Improving anaesthetists' communication skills

Continuing professional development (CPD) for anesthetists: A systematic review

BACKGROUND

In accordance with the focus on patient safety and quality in healthcare, continuing professional development (CPD) has received increasing levels of attention as a means to ensure physicians maintain their clinical competencies and are fit to practice. There is some evidence of a beneficial effect of CPD, though few studies have evaluated its effect within anesthesia. The primary aim of this systematic review was to establish which CPD activities anesthetists are engaged in and their effectiveness. The secondary aim was to explore which methods are employed to evaluate anesthetists' clinical performance.

METHODS

Databases searched: Medline, Embase and Web of Science, in May 2023. Additional papers were identified through searching the references of included studies. Eligible studies included anesthetists, either exclusively or combined with other healthcare professionals, who underwent a learning activity or assessment method as part of a formalized CPD program or a stand-alone activity. Non-English language studies, non-peer reviewed studies and studies published prior to 2000 were excluded. Eligible studies were quality assessed and narratively synthesized, with results presented as descriptive summaries.

RESULTS

A total of 2112 studies were identified, of which 63 were eligible for inclusion, encompassing more than 137,518 participants. Studies were primarily of quantitative design and medium quality. Forty-one studies reported outcomes of single learning activities, whilst 12 studies investigated different roles of assessment methods in CPD and ten studies evaluated CPD programs or combined CPD activities. A 36 of the 41 studies reported positive effects of single learning activities. Investigations of assessment methods revealed evidence of inadequate performance amongst anesthetists and a mixed effect of feedback. Positive attitudes and high levels of engagement were identified for CPD programs, with some evidence of a positive impact on patient/organizational outcomes.

DISCUSSION

Anesthetists are engaged in a variety of CPD activities, with evidence of high levels of satisfaction and a positive learning effect. However, the impact on clinical practice and patient outcomes remains unclear and the role of assessment is less well-defined. There is a need for further, high-quality studies, evaluating a broader range of outcomes, in order to identify which methods are most effective to train and assess specialists in anesthesia.

Coaching to Improve Individual and Team Performance in Anesthesiology

In addition to medical knowledge and psychomotor skills, anesthesiology practice requires the ability to work within a complex system, navigate social situations, manage conflict, and lead teams. Coaching has foundations in psychology and adult learning theory and uses a process of inquiry, reflection, and shared discernment to discover values, goals, and solutions. There is increasing use and evidence for coaching in medicine and anesthesiology to support personal and professional growth. Individual and group coaching for anesthesiologists may improve anesthesiologists' ability to communicate, collaborate and solve problems, improving well-being, culture, and plausibly, patient outcomes.

Assessing Communication Quality in the Intensive Care Unit

Introduction: Successful shared decision-making for critically ill intensive care unit (ICU) patients requires bidirectional communication. Through observation of ICU conversations, our study aimed to identify communication skill deficiencies in providers who care for patients in the ICU. Methods: This was an observational prospective study performed in a single urban academic medical center (671 beds) from June 2021 through August 2021. Twenty-three providers were recruited from medical and surgical ICU services (56 beds). Thirty-nine surrogate decision makers were identified. Provider skills were assessed using a customized observational tool that examined nonverbal communication, verbal communication, opening the discussion, gathering information, understanding the family's perspective, sharing information, reaching agreements on problems and plans, and providing closure. Results: Thirty-nine conversations were observed for six attending physicians, four fellow physicians, eight resident physicians, two nurse practitioners, and three physician assistants during the coronavirus 19 (COVID19) pandemic. A dedicated critical care provider engaged in 19 observed conversations; 20 discussions occurred with individuals rotating/consulting in the ICU. Communication skill did not depend on experience or area of expertise. Less than half of conversations achieved bidirectional communication proficiency. Scheduled conversations (n = 14) had significantly higher average communication scores than unscheduled encounters (n = 25). Conclusions: Superficial unidirectional communication with decision makers was commonly observed. Providers were less proficient at advanced communication skills needed for shared decision-making. We recommend that providers have more scheduled conversations, which were more productive in achieving bidirectional communication. A targeted simulation curriculum addressing these areas may improve patient, decision maker, and provider satisfaction, while promoting patient-centered care.

Patient-reported perioperative anaesthesia-related anxiety is associated with impaired patient satisfaction: a secondary analysis from a prospective observational study in Switzerland

