***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Although older people frequently present to the emergency department ( ED ) , little is known about their experiences in this setting , despite increasing attendance rates reported in this population internationally . This study explores the experiences of older people and their carers leading to and during ED care in a metropolitan university hospital in Sydney , Australia . The study forms part of a larger prospect i ve exploratory study on this topic . Individual in-depth interviews were conducted with 10 people over 65 years of age who had a chronic illness and their carers one month after they presented to the ED . Interviews were transcribed verbatim and analyzed using general interpretive methods . The results revealed that the participants presented to the ED as a result of escalating symptoms and on their general practitioner 's advice . Participants felt uninformed about ED procedures , therefore , families/carers felt the need to advocate for information and basic services . Participants were grateful for the care received and mindful of the busy environment . To meet the expectations of older people , nurses need to provide timely information and advise carers how they can assist BACKGROUND Past research has documented that primary care physicians and family members are often inaccurate when making substituted judgments for patients without advance directives ( ADs ) . This study compared the accuracy of substituted judgments made by primary care physicians , hospital-based physicians , and family surrogates on behalf of elderly out patients and examined the effectiveness of ADs in improving the accuracy of these judgments . PARTICIPANTS AND METHODS Participants were 24 primary care physicians of 82 elderly out patients , 17 emergency and critical care physicians who had no prior experience with the patients , and a baseline comparison group of family surrogates .  The primary outcome was accuracy of physicians ' predictions of patients ' preferences for 4 life-sustaining treatments in 9 hypothetical illness scenarios . Physicians made substituted judgments after being provided with no patient AD , patient 's value-based AD , or patient 's scenario-based AD . RESULTS Family surrogates ' judgments were more accurate than physicians ' . Hospital-based physicians making predictions without ADs had the lowest accuracy . Primary care physicians ' accuracy was not improved by either AD . Accuracy and confidence in predictions of hospital-based physicians was significantly improved for some scenarios using a scenario-based AD . CONCLUSIONS Although ADs do not improve the accuracy of substituted judgments for primary care physicians or family surrogates , they increase the accuracy of hospital-based physicians . Primary care physicians are withdrawing from hospital-based care in growing numbers , and emergency medicine and critical care specialists most often are involved in decisions about whether to begin life-sustaining treatments . If ADs can help these physicians better underst and patients ' preferences , patient autonomy more likely will be preserved when patients become incapacitated STUDY OBJECTIVES We sought to assess older patients ' satisfaction with care in the emergency department and to identify factors associated with global satisfaction with care . METHODS We performed a prospect i ve cohort study of 778 patients 65 years of age and older presenting to an urban academic ED between 1995 and 1996 , of whom 79 % were black and 63 % were female . A baseline survey at presentation to the ED asked for demographic information , medical history , and health-related quality of life information . A follow-up satisfaction survey asked patients to rate the care they received in the ED on a 5-point Likert scale ( 1=excellent , 5=poor ) . Overall satisfaction with care , dichotomized into responses of " excellent " versus all others , was the primary dependent variable in our bivariate analyses . RESULTS Of respondents , 40 % rated their ED care as " excellent . " Variables significantly correlated with high satisfaction include having the perception of time spent in the ED as not " too long , " having the emergency physicians and nurses clearly answer patients ' questions , having a relationship of trust with an ED staff member , being told why tests were done , feeling involved in decisions about care as much as they wanted , having pain addressed fully , having a perception of greater health status , and having fewer comorbid conditions at the time of the ED visit . Results may be applicable only to urban academic EDs and may be limited by time elapsed between ED visits and follow-up surveys . CONCLUSION To improve quality of care for older adults in the ED , physicians should be more attentive to older patients ' concerns and questions , recognize and aggressively treat pain , and reduce the patients ' perception of a long waiting time AIMS AND OBJECTIVES To investigate the factors that influence satisfaction with emergency care  among individuals accompanying patients to the emergency department and explore agreement between the  triage nurse  and  