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Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centres in the USA

Petrilli, Christopher M; Saint, Sanjay; Jennings, Joseph J; Caruso, Andrew; Kuhn, Latoya; Snyder, Ashley; Chopra, Vineet
OBJECTIVE:Several large studies have shown that improving the patient experience is associated with higher reported patient satisfaction, increased adherence to treatment and clinical outcomes. Whether physician attire can affect the patient experience-and how this influences satisfaction-is unknown. Therefore, we performed a national, cross-sectional study to examine patient perceptions, expectations and preferences regarding physicians dress. SETTING/METHODS:10 academic hospitals in the USA. PARTICIPANTS/METHODS:Convenience sample of 4062 patients recruited from 1 June 2015 to 31 October 2016. PRIMARY AND SECONDARY OUTCOMES MEASURES/UNASSIGNED:We conducted a questionnaire-based study of patients across 10 academic hospitals in the USA. The questionnaire included photographs of a male and female physician dressed in seven different forms of attire. Patients were asked to rate the provider pictured in various clinical settings. Preference for attire was calculated as the composite of responses across five domains (knowledgeable, trustworthy, caring, approachable and comfortable) via a standardised instrument. Secondary outcome measures included variation in preferences by respondent characteristics (eg, gender), context of care (eg, inpatient vs outpatient) and geographical region. RESULTS:Of 4062 patient responses, 53% indicated that physician attire was important to them during care. Over one-third agreed that it influenced their satisfaction with care. Compared with all other forms of attire, formal attire with a white coat was most highly rated (p=0.001 vs scrubs with white coat; p<0.001 all other comparisons). Important differences in preferences for attire by clinical context and respondent characteristics were noted. For example, respondents≥65 years preferred formal attire with white coats (p<0.001) while scrubs were most preferred for surgeons. CONCLUSIONS:Patients have important expectations and perceptions for physician dress that vary by context and region. Nuanced policies addressing physician dress code to improve patient satisfaction appear important.
PMID: 29844101
ISSN: 2044-6055
CID: 3154472

Evidence-Based Guidelines to Eliminate Repetitive Laboratory Testing

Eaton, Kevin P; Levy, Kathryn; Soong, Christine; Pahwa, Amit K; Petrilli, Christopher; Ziemba, Justin B; Cho, Hyung J; Alban, Rodrigo; Blanck, Jaime F; Parsons, Andrew S
Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laboratory expenditure often represents less than 5% of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60% to 70% of all medical decisions. Excessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures. Efforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes. To date, numerous interventions have been deployed across multiple institutions without a standardized approach. Health care professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing. This review presents an evidence-based implementation blueprint to guide teams aimed at improving appropriate routine laboratory testing among hospitalized patients.
PMID: 29049500
ISSN: 2168-6114
CID: 3085092

Innovating Toward High-Value Cardiovascular Care [Editorial]

Alyesh, Daniel; Petrilli, Christopher; Obi, Andrea
PMID: 28982508
ISSN: 1558-3597
CID: 3154462

Inpatient Thrombophilia Testing: At What Expense?

Heidemann, Lauren A; Petrilli, Christopher M; Barnes, Geoffrey D
PMID: 28914288
ISSN: 1553-5606
CID: 3076712

Letter to the Editor, The Authors Reply: "Cost and Utility of Thrombophilia Testing" [Letter]

Petrilli, Christopher M; Heidemann, Lauren; Mack, Megan; Durance, Paul; Chopra, Vineet
We thank Dr. Berse and colleagues for their correspondence about our paper. We are pleased they agreed with our conclusion: Thrombophilia testing has limited clinical utility in most inpatient settings.
PMID: 29190304
ISSN: 1553-5606
CID: 3076722

The effect of merging two infectious disease units on hand hygiene adherence in Italy

Petrilli, Christopher M; Mantengoli, Elisabetta; Saint, Sanjay; Fowler, Karen E; Bartoloni, Alessandro
BACKGROUND:Healthcare-associated infections (HAIs) are common and harmful to patients. Effective hand hygiene can help prevent HAIs, however, suboptimal healthcare worker hand hygiene remains problematic across the globe. This study analyses the impact of organisational changes on hand hygiene. METHODS:This observational study assessed hand hygiene by different professions before and after a merger of a recently combined infectious diseases (ID) unit coupled with a qualitative study about barriers to optimal hand hygiene. Direct observations were compared with previous data collected on both units before they merged. We also conducted focus groups with the doctors and nurses about hand hygiene. RESULTS:= 0.004). Data from the focus groups revealed a gap between doctor and nurses perceptions of education and goal adherence rates. CONCLUSIONS:Our findings underscore the important role played by effective unit leaders to prevent infection. We found long-term sustainability of hand hygiene practices among doctors. However, adherence among nurses was substantially lower.
PMID: 28989518
ISSN: 1757-1774
CID: 3076732

Inpatient inherited thrombophilia testing

Petrilli, Christopher M; Heidemann, Lauren; Mack, Megan; Durance, Paul; Chopra, Vineet
PMID: 27782379
ISSN: 1553-5606
CID: 3076702