Perioperative anxiety is common. The relationship between anxiety and patient satisfaction with anaesthesia is still under debate. We assessed the prevalence and different causes of anaesthesia-related fears leading to perioperative anxiety and its association with patient satisfaction. A multiple-time validated, psychometrically developed questionnaire assessing the presence of anxiety, causes of fear, and different dimensions of patient satisfaction was sent to patients after discharge. The clinical data were obtained from a previous study. The sample size was calculated to recruit a minimum of 300 completed questionnaires. Statistical analyses included multivariate logistic regression models. Complete data were available for 474 of the 600 patients recruited for the study (response rate: 79%). A total of 141 patients (30%) reported anxiety regarding anaesthesia before hospital admission. The prevalence of anxiety was significantly associated with patient age (< 54 years: n = 196, prevalence = 37%; > 54 years: n = 263, prevalence = 24%; p = 0.002), female sex (female: n = 242, prevalence 39%; male: n = 223, prevalence 20%; p < 0.001), and surgical speciality (gynaecology (n = 61, prevalence = 49%), otolaryngology (n = 56, prevalence = 46%); p < 0.001). Fear of not awakening from anaesthesia (n = 44, prevalence = 32%, SD 45.8) and developing postoperative nausea or vomiting (n = 42, prevalence = 30%, SD 46.0) were the most reported anaesthesia-related causes of fear. Anxiety was associated with impaired overall patient satisfaction (mean dissatisfaction score 15%, versus 23%, SD 16.3 in the anxious group, SD 16.3, p < 0.001), especially regarding the dimensions "information and involvement in decision-making" (14% of deficits stated in the non-anxious group compared to 23% in the anxious group, p < 0.001), "respect and trust" (2% vs 6.26%, p < 0.001) and "continuity of care" (50% vs 57%, p < 0.015). Patient-reported anaesthesia-related anxiety is common and may affect important outcome parameters such as patient satisfaction. Abstract presented in e-poster format at Euroanaesthesia 2023, June 3-5, Glasgow.

Patient satisfaction in anesthesiology: a narrative review

PURPOSE OF REVIEW

Healthcare is increasingly expanding its view in outcome discussions to integrate patient-reported outcomes such as patient satisfaction. Involving patients in the evaluation of services and the development of quality improvement strategies is paramount, especially in the service-oriented discipline of anaesthesiology.

RECENT FINDINGS

Currently, while the development of validated patient satisfaction questionnaires is well established, the use of rigorously tested scores in research and clinical practice is not standardized. Furthermore, most questionnaires are validated for specific settings, which limits our ability to draw relevant conclusions from them, especially considering the rapidly expanding scope of anaesthesia as a discipline and the addition of same-day surgery.

SUMMARY

For this manuscript, we review recent literature regarding patient satisfaction in the inpatient and ambulatory anaesthesia setting. We discuss ongoing controversies and briefly digress to consider management and leadership science regarding 'customer satisfaction'.

Do patients' characteristics influence their healthcare concerns?-A hospital care survey

Background

Hospital performance is often monitored by surveys that assess patient experiences with hospital care. Certain patient characteristics may shape how some aspects of hospital care are viewed and reported on surveys.

Objective

The aim of the study was to examine factors considered important to patients and determine whether there were differences in answers based on age, gender, or educational level.

Methods

Cross-sectional study based on a hospital survey developed via literature review and specialist recommendations. This study included randomly selected patients 18 years or older who were recently admitted to the hospital or admitted more than 50 days before the survey was being applied. Survey domains included age, gender, educational level, factors considered important for the health care in a hospital setting and sources of information about hospital quality used by each subject. Answers description and statistical analysis using Fisher exact test were performed.

Results

The survey was applied to 262 patients who were admitted under different services. The most important concern reported was the risk of getting a hospital-acquired infection (67.18%), followed by understanding explanation from the doctors’ plans (64.12%) and doctors’ ability to listen carefully (58.78%). Women are more concerned about their risk of falling (p = 0.03). Patients older than 65 years find important that the doctors explain everything in a way they can easily understand (p = 0.02), while lower educated patients consider most if the doctor treats them with courtesy and respect (p = 0.0027).

Conclusion

Patient characteristics have an effect on how hospital care is perceived. Regardless of the characteristics of the population, the risk of getting an infection was the main concern overall, so it is important that hospitals promote actions to prevent it and share them with patients.

Comparison of Access to Primary Care Medical and Dental Appointments Between Simulated Patients Who Were Deaf and Patients Who Could Hear

Importance

Primary medical and dental clinics may accept fewer people who are deaf as patients than persons who can hear, and clinics may deny requests by patients who are deaf for American Sign Language (ASL) interpretation at appointments when necessary, creating diminished access to primary medical and dental care.

Objective

To compare the rate at which patients who are deaf are offered primary care medical or dental appointments with the rate at which appointments are offered to patients who can hear in a real-world context.

Design, Setting, and Participants

This cross-sectional study used a simulated patient (SP) call audit method. Simulated patients (4 who could hear and 4 who were deaf) followed a call script in which an adult sought to establish care, requesting new patient appointments from a statewide stratified random sample of clinicians listed in the Idaho Medical and Dental Associations member databases at 445 clinics (334 primary care and 111 general dentistry) throughout Idaho. Simulated patients who were deaf also requested interpreting services at the appointment. Calls were made between June 7 and December 6, 2018. Data analysis was conducted from December 2019 to April 2020.

Exposures

Simulated patients who were deaf or could hear called primary care medical or dental clinics from the sampling frame and requested an appointment, supplying the same basic information. In addition, SPs who were deaf requested that an ASL interpreter be provided by the clinic for the appointment.

Main Outcomes and Measures

Rates of new appointments offered and, for SPs who were deaf, whether ASL interpreter services were confirmed for the appointment.

