Patient satisfaction in ambulatory surgery

Same-Day Discharge after Non-Perforated Laparoscopic Appendectomy Is Safe

Purpose: Several single-center studies have demonstrated same-day discharge (SDD) to be safe in adults undergoing laparoscopic appendectomy (LA) for non-perforated appendicitis (NPA). The proportion of SDD appendectomy patients nationally is unknown. We sought to identify the incidence of SDD among patients undergoing LA after NPA hypothesizing a similar risk of complications including superficial surgical site infections (SSSIs), post-operative intra-abdominal abscess, and 30-day readmission rates. Materials and methods: The 2016-2017 ACS-NSQIP Procedure-Targeted Appendectomy database was queried for adults undergoing LA with no intraoperative findings of perforation or abscess. Patients with SDD were compared to those discharged within two days. A multivariable logistic regression model was used for analysis. Results: From 16,931 patients undergoing LA, 3988 (23.6%) were SDD. Compared to those with a longer hospital stay, patients with SDD were of similar age (p = 0.29) and less likely to have a contaminated wound-class (58.5% vs. 62.6%, p < 0.001). After adjusting for age and comorbidities, patients with SDD had a similar risk of 30-day readmission (p = 0.088) and post-operative abscess (p = 0.739) but lower risk of SSSI (OR: 0.48, 0.28-0.82, p = 0.008), compared to those discharged within two days. Conclusions: Nearly a quarter of patients with NPA undergoing LA are discharged the same day. The risk of 30-day readmission is similar compared to those with a longer index hospital stay. Interestingly, the risk of SSSI is lower, however this may be related to differences in wound classification and/or selection bias. Regardless, SDD for NPA patients appears safe and should be utilized whenever possible.

Measuring satisfaction and anesthesia related outcomes in a surgical day care centre: A three-year single-centre observational study

STUDY OBJECTIVE

To evaluate patient satisfaction and patient reported anaesthesia related outcome parameters after outpatient surgery.

DESIGN

A three-year (2013-2016) observational study.

SETTING

A surgical day care centre embedded in a tertiary care, university hospital.

PATIENTS

Adult Dutch-speaking patients who underwent surgery under general or regional anaesthesia on an outpatient basis (n=5424).

INTERVENTIONS

A questionnaire was developed to evaluate patients' satisfaction with care during their hospitalisation in the surgical day centre, as well as to assess their reports of anaesthesia related outcomes.

MEASUREMENTS

Various aspects of care were measured, including care by nurses, care by doctors, organisational and safety items. Variation in satisfaction and surgery and anaesthesia related outcomes as a function of different categories (gender, age, education, type of anaesthesia, discipline and era) were also investigated.

MAIN RESULTS

Confirmatory factor analysis showed an excellent fit to the hypothesized factors of the survey. Satisfaction scores were very high for different aspects of care, resulting in 98% of patients being (very) satisfied (59.1% very satisfied, 38.9% satisfied). Male (p=0.0003), higher educated (p<0.0001) and older patients (p<0.0001) were more likely to be very satisfied. Postoperative nausea and vomiting (PONV) were frequent (nausea: 13.9%, vomiting: 3.3%), and more present in female than in male patients (p<0.0001). Pain scores at the PACU differed among disciplines (p<0.0001) were higher in female patients compared to male patients (3.41% versus 2.54%, p<0.0001) and after general anaesthesia compared to regional anaesthesia (3.25% versus 0.39%, p<0.0001) and decreased with higher age (p=0.0001) and education level (p=0.0033).

CONCLUSIONS

Whereas satisfaction with all aspects of care is generally high, the results regarding pain and PONV should inspire quality improvement initiatives. The questionnaire developed in this study can be a vehicle to assess and improve the quality of care in surgical day care centres.

Patient satisfaction in home health care

AIMS AND OBJECTIVES

  To assess the current use of patient satisfaction measures in home health care and to examine the reliability and validity of current measures of patient satisfaction in home health care.

BACKGROUND

  Patient satisfaction has been one of the widely used measures in home health care as an indicator of quality of care. A few efforts have been made to develop psychometrically sound patient satisfaction scales for use in home health care.

DESIGN

  A critical review of the literature.

METHODS

  Electronic databases were systematically searched to identify the studies or publications that measured and addressed patient satisfaction and its measurement in home health care.

RESULTS

  The review of the literature showed that patient satisfaction measures have been used in the evaluation of care programmes including rehabilitation programmes, discharge and home follow-up programmes, care process and management practices. Also, patient satisfaction measures were used to evaluate new care protocols and treatments.

CONCLUSIONS

  Home healthcare agencies need valid and reliable patient satisfaction scales. Frameworks of patient satisfaction are still in their early developmental stage. Only some of the variables related to patient satisfaction are explained by many frameworks.

RELEVANCE TO CLINICAL PRACTICE

  Home healthcare mangers and researchers need to take in consideration the reliability and validity of measures and tools of patient satisfaction.

