Evaluating the effect of a patient education brochure on patients’ expectations and satisfaction with emergency department service

Introduction: The purpose of this study was to assess the capacity of a written intervention, in this case a patient information brochure, to improve patient satisfaction during an Emergency Department (ED) visit. For the purpose of measuring the effect of the intervention the ED journey was conceptualised as a series of distinct areas of service comprising waiting time, service by the triage nurse, care from doctors and nurses and information giving Background of study: Research into patient satisfaction has become a widespread activity endorsed by both governments and hospital administrations. The literature on ED patient satisfaction has consistently indicated three primary areas of patient dissatisfaction: waiting time, nursing care and communication. Recent developments in the literature on patient satisfaction studies however have highlighted the relationship between patients. expectations of a service encounter and their consequent assessment of the experience as dissatisfying or satisfying. Disconfirmation theory posits that the degree to which expectations are confirmed will affect subsequent levels of satisfaction. The conceptual framework utilised in this study is Coye.s (2004) model of disconfirmation. Coye while reiterating satisfaction is a consequence of the degree expectations are either confirmed or disconfirmed also posits that expectations can be modified by interventions. Coye.s work conceptualises these interventions as intra encounter experiences (cues) which function to adjust expectations. Coye suggests some cues are unintended and may have a negative impact which also reinforces the value of planned cues intended to meet or exceed consumer expectations. Consequently the brochure can be characterized as a potentially positive cue, encouraging the patient to understand processes and to orient them in what can be a confronting environment. Only a limited number of studies have examined the effect of written interventions within an ED. No studies could be located which have tested the effect of ED interventions using a conceptual framework which relates the effect of the degree to which expectations are confirmed or disconfirmed in terms of satisfaction with services. Method: Two studies were conducted. Study One used qualitative methods to explore patients. expectations of the ED from the perspective of both patients and health care professionals. Study One was used in part to direct the development of the intervention (brochure) in Study Two. The brochure was an intervention designed to modify patients. expectations thus increasing their satisfaction with the provision of ED service. As there was no existing tools to measure ED patients. expectations and satisfaction a new tool was also developed based on the findings and the literature of Study One. Study Two used a non-randomised, quasi-experimental approach using a non-equivalent post-test only comparison group design used to investigate the effect of the patient education brochure (Stommel and Wills, 2004). The brochure was disseminated to one of two study groups (the intervention group). The effect of the brochure was assessed by comparing the data obtained from both the intervention and control group. These two groups consisted of 150 participants each. It was expected that any differences in the relevant domains selected for examination would indicate the effect of the brochure both on expectation and potentially satisfaction. Results: Study One revealed several areas of common ground between patients and nurses in terms of relevant content for the written intervention, including the need for information on the triage system and waiting times. Areas of difference were also found with patients emphasizing communication issues, whereas focus group members expressed concern that patients were often unable to assimilate verbal information. The findings suggested the potential utility of written material to reinforce verbal communication particularly in terms of the triage process and other ED protocols. This material was synthesized within the final version of the written intervention. Overall the results of Study Two indicated no significant differences between the two groups. The intervention group did indicate a significant number of participants who viewed the brochure of having changed their expectations. The effect of the brochure may have been obscured by a lack of parity between the two groups as the control group presented with statistically significantly higher levels of acuity and experienced significantly shorter waiting times. In terms of disconfirmation theory this would suggest expectations that had been met or exceeded. The results confirmed the correlation of expectations with satisfaction. Several domains also indicated age as a significant predictor with older patients tending to score higher satisfaction results. Other significant predictors of satisfaction established were waiting time and care from nurses, reinforcing the combination of efficient service and positive interpersonal experiences as being valued by patients. Conclusions: Information presented in written form appears to benefit a significant number of ED users in terms of orientation and explaining systems and procedures. The degree to which these effects may interact with other dimensions of satisfaction however is likely to be limited. Waiting time and interpersonal behaviours from staff also provide influential cues in determining satisfaction. Written material is likely to be one element in a series of coordinated strategies to improve patient satisfaction during periods of peak demand.

Investigation into travel of transit oriented development : school students’ travel survey of Kelvin Grove Urban Village

Travel surveys were conducted for collecting data related to school students’ travel at Kelvin Grove Urban Village (KGUV). Currently, KGUV has school students studying at grade 10 to 12. As a part of data collection process, travel surveys were undertaken for school students studying. This document contains the questionnaire form used to collect the demographic and travel data related to school students at KGUV. The surveys forms were hand delivered to the school and the responses were collected back via reply paid envelop provided with the questionnaire form.

The mobile phone as a multi OTP device using trusted computing

The rapid growth in the number of online services leads to an increasing number of different digital identities each user needs to manage. As a result, many people feel overloaded with credentials, which in turn negatively impact their ability to manage them securely. Passwords are perhaps the most common type of credential used today. To avoid the tedious task of remembering difficult passwords, users often behave less securely by using low entropy and weak passwords. Weak passwords and bad password habits represent security threats to online services. Some solutions have been developed to eliminate the need for users to create and manage passwords. A typical solution is based on giving the user a hardware token that generates one-time-passwords, i.e. passwords for single session or transaction usage. Unfortunately, most of these solutions do not satisfy scalability and/or usability requirements, or they are simply insecure. In this paper, we propose a scalable OTP solution using mobile phones and based on trusted computing technology that combines enhanced usability with strong security.

A matter of confidence : privacy compliance for connected-up enterprises

Governments around the world are increasingly investing in information and communications technology (ICT) as a means of improving service delivery to citizens. Government ICT adoption is also being driven by a desire to streamline information accessibility and information flows within government - both between different levels of government and between different departments at the same level. Increasing the availability of information internally and to citizens has clear and compelling benefits but it also carries risks that must be carefully managed. This talk will examine the implications of such E-government initiatives for a range of compliance obligations, with a focus on information privacy. It will review recent developments in the area of systems-based enforcement of privacy policies and the particular privacy challenges presented by the aggregation of geospatial information.

A distributed denial of service testbed

The Denial of Service Testing Framework (dosTF) being developed as part of the joint India-Australia research project for ‘Protecting Critical Infrastructure from Denial of Service Attacks’ allows for the construction, monitoring and management of emulated Distributed Denial of Service attacks using modest hardware resources. The purpose of the testbed is to study the effectiveness of different DDoS mitigation strategies and to allow for the testing of defense appliances. Experiments are saved and edited in XML as abstract descriptions of an attack/defense strategy that is only mapped to real resources at run-time. It also provides a web-application portal interface that can start, stop and monitor an attack remotely. Rather than monitoring a service under attack indirectly, by observing traffic and general system parameters, monitoring of the target application is performed directly in real time via a customised SNMP agent.