Results

Two male and 2 female SPs who could hear were successful on 210 occasions (64.4%) when requesting a new patient appointment compared with 2 male and 2 female SPs who were deaf who were successful on 161 occasions (49.1%) (P < .001). Simulated patients who could hear were nearly 2 times more likely to secure appointments than were SPs who were deaf (adjusted odds ratio, 1.88; 95% CI, 1.27-2.79). For SPs who were deaf, 80 unsuccessful appointment requests (48.2%) were associated with a request for interpretation.

Conclusions and Relevance

The findings suggest that in a statewide representative sample, access to primary medical and dental care for patients who are deaf is significantly reduced. Patients who are deaf may not receive an appointment if they request interpreter services, even when such services are required to provide effective communication.

Primer on adult patient satisfaction in perioperative settings

The topic of patient satisfaction has gained increasing importance over the past decade. Due to the impact of patient satisfaction on health care quality, understanding factors that predict satisfaction is vital. The purpose of this review is to examine the literature and identify factors related to patient perioperative satisfaction as well as predictive variables that, if modified, can enhance satisfaction scores of patients undergoing surgery. Our review reports that patient satisfaction scores are affected by modifiable factors such as clinician-patient communication, information provision to patients, and operational function of a hospital. Non-modifiable factors affecting patient satisfaction scores include patient demographics such as gender, age, and education. In order to enhance patient perioperative satisfaction, we suggest that anesthesiologists and surgeons focus their efforts on enhancing their communication skills and providing information that is appropriately tailored to the understanding of their patients.

An intervention to improve provider-patient interaction at methadone maintenance treatment in China

BACKGROUND

This study evaluated an intervention aiming to improve methadone maintenance therapy (MMT) service providers' interaction with their patients in China.

METHODS

Sixty-eight MMT clinics were randomized to either an intervention or a control condition. Providers in the intervention group attended three group training sessions to enhance their communication skills. Trained providers were encouraged to practice the taught communication skills through provider-initiated individual sessions with their patients. A total of 418 service providers completed assessments from baseline to 24-month. Linear mixed-effects regression models were used to compare self-reported short-term and sustained improvement in provider-patient interaction between the intervention and the control conditions.

RESULTS

The intervention group service providers perceived significantly greater short-term and sustained improvement in provider-patient interaction compared to the control group service providers (estimated difference (±SE): 1.20 (0.24) and 1.35 (0.33), respectively; p-values < 0.0001). Providers' baseline job satisfaction was significantly associated with a greater perceived improvement in provider-patient interaction for both periods (reg. coef. (±SE): 0.02 (0.01) and 0.04 (0.01) for short-term and sustained periods, respectively; p-values < 0.01).

CONCLUSION

Study findings suggest that the intervention could be beneficial for improving perceived provider-patient interaction in MMT programs. Service providers' job satisfaction should be addressed in training programs for the improvement of provider-patient interaction.

Developing a health interview tool for Medicaid home and community-based services clients and home care aides through a community-engaged approach

We describe a community-engaged approach to develop and pilot a home care aide (HCA) administered health interview with Medicaid Home and Community-based Services clients. Stakeholders identified five priority health topics and selected a card sorting methodology for interviews. A barrier to interviewing clients was decreased communication skills among HCAs, and we modified health interview training to include communication training. Stakeholders reported the interview methodology was feasible within usual care, acceptable to clients, and contributed to increased knowledge on providing person-centered care. Stakeholder engagement resulted in valuable insights regarding the health interview methodology and relevant training needs.

[Assessment of the therapeutic communication in order to improve the welcoming of patients in the operating room: impact study]

PURPOSE

We wanted to assess the awareness of the nursing staff to therapeutic communications on improving the welcoming experience of patients in the operating room for outpatient surgery.

METHODS

This was a single centre prospective impact study performed in an outpatient surgery clinic. In a first phase, a questionnaire was administered by the anesthetist nurse upon arrival of the patient to assess the patient's comfort (NRSc) and satisfaction on a simple numeric scale, and calculate a negative communication score ('NC'). In the second phase, the awareness of the nursing staff on therapeutic communication was emphasized on listening, empathy and the use of positive wording, using educational videos. In the third phase, after the staff awareness-raising period, the questionnaire was repeated. Quantitative variables (primary outcome criterion made of the number of patients with a NC score ≥ 5, NRSc, satisfaction), and qualitative variables before and after the awareness raising phase to therapeutic communications were compared.

RESULTS

A total of 234 patients were included (109 before and 125 after). Following the staff awareness session to therapeutic communication, the NC score ≥ 5 decreased significantly from 20% to 6% as well as the median NRSc [P₂₅-P₇₅] before (8 [8-9] vs 8 [7-8]) and after (8 [8-9] vs 8 [7-8]) anesthesia. The proportion of less anxious patients before the initiation of anesthesia was significantly higher after the therapeutic communication (32% vs 17%). Satisfaction significantly increased after the awareness phase (8 [7-10] vs (9 [8-10]).

CONCLUSION

This preliminary study shows a mild improvement of the patients' comfort and satisfaction after therapeutic communication. A controlled randomized trial is needed to confirm those results.

A Metasynthesis of Phenomenographic Articles on Understandings of Work Among Healthcare Professionals

Phenomenography is a qualitative research method based on the assumption that almost any phenomenon will be understood by a group of people in a limited number of ways. Our aim in this article was to identify the different ways work can be understood by healthcare professionals. In a world where the delivery of healthcare is continually changing, a metasynthesis of phenomenographic articles on healthcare professionals' understandings can provide knowledge about the focus and meaning of work for these individuals today. Our metaethnographic synthesis of 14 selected phenomenographic articles identified five different ways of understanding work, ranging from a limited to an all the more comprehensive view on patients and their needs. This range of understandings reveals problem areas and challenges facing healthcare professionals today. The possibility exists as well that limited understandings of work may be negative consequences of current demands for efficiency and all the more limited healthcare resources.

Report on Provider-Client Interaction From 68 Methadone Maintenance Clinics in China

Provider-client interaction is an integral of clinical practice and central to the delivery of high-quality medical care. This article examines factors related to the provider-client interaction in the context of methadone maintenance treatment (MMT). Data were collected from 68 MMT clinics in China. In total, 418 service providers participated in the survey. Linear mixed effects regression models were performed to identify factors associated with provider-client interaction. It was observed that negative attitude toward drug users was associated with lower level of provider-client interaction and less time spent with each client. Other factors associated with lower level of interaction included being female, being younger, being a nurse, and fewer years in medical field. Higher provider-client interaction was associated with provider reported job satisfaction. The findings of this study call for a need to address provider negative attitudes that can impact provider-client interaction and the effectiveness of MMT. Future intervention efforts targeting MMT providers should be tailored by gender, provider type, and medical experiences.

Effect of a simulation-based workshop on breaking bad news for anesthesiology residents: an intervention study

Background

Breaking bad news (BBN) to patients and their relatives is a complex and stressful task. The ideal structure, training methods and assessment instruments best used to teach and assess BBN for anesthesiology residents remain unclear. The purpose of this study is to evaluate the effectiveness of an education intervention for BBN based on immersive experiences with a high fidelity simulator and role-play with standardized patients (SPs). A secondary purpose is to gather validity evidence to support the use of a GRIEV_ING instrument to assess BBN skills.

Methods

The communication skills for BBN of 16 residents were assessed via videotaped SP encounters at baseline and immediately post-intervention. Residents’ perceptions about their ability and comfort for BBN were collected using pre and post workshop surveys.

Results

Posttest scores were significantly higher than the pretest scores for the GRIEV_ING checklist, as well as on the communication global rating. The GRIEV_ING checklist had acceptable inter-rater and internal-consistency reliabilities. Performance was not related to years of training, or previous BBN experience.

Conclusion

Anesthesiology residents’ communication skills when BBN in relation to a critical incident may be improved with educational interventions based on immersive experiences with a high fidelity simulator and role-play with SPs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12871-017-0374-7) contains supplementary material, which is available to authorized users.

Coping strategies in anxious surgical patients

Background

Anaesthesia and surgery provoke preoperative anxiety and stress. Patients try to regain control of their emotions by using coping efforts. Coping may be more effective if supported by specific strategies or external utilities. This study is the first to analyse coping strategies in a large population of patients with high preoperative anxiety.

Methods

We assessed preoperative anxiety and coping preferences in a consecutive sample of 3087 surgical patients using validated scales (Amsterdam Preoperative Anxiety and Information Scale/Visual Analogue Scale). In the subsample of patients with high preoperative anxiety, patients’ dispositional coping style was determined and patients’ coping efforts were studied by having patients rate their agreement with 9 different coping efforts on a four point Likert scale. Statistical analysis included correlational analysis between dispositional coping styles, coping efforts and other variables such as sociodemographic data. Statistical significance was considered for p < 0.05.

Results

The final analysis included 1205 patients with high preoperative anxiety. According to the initial self-assessment, about two thirds of the patients believed that information would help them to cope with their anxiety (“monitors”); the remainder declined further education/information and reported self-distraction to be most helpful to cope with anxiety (“blunters”). There was no significant difference between these two groups in anxiety scores.

Educational conversation was the coping effort rated highest in monitors whereas calming conversation was the coping effort rated highest in blunters. Coping follows no demographic rules but is influenced by the level of education. Anxiolytic Medication showed no reliable correlation to monitoring and blunting disposition. Both groups showed an exactly identical agreement with this coping effort.

Demand for medical anxiolysis, blunting or the desire for more conversation may indicate increased anxiety. The use of the internet was independent of the anxiety level and the demand of information.

Conclusion

Conversation with medical staff proved to be the most popular coping strategy. Acknowledgment of the division between information-seeking and blunting-like personalities is central to supporting the patient’s individual coping efforts. Internet access may be the easiest way to support coping today.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1492-5) contains supplementary material, which is available to authorized users.

Patient's knowledge and perception of preanesthesia check-up in rural India

Background:

Preanesthesia assessment is an important aspect of patient care. If a patient shows lack of interest during preanesthesia check-up or tries to rush through, it may result in incomplete history and general physical examination, compromising patient care.