Why July Matters

Petrilli, Christopher M; Del Valle, John; Chopra, Vineet
Each July, new graduates from premedical, medical, and residency programs, along with junior and midcareer faculty, acclimatize to their changing roles. During this month, overall efficiency, quality, and patient safety may suffer, a problem dubbed the "July effect." The many transitions that occur in teaching hospitals during July are often implicated as the root cause of this problem. The question, then, of how best to improve the team-based clinical care provided in July remains important. In this Commentary, the authors outline a model that combines the team-based care paradigm with effective leadership, followership, and communication-based strategies and propose some actionable steps.A key first step to enhancing patient safety in July is improving effective leadership through use of a select group of attendings whose teaching style empowers learners within a framework of close supervision. Second, programmatic efforts to pair these leaders with good followers are needed. Senior residents in July should be selected on their ability to mentor, guide, and support interns. Third, a system of free-flowing, bidirectional communication must be nurtured to ensure optimal outcomes. Adapting strategies from the airlines (e.g., interdisciplinary conferences to discuss optimal patient care approaches; checklists for daily activities such as sign-outs; directed feedback and debriefing techniques emphasizing actionable areas for improvement) is promising and worth studying.Available data suggest that the "July effect" is real. Developing new and exploring existing approaches for allaying this phenomenon are important areas of further investigation.
PMID: 27119323
ISSN: 1938-808x
CID: 3076682

Examining the July Effect: A National Survey of Academic Leaders in Medicine

Levy, Kathryn; Voit, Jessica; Gupta, Amit; Petrilli, Christopher M; Chopra, Vineet
BACKGROUND:Whether the "July Effect" affects perspectives or has prompted changes in US Internal Medicine residency programs is unknown. METHODS:We designed a survey-based study to assess views and efforts aimed at preventing harm in July. A convenience sampling strategy (email listserv and direct messages to program leaders via the Electronic Residency Application Service) was used to disseminate the survey. RESULTS:The response rate was 16% (65/418 programs); however, a total of 262 respondents from all 50 states where residency programs are located were included. Most respondents (n = 201; 77%) indicated that errors occur more frequently in July compared with other months. The most common identified errors included incorrect or delayed orders (n = 183, 70% and n = 167, 64%, respectively), errors in discharge medications (n = 144, 55%), and inadequate information exchange at handoffs (n = 143, 55%). Limited trainee experience (n = 208, 79%), lack of understanding hospital workflow, and difficulty using electronic medical record systems (n = 194; 74% and n = 188; 72%, respectively) were reported as the most common factors contributing to these errors. Programs reported instituting several efforts to prevent harm in July: for interns, additional electronic medical record training (n = 178; 68%) and education on handoffs and discharge processes (n = 176; 67% and n = 108; 41%, respectively) were introduced. Similarly, for senior residents, teaching sessions on how to lead a team (n = 158; 60%) and preferential placement of certain residents on harder rotations (n = 103; 39%) were also reported. Most respondents (n = 140; 53%) also solicited specific "July attendings" using a volunteer system or highest teaching ratings. CONCLUSION/CONCLUSIONS:Residency programs in Internal Medicine appear to have instituted various changes to mitigate harm in July. Further evaluation to understand the impact of these interventions on trainee education and patient safety is necessary.
PMID: 27180313
ISSN: 1555-7162
CID: 3076692

Improving Interdisciplinary Provider Communication Through a Unified Paging System

Heidemann, Lauren; Petrilli, Christopher; Gupta, Ashwin; Campbell, Ian; Thompson, Maureen; Cinti, Sandro; Stewart, David A
OBJECTIVES:Interdisciplinary communication at a Veterans Affairs (VA) academic teaching hospital is largely dependent on alphanumeric paging, which has limitations as a result of one-way communication and lack of reliable physician identification. Adverse patient outcomes related to difficulty contacting the correct consulting provider in a timely manner have been reported. METHODS:House officers were surveyed on the level of satisfaction with the current VA communication system and the rate of perceived adverse patient outcomes caused by potential delays within this system. Respondents were then asked to identify the ideal paging system. These results were used to develop and deploy a new Web site. A postimplementation survey was repeated 1 year later. This study was conducted as a quality improvement project. RESULTS:House officer satisfaction with the preintervention system was 3%. The majority used more than four modalities to identify consultants, with 59% stating that word of mouth was a typical source. The preferred mode of paging was the university hospital paging system, a Web-based program that is used at the partnering academic institution. Following integration of VA consulting services within the university hospital paging system, the level of satisfaction improved to 87%. Significant decreases were seen in perceived adverse patient outcomes (from 16% to 2%), delays in patient care (from 90% to 16%), and extended hospitalizations (from 46% to 4%). CONCLUSIONS:Our study demonstrates significant improvement in physician satisfaction with a newly implemented paging system that was associated with a decreased perceived number of adverse patient events and delays in care.
PMID: 27255097
ISSN: 1541-8243
CID: 3154452