accompanying person  regarding urgency . BACKGROUND Many patients seeking treatment in hospital are escorted by an accompanying person , who may be a friend , family member or carer . Several factors influence patient satisfaction with emergency care , including waiting time and time to treatment . It is also influenced by provision of information and interpersonal relations between staff and patients . Research on satisfaction has focused on the patient perspective ; however , individuals who accompany patients are potential consumers . Knowledge about the ways accompanying persons perceive the patient 's medical condition and level of urgency will identify areas for improved patient outcomes . DESIGN AND METHODS A prospect i ve cross-sectional survey with a consecutive sample ( n = 128 response rate 83.7 % ) was undertaken . Data were collected in an Australian metropolitan teaching hospital with about 32,000 visits to the emergency department each year . The Consumer Emergency Satisfaction Scale was used to measure satisfaction with nursing care . RESULTS Significant differences in perceptions of patient urgency between accompanying persons and nurses were found . Those people accompanying patients of a higher urgency were significantly more satisfied than those accompanying patients of a lower urgency . These results were independent of real waiting time or the accompanying person 's knowledge of the patients ' triage status . In addition , older accompanying persons were more satisfied with emergency care than younger accompanying persons . DISCUSSION Little attention has been paid to the social interactions that occur between nurses and patients at triage and the ways in which these interactions might impact satisfaction with emergency care . RELEVANCE TO CLINICAL PRACTICE Good interpersonal relationships can positively influence satisfaction with the emergency visit . This relationship can contribute to improved patient care and health outcomes Objectives : To identify health beliefs of emergency department ( ED ) patients with low acuity conditions and how these affect ambulance ( AMB ) utilization . Methods : We performed a prospect i ve , observational study on a convenience sample of patients 18 years or older , who presented to the ED of an urban , academic hospital with an Emergency Severity Index ( ESI ) triage level of 4 or 5 . Demographics , treatment , and disposition data were obtained along with self‐administered surveys . Characteristics of patients with low acuity conditions who presented to the ED by AMB were compared to the patients who came to the ED by private transportation ( PT ) .  Data were analyzed with the chi‐square test , t‐test , and Mann‐Whitney test . Results : A total of 197 patients ( 97 AMB and 100 PT ) were enrolled . Compared to PT , AMB patients were more likely to : be insured ( 82 % vs. 56 % ; p = 0.000 ) , have a primary care provider ( 62 % vs. 44 % ; p = 0.048 ) , and lack a regular means of transportation ( 53 % vs. 33 % ; p = 0.005 ) . Three surveys were used the SF‐8 , Short Test of Functional Health Literacy in Adults [ STOFHLA ] , and Health Belief Model [ HBM ] . Answers to HBM showed patients perceive that their illness required care within one hour of arrival ( 38 % vs. 21 % ; p = 0.04 ) , have used an ambulance in the past year ( 76 % vs. 33 % ; p = 0.001 ) and to utilize an ambulance in the future for similar concerns ( 53 % vs. 15 % ; p = 0.000 ) . AMB patients were more likely to call an ambulance for any health concern ( p = 0.035 ) and felt that there were enough ambulances for all patients in the city ( p = 0.01 ) . There were no differences in age , employment , level of income and education , nor hospital admission rate between groups . Conclusions : Ambulance use in low‐acuity ED patients is associated with misperceptions regarding severity of illness and re source allocation as well as limited access to private transportation . Underst and ing patient perceptions of illness and other barriers to receiving care is imperative for the development of interventions aim ed at enabling change in health behaviors such as the elective use of limited re sources OBJECTIVES To test the hypotheses that ED patients ' desires for medical information and for autonomy in decision making are inversely related to increasing acuity of illness , increasing age , and lower level of formal education . METHODS The authors conducted a prospect i ve study of ED patients who presented for care during seven nonconsecutive 24-hour periods . Of 804 patients approached , 665 completed a  question naire  that was administered by a trained research assistant . Patients rated their desire for medical information , and for participation in medical decision making , on two 10-cm visual analog scales . Patient acuity level was determined in routine fashion by trained triage nurses , who were unaware of the nature of this study . RESULTS Desire for information was uniformly high , and did not vary statistically between triage groups ( p = 0.41 ) . The most acutely ill patients ( level I ) were more likely to be excluded by the research interviewer ( p < 0.001 ) . Of included level I patients , desire to participate was not decreased ( p < 0.01 ) . Higher level of formal education ( p = 0.036 ) and younger age ( p < 0.001 ) were associated with greater desire for autonomy in decision making . CONCLUSION Among ED patients able to participate , higher acuity of illness was not associated with a decreased desire for medical information . Many very acutely ill patients preferred autonomy in medical decision making . Older patients and those with less formal education expressed a lesser desire for decision-making autonomy OBJECTIVES Previous studies have shown that family members wish to be present during the resuscitation of a family member . No studies have addressed whether the patient would want family members present if he or she required resuscitation . The authors wanted to determine patients ' preferences regarding family member presence during their own resuscitation . METHODS A seven-item survey was administered to a sample of patients and their family members older than 17 years of age on six r and omly chosen shifts in an academic community hospital emergency department . Responses were analyzed using chi-square and t-tests . Subjective comments were also recorded . RESULTS A total of 266 subjects were asked to participate in the study ; 200 subjects agreed to complete the survey . Most ( 72 % ) wanted a family member present . However , 21 % did not wish any family member to be present . Positive responders ( family present ) tended to be younger ( mean , 39.4 years ; 95 % confidence interval = 36.7 to 42.2 ) than negative responders ( mean , 50.5 years ; 95 % confidence interval = 42.9 to 55.7 ; p < 0.001 ) . Positive responders were also more likely to be nonwhite ( chi2 = 6.29 , p < 0.05 ) . Gender , education , or health status was not associated with responder type . Of positive responders , 56 % stated they wanted only certain members present , and these preferences were variable . CONCLUSIONS Patients preferred to have family members  present during their resuscitation . However , most of the positive responders wanted only certain members present , and approximately one in five patients , who tended to be older and white , did not want any family present . This study does not support an open policy of allowing family members into a resuscitation without prior knowledge of the patient 's preferences OBJECTIVES To inform dem and management strategies aim ed at reducing congestion in EDs by : ( i ) identifying public use of EDs , decision-making and reasons ; and ( ii ) measuring acceptance of alternative care models . METHODS A cross-sectional telephone survey of a r and om sample of Queensl and population aged 18 years or older residing in a dwelling unit in Queensl and that could be contacted on a l and -based telephone service was conducted . One person per household was selected according to a predetermined algorithm to ensure sex and regional balance were interviewed . The main outcome measures were : ED use , attitudes towards ED staff and services , and alternative models of care .  RESULTS The final sample included a total of 1256 respondents ( response rate = 40.3 % ) . Twenty-one per cent attended EDs in the preceding 12 months . The decision to attend was made by patients ( 51 % ) , health and medical professionals ( 31 % ) , and others ( 18 % ) . The main reasons included perceived severity of the illness ( 47 % ) , unavailability of alternative services ( 26 % ) and better care ( 11 % ) . Most respondents agreed with more flexible care models of service delivery including incentives for general practitioners ( 90 % ) , private health insurance coverage for ED use ( 89 % ) , and enhanced roles for paramedics and nurses . CONCLUSIONS Main reason for attending ED is perceived severity of illness , followed by lack of alternative care . The majority of both consumers and the public are in favour of more  flexible care models . However , further research is necessary to detail those alternatives and to test and vali date their effectiveness OBJECTIVES To compare group perceptions of reasons for emergency department care , ED use patterns , and the effect of illness on self-care ability for elderly and younger adult patients . DESIGN Patient survey . SETTING Six geographically distinct US hospital EDs . PARTICIPANTS From each site , a stratified sample ( approximately 7:3 ) of elderly ( 65 years and older ) and nonelderly ( 21 to 64 years old ) control ED patients treated during the same time period was contacted . METHODS Three hundred ninety-nine elderly patients and 172 adult controls were interviewed using a structured 
    Output:
    
RESULTS Older people wished to have prompt waiting times , efficient care , clear communication and comfortable environments .
They had additional and unique expectations for holistic care and support in decision-making .
The ED provoked a sense of vulnerability among older people who were likely to have had frailty .
CONCLUSION The lack of dominant themes among included studies suggests that older people should be treated as individuals rather than a homogenous group .
Establishing individuals ' preferred outcomes could improve person-centred care .