Aim:

The aim of this study was to assess the knowledge of patients presenting for elective surgery to Tertiary Care Hospital in Rural India regarding value and importance of preanesthesia check-up.

Settings and Design:

This observational study was conducted in a Tertiary Care Teaching Hospital in Rural India. 1000 patients posted for elective surgery coming to preadmission anesthesia consultation (PAC) clinic over a period of 3 months were included in this study.

Methods:

Patients were asked to fill a questionnaire consisting of 15 questions before start of preanesthesia assessment. Each question was provided with multiple possible choices, out of which patient had to choose the most appropriate according to him/her. Scoring was done, with each question answered correctly being given 1 mark while incorrect answer was awarded 0 marks.

Statistical Analysis:

Data were expressed as frequencies and percentage. Correlations studies were performed by unpaired t-test and one-way analysis of variance.

Results:

About 27.4% of patients knew that they had come to PAC clinic for preanesthesia assessment, the rest were not clear. Similarly, only 18.1% knew that only anesthesiologist can perform a preanesthesia examination. 16.5% patients said that they would discuss their fears or queries regarding anesthesia in PAC clinic while 58.6% said that they would share such feelings with the surgeon in ward.

Conclusion:

Patients had insufficient knowledge about preanesthesia assessment and its role in improving the outcome of surgery.

Data-prompted interviews: Using individual ecological data to stimulate narratives and explore meanings

Objective: An emerging trend in qualitative research is to use individual participant data to stimulate narratives in interviews. This article describes the method of the data-prompted interview (DPI) and highlights its potential benefits and challenges. Method: DPIs use personal ecological data gathered prior to the interview to stimulate discussion during the interview. Various forms of data can be used including photographs, videos, audio recordings, graphs, and text. This data can be gathered by the researcher or generated by the participant and may utilize ecological momentary assessment. Results: Using individual data in DPIs can stimulate visual and auditory senses, enhance memory, and prompt rich narratives anchored in personal experiences. For the researcher, DPIs provide an opportunity to explore the meaning of the data and to explain data patterns. For the participant, presented stimuli give guidance for discussion and allow them to reflect. The challenges associated with conducting DPIs include practical issues such as data selection and presentation. Data analyses require narratives to be interpreted together with the data. Ethical challenges of DPI include concerns around data anonymity and sensitivity. Conclusions: Combining various sources of data to stimulate the interview provides a novel opportunity to enhance participants’ memories and to meaningfully assess and analyze data patterns. In the context of health promotion and illness prevention, DPI offers a unique opportunity to explore reasons, opinions, and motivations for health-related behaviors in the light of previously gathered data.

Communication skills of anesthesiologists: An Indian perspective

BACKGROUND

Communication failure is a risk factor for mishaps and complaints, which can be reduced by effective communication between operating room team members and patients.

AIM

To conduct a survey among anesthesiologists regarding communications skills and related issues like stress in case of communication failure, need for training, music in operation theater, and language barrier at their work place.

MATERIALS AND METHODS

We conducted a survey among anesthesiologists coming for a neuroanesthesia conference in India (n = 110) in February 2011 by questionnaire sent by e-mail to them.

RESULTS

The response rate was 61.8% (68/110). Majority (95.5%) of the respondents agreed that good verbal communication leads to better patient outcome, better handling of crisis and is important between surgeons and anesthesiologists (98.5%). A total of 86% of the anesthesiologists felt that failure of communication caused stress to them. The idea of communication by e-mail or phone text messages instead of verbal communications was discouraged by 65.2%. A total of 82% of respondents felt that training of communication skills should be mandatory for all medical personnel and 77.6% were interested in participating in such course. Language barrier at work place was seen as hurdle by 62.7% of the respondents. A total of 80% of respondents felt that playing music in operating theater is appropriate.

CONCLUSION

Results of the survey highlight the need for effective communication in the operating room between team members and need for formal training to improve it.

Patient-Satisfaction Measures in Anesthesia

Patient satisfaction is an important measure of the quality of health care and is used as an outcome measure in interventional and quality improvement studies. Previous studies have found that there are few appropriately developed and validated questionnaires available. The authors conducted a systematic review to identify all tools used to measure patient satisfaction with anesthesia, which have undergone a psychometric development and validation process, appraised the quality of these processes, and made recommendations of tools that may be suitable for use in different clinical and academic settings. There are a number of robustly developed and subsequently validated instruments, however, there are still many studies using nonvalidated instruments or poorly developed tools, claiming to accurately assess satisfaction with anesthesia. This can lead to biased and inaccurate results. Researchers in this field should be encouraged to use available validated tools, to ensure that patient satisfaction is measured and reported fairly and accurately.

On residents' satisfaction with community health services after health care system reform in Shanghai, China, 2011

Background

Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents’ satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform.

Methods

Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents’ satisfaction.

Results

Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1) the health insurance system; 2) essential drugs; 3) basic clinical services; and 4) public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied) and the public health/preventive services (average score=3.62); but less satisfied with the provision of essential drugs (average score=3.20) and health insurance schemes (average score=3.23). The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes) had overall poorer satisfaction levels on these four aspects of health care (P<0.01). 25.39% of the respondents thought that their financial burden had increased and 38.49% thought that drugs had become more expensive.

