378 Patient Satisfaction in the Clinical Decision Unit

Abstract

The vast majority of tertiary ED repeated tests were on patients from three outside facilities (28.4% of patients). Within this group there were 17 patients with repeated complete blood count (CBC), 12 with repeated basic metabolic panel (BMPs) and 6 with repeated electrocardiogram (EKG). There were 10 patients with repeated radiographs. Overall there was an average of 1.0 repeated tests per patient, 0.79 labs and 0.14 radiographs. In only 20 cases (6.7%) there was mention of the outside ED directly consulting a specialist at the accepting tertiary center, who advised ED to ED transfer. Thirty patients did not receive specialist consults in the ED of which 19 were discharged (13 to follow-up with PCP and 6 to followup with a specialist). The tertiary care emergency physician significantly disagreed with the referring diagnosis in 28 cases (9.8%). The patients' dispositions were: floor 39.5%, discharged with specialist follow-up 29.4%, discharged with primary care physician (PCP) follow-up 11.8%, intensive care unit 8.8%, Operating room 5.4%, step-down unit 4.3%, with one patient going to interventional Radiology and one leaving against medical advice.Conclusion: The majority of patients in this study required surgical specialty care due to injuries. However, several cases may not have benefitted from transfer, as they neither required specialist care nor admission, as well as select cases that were "over-called" by the referring physician. Only for a small proportion of cases did the outside ED attempt to consult a specialist before transferring. Better communication and cooperation with outside referring EDs is needed to assure the most appropriate care for all patients.