Measuring and improving ambulatory surgery patients' satisfaction

The pressure on perioperative services to improve quality for health care consumers creates both challenges and opportunities. To make positive changes, many health care organizations contract with Press Ganey (PG), which processes an extensive database of more than 9.5 million surveys annually and provides benchmark reports to same-type organizations. To measure and improve ambulatory surgery patient satisfaction at one health care network in northeastern Pennsylvania, the nursing leaders in the ambulatory surgery center and OR undertook a quality improvement project focused on educating perioperative nurses on the use of PG reports. After we reviewed the PG reports and implemented changes with nursing staff members in perioperative areas, PG patient satisfaction scores improved regarding information about delays (4.1%) and center attractiveness (0.2%).

Psychometric evaluation of the post-discharge surgical recovery scale

RATIONALE, AIM AND OBJECTIVES: Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patient's recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness.

METHODS

Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach's alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearson's correlation coefficient. Patients' ability to work and their self-rated health on postoperative day 14 were used as external indicators of change.

RESULTS

Six items showed floor or ceiling effects. Cronbach's coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63).

CONCLUSIONS

The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

An investigation into the information received by patients undergoing a gastroscopy in a large teaching hospital in Ireland

The purpose of this article is to examine the information received by patients undergoing a gastroscopy. The growing number and complexity of day-case endoscopy increases the need for quality patient information. Provision of patient information reduces anxiety, increases knowledge, improves cooperation during endoscopy and increases compliance with discharge instructions. The study used a descriptive survey with convenience sampling (response rate 66%, N = 137). Patients received most of the standard procedural information (how and why the procedure is carried out), but they received considerably less sensory information (information regarding what they would hear, feel, smell, etc.). In addition, age and gender appeared to affect the amount of information received. Older patients received more procedural information than younger patients, and male patients received more information than female patients. The nurse was the main source of information. The majority of patients (>80%) received adequate information and were satisfied with the information received. Patients also received most of the information verbally on the day of the procedure rather than before admission. This study identified the need for patient information leaflets. The role of the nurse and the effect of age and gender on information provision are important considerations for healthcare professionals.

Patient subjective experience and satisfaction during the perioperative period in the day surgery setting: a systematic review

This systematic review used the Joanna Briggs Institute Qualitative Assessment and Review Instrument to manage, appraise, analyse and synthesize textual data in order to present the best available information in relation to how patients experience nursing interventions and care during the perioperative period in the day surgery setting. Some of the significant findings that emerged from the systematic review include the importance of pre-admission contact, provision of relevant, specific education and information, improving communication skills and maintaining patient privacy throughout their continuum of care.

Assisting Older Adults With Orthopaedic Outpatient Acute-Pain Management

Management of acute pain by older adults with orthopaedic conditions in their community setting after surgical procedures or injury can be challenging. As older adult orthopaedic outpatients have unique requirements in their pain management, nurses and advanced practice nurses must be cognizant of these needs and intervene when needed to promote a satisfactory recovery. This article will focus on the older adults experiences of orthopaedic pain, barriers to their pain reporting and relief, and acute pain management considerations for the older adult in the home setting.

Patient Anxiety and Patient Satisfaction in Hospital-based and Freestanding Ambulatory Surgery Centers

The study examined differences in patient anxiety and patient satisfaction between patients who experienced surgery at a hospital-based ambulatory surgery center versus a freestanding ambulatory surgery center. Forty-seven participants completed the State Trait Anxiety Inventory and Press Ganey Ambulatory Surgery Survey. Patients at both types of facilities experienced moderate levels of preoperative anxiety and were highly satisfied with care received. No significant differences were found in preoperative anxiety, overall satisfaction with care, or overall satisfaction with nursing care. The site where the surgery was performed may not be a determining factor in patient anxiety or satisfaction levels.

Patients' Perceptions of Emotional Support and Information Provided to Family Members

The purpose of this quality improvement project was to determine patients' perceptions of the emotional support and information provided to their family members by nurses in a day surgery setting. The project was conducted in a day surgery unit of a hospital in western Finland. Data were collected from 60 participants using a questionnaire designed specifically for the project. The results showed that half of the patients appreciated the presence of their family members during hospital care. The emotional support provided to family members was rated as moderate, and more than 50% of the patients believed their family members were adequately informed. The results were used to help develop tools for patient and family member education.

The Influence of Nurse-Sensitive Variables on Patient Satisfaction

A DESCRIPTIVE STUDY was conducted in an ambulatory surgical unit to explore the influence of selected nurse-sensitive variables on patient satisfaction and compare the reliability and validity of existing instruments that measure patient satisfaction. STUDY RESULTS indicate that age, gender, culture, pain control, and communication affect patient satisfaction in ambulatory care. A reliable tool to measure patient satisfaction is needed to promote improvements in care.