Conclusion

The respondents showed more satisfaction with the clinical services (average score=3.79) and public health services/interventions (average score=3.79); and less satisfaction with the health insurance system (average score=3.23) and the essential drug system (average score=3.20). Disadvantaged groups showed lower satisfaction levels overall relative to non-disadvantaged groups.

The preanesthetic interview by anesthesiology residents: analysis of time and content

Background

A preanesthetic visit can increase a patient's satisfaction. However, it is uncertain whether a preanesthetic visit by an anesthesiology resident can achieve the goal. We studied the time distribution for content of preanesthetic interviews (PI) and evaluated the patient's satisfaction with the PI.

Methods

We recorded the PI duration of 200 patients by a voice recorder. The degrees of patient satisfaction with the PI and the changes of anxiety level after the PI were quantified by a questionnaire. We analyzed the time distribution for content of the PI and the correlation between patient characteristics and PI duration or a patient's satisfaction.

Results

The total PI duration was 184 (134-286) sec (median, 25-75%), and the time distributions for content of the PI were 8 (5-10) of greeting, 45 (23-70) of history taking, 15 (10-20) of physical examination, 50 (25-98) for obtainingan informed consent, 20 (10-30) of explanation for anesthetic planning, 15 (5-28) for explanation of patient controlled analgesia, and 10 (0-4) sec for questions and answers. Age, ASA physical status, and educational level were correlated with PI duration (P < 0.001). The patient's level of satisfaction was "very satisfied" in 39%, "satisfied" in 50%, and "moderate" in 11% of interviews. The anxiety level was "decreased" in 50%, "increased" in 8%, and "not changed" in 42% of patients.

Conclusions

Although the duration of a PI given by residents was a relatively short, 89% of patients of were satisfied with the interview. The PI took a longer time to complete in patients of older age, higher ASA physical status, or lower educational levels.

Video elicitation interviews: a qualitative research method for investigating physician-patient interactions

We describe the concept and method of video elicitation interviews and provide practical guidance for primary care researchers who want to use this qualitative method to investigate physician-patient interactions. During video elicitation interviews, researchers interview patients or physicians about a recent clinical interaction using a video recording of that interaction as an elicitation tool. Video elicitation is useful because it allows researchers to integrate data about the content of physician-patient interactions gained from video recordings with data about participants' associated thoughts, beliefs, and emotions gained from elicitation interviews. This method also facilitates investigation of specific events or moments during interactions. Video elicitation interviews are logistically demanding and time consuming, and they should be reserved for research questions that cannot be fully addressed using either standard interviews or video recordings in isolation. As many components of primary care fall into this category, high-quality video elicitation interviews can be an important method for understanding and improving physician-patient interactions in primary care.

Relationship express: a pilot program to teach anesthesiology residents communication skills

BACKGROUND

The Accreditation Council for Graduate Medical Education requires residency programs to teach 6 core competencies and to provide evidence of effective standardized training through objective measures. George Washington University's Department of Anesthesiology and Critical Care Medicine implemented a pilot program to address the interpersonal and communication skill competency. In this program, we aimed to pilot the Relationship Express model, a series of exercises in experiential learning to teach anesthesiology residents to build effective relationships with patients in time-limited circumstances. The purpose of this paper is to describe the application of this model for anesthesiology training.

METHODS

A total of 7 first-year clinical anesthesiology residents participated in this pilot study, and 4 residents completed the entire program for analysis purposes. Relationship Express was presented in three 1.5-hour sessions: (1) introduction followed by 2-case, standardized patient pretest with feedback to residents from faculty observers; (2) interpersonal and communication skills didactic workshop with video behavior modeling; and (3) review discussion followed by 2-case, standardized patient posttest and evaluation.

RESULTS

MODIFIED BROOKFIELD COMMENTS REVEALED THE FOLLOWING THEMES: (1) time constraints were realistic compared with clinical practice; (2) admitting errors with patients was difficult; (3) patients were more aware of body language than anticipated; (4) residents liked the group discussions and the video interview; (5) standardized patients were convincing; and (6) residents found the feedback from faculty and standardized patients helpful.

CONCLUSIONS

Resident retrospective self-assessment and learning comments confirm the potential value of the Relationship Express model. This program will require further assessment and refinement with a larger number of residents.

[Simulation-based anaesthesia crisis resource management training. Results of a survey on learning success]

BACKGROUND

Up to as many as 38,000 people die in German hospitals each year as a result of preventable medical errors. Anesthetic procedures are generally safer than internal medical procedures and the mortality associated with anesthesia is estimated to be 3.3-5 cases per million. However, this is still 10 times higher than the risk associated with civilian aviation for example. Up to 80% of mistakes are attributable to inadequate execution of non-technical skills (NTS) such as communication, teamwork and organization of the working environment. Training in non-technical skills through Anesthesia Crisis Resource Management (ACRM) is an integral part of the Berlin Simulation Training (BeST) curriculum. The aim of this study was to describe the subjective evaluation of change in routine clinical behavior as a result of simulator training using latent outcome variables such as "subjective evaluation of learning outcome", with special emphasis on communication.

