Conclusions:The implementation of AIDET education may have had a significant impact on provider-patient communication in our facility, especially in the patient's perception of explaining things in a way they could understand. On the other hand, in the responses to the question of whether or not doctors listened carefully to them, there was some improvement over time, however this did not achieve statistical significance.
The diagnosis of acute appendicitis can be somewhat obscure in a patient that presents with right lower quadrant abdominal pain. The advancement and ease of imaging have made CT scanning readily available in the emergency department. Management can be challenging when the patient has a high likelihood of appendicitis based on clinical suspicion and negative CT scan. The purpose of this case report is to demonstrate how an obstructing bezoar caused an appendicitis-like syndrome in a patient with negative CT scan and clinical diagnosis of acute appendicitis. This case report will discuss the appendicitis-like syndrome of an obstructing bezoar and an approach at management.
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