MATERIAL AND METHODS

In total 235 doctors with varying levels of professional experience received BeST training between 2001 and 2004. An anonymous postal questionnaire was sent to 228 of these participants and the response rate was 64% The questionnaire contained 13 questions covering evaluation of the workshop and learning outcome with respect to communication in the operating room (OR), teamwork in the OR and medical knowledge. Following factor analysis 3 latent outcome variables (subjective evaluation of the learning outcome, workshop-related change in perception of the value of communication and general value and relevance) were generated. Logistic regression was used to determine whether there was any relationship between the latent outcome variables and a number of independent factors.

RESULTS

It was not possible to demonstrate any relationship between the level of professional training, age or date of the workshop and the variables selected to describe subjective evaluation of behavioral change as a result of the workshop. How realistic the candidates perceived the training scenarios to be (p<0.01) and the sex of the candidates (p=0.03) were both significantly related to evaluation and female candidates were more likely to positively evaluate the simulator training. From the candidates' perspective the training significantly altered their perception of the value of NTSs, and in particular communication, during the management of critical incidents in the OR.

CONCLUSION

Well-staged and realistic simulation is associated with better learning outcomes. It may be important to take gender aspects into account in ACRM training.

Meeting the Health Professions Council's standards of proficiency: a student's experience

A core component of healthcare courses involves reflective learning. This article discusses a student's learning experience while undertaking the diploma in operating department practice. Core skills development is important in facilitating the learning process, and can be identified through reflective practice. Reflecting on individual learning experiences can support students in meeting the Health Professions Council's (HPC) standards of proficiency.

Patients’ Understanding of Technical Terms used during the Pre-Anaesthetic Consultation

Communication between patients and anaesthetists is being recognised as an increasingly important aspect of clinical care. Patients need to understand the nature and consequences of any proposed procedure prior to giving informed consent. In this regard, anaesthetists have a responsibility to provide adequate information about anaesthesia and related procedures in a form that patients are likely to understand. We investigated whether patients understood the technical terms used by the anaesthetist. We observed 68 obstetric and gynaecological pre-anaesthesia consultations at two tertiary hospitals in South Australia. These pre-anaesthesia consultations were conducted by consultant anaesthetists on 46 occasions (68%) and by anaesthesia trainees (nine registrars and one resident medical officer) on 22 occasions (32%). Approximately half of the patients participating in the study (45%) failed to understand one or more of the terms used during their consultation. Of the technical terms used more than once, “reflux” was the most poorly understood, with seven of 36 patients (19%) having either poor or no understanding. The next five most commonly misunderstood technical terms were “aspiration”, “allergy”, “anaphylaxis, “local anaesthetic” and “sedation”. We have identified many technical terms that may not be understood by patients presenting for anaesthesia care. An awareness of commonly misunderstood words may facilitate better transfer of information during pre-anaesthesia consultations. Our study findings should remind doctors that patients frequently fail to understand or take in what we tell them.

[Patients' perception of certainty about decisions to undergo surgery and the relationship between certainty and prior information received]

OBJECTIVE

To evaluate the certainty of patients deciding whether or not to undergo a proposed operation and the relationship between the degree of certainty and the prior information received.

METHODS

A cross-sectional study was performed using the decisional conflict scale (DCS) to evaluate the degree of certainty of patients deciding to undergo surgery. A standardized questionnaire was used to obtain demographic data (age, sex, and level of education) and details about the information the patients had received regarding the surgical procedure. Patients were classified as certain or uncertain of their decision to undergo surgery according to the DCS score. A logistic regression model was constructed to adjust for confounding factors and to analyze the relationship between certainty and variables reflecting the information received by the patient.

RESULTS

A total of 358 patients were included. Thirty percent of the patients stated that they had not received prior information and 31.6% showed uncertainty in their decision. Younger men with a higher level of education felt more certain of their decision. After adjusting for age, sex, and level of education, we found that uncertainty was related to the perception of not having received enough prior information (odds ratio, 43; 95% confidence interval, 2.4-7.7).

CONCLUSION

The perception of certainty is clearly linked to patients' understanding of prior information received. The results show a need to improve the information given to patients--particularly to elderly patients and those with a low level of education.

Postoperative Analgesic THerapy Observational Survey (PATHOS): a practice pattern study in 7 central/southern European countries

Surveys evaluating pain in hospitals keep on showing that postoperative pain (POP) remains undertreated. At the time when guidelines are edited and organisational changes are implemented, more recent data are necessary to check the impact of these measures on daily practice and needs for improvement. This prospective, cross-sectional, observational, multi-centre practice survey was performed in 2004-2005 in 7 European countries. It was conducted in surgical wards of a randomised sample of hospitals. Data on POP management practices following surgery in adult in-patients were collected anonymously via a standardised multiple choice questionnaire. Among 1558 questionnaires received from 746 European hospitals, 59% were provided by anaesthetists and 41% by surgeons. There are no regular on-site staff training programmes on POP management in the institution for 34% of the respondents, patients are systematically provided with POP information before surgery for 48% of respondents; balanced analgesia following major surgery and regular administration of analgesics are largely used; 25% of respondents have specific written POP management protocols for all patients in their ward; 34% of respondents say that pain is not assessed and 44% say that pain scores are documented in the patient's chart. This largest ever performed survey confirms the extensive body of evidence that current POP management remains suboptimal and identifies needs for improvement on European surgical wards. However, the wide use of balanced analgesia and the regular administration of analgesics are indicators of ongoing change.

Patient satisfaction with continued versus divided anesthetic care

STUDY OBJECTIVE

To evaluate patient acceptability of continued versus divided anesthetic care.

DESIGN

Patient satisfaction ratings with continuous and divided anesthetic care were assessed by patient questionnaire. In addition, the effect of training anesthesia personnel in communication regarding divided anesthesia care was examined.

SETTING

University medical center.

PATIENTS

654 consecutive patients scheduled for elective surgery.

MEASUREMENTS AND MAIN RESULTS

Overall postoperative patient satisfaction was high and not different between patients experiencing continued or divided anesthetic care (P=0.97). Asking patients before their operations about the importance of continued anesthetic care resulted in a highly significant difference between the two groups. In the continued anesthetic care model, patients felt it more important to experience continued care. In contrast, patients who were told that another anesthesiologist would take care of them rated the same question with a lower importance (P<0.001).

CONCLUSION

Before their operations, more than half of the patients felt it very important that they were visited and anesthetized by the same physician. Nevertheless, postoperative patient satisfaction was equally high regardless of whether they were anesthetized by the same physician who had visited them preoperatively.

Patient's satisfaction and distress compared with expectations of the medical staff

OBJECTIVE

Patient satisfaction is increasingly used to measure and evaluate patient treatment in hospital. The aim of this study is to assess satisfaction regarding communication, support and the degree of anxiety and depression among the patients, and to compare reports from the patients with the expectations of the staff.

METHODS

In a prospective study, 176 (93%) of the patients and 52 (80%) of the nurses completed a similar questionnaire. Degree of satisfaction was measured on a five-point scale (0-4), and degree of anxiety and depression was measured with the hospital anxiety and depression scale (HAD).

RESULTS

Satisfaction regarding communication with nurses (3.4+/-0.07) and physicians (3.0+/-0.08) was higher than expected by the staff (2.9+/-0.09 and 2.4+/-0.09, respectively) (p<0.01). The staff expected a higher degree of anxiety (2.3+/-0.10 versus 1.5+/-0.12) (p<0.01). The patients scored significantly higher on HAD anxiety compared with the population in general. The HAD score correlated negatively with the level of satisfaction.

CONCLUSION

The patients generally showed a high degree of satisfaction with communication and support. The staff underestimated the patients' degree of satisfaction and overestimated their degree of anxiety.

PRACTICE IMPLICATIONS

Knowledge of patients' degree of satisfaction is important for satisfactory communication with the staff, compliance with treatment and in order to reduce staff's concern for their care.

[Assessment of patient satisfaction after regional anaesthesia in two institutions]

OBJECTIVES

This study was designed to assess patient satisfaction after regional anaesthesia for limb surgery.

METHODS

An anaesthesia satisfaction questionnaire was developed, validated (Kappa coefficient) and submitted to 314 patients operated in two institutions (one university hospital with anaesthesiology residents and one specialised in orthopaedics with experienced anaesthesiologists). Items explored were information modalities, pain and anxiety during procedure and global satisfaction rated with four levels (very satisfied [VS], satisfied [S], partially satisfied [PS], non-satisfied [NS]). Patients were interviewed by telephone at postoperative D1 and D8 by a pharmacist student not involved in the patient's care.

RESULTS

Inspite of a high level of patient satisfaction at D8 (VS: 50%, S: 44%), some interesting aspects should be emphasised: a) sedation given before nerve block was not efficient to reduce anxiety and pain during procedure; b) VS levels decreased from D1 (56%) to D8 (50%) mainly because of late postoperative pain (after discharge) and discomforts; c) willingness to undergo the same nerve block again (294/314) was not correlated with patient's satisfaction since among PS and NS patients, a majority (9/15) wished for a block in case of renewed limb surgery; d) multivariate analysis showed that VS level was highly correlated with the quality of communication by the anaesthesiologist mainly for informations about pre and postoperative periods. No correlation was found with pain level during procedure; e) satisfaction levels were not different in the two institutions.

CONCLUSION

This study has emphasised some important factors of patient satisfaction which were not sufficiently taken into account in our daily practice.

Patient satisfaction with anaesthesia care: What is patient satisfaction, how should it be measured, and what is the evidence for assuring high patient satisfaction?

Patient satisfaction is a part of outcome quality. Many theories of satisfaction include patients' expectation. One definition of satisfaction is therefore the degree of congruence between expectation and accomplishment. The involvement of patients as well as experts is therefore an important step in the development of an instrument to measure patient satisfaction. Results of single-item ratings or overall satisfaction surveys are over-optimistic and do not represent the true indication of care. The construction of highly standardized (psychometric) questionnaires should include elements of content validity, criterion and construct validity, reliability and practicability. Based on the few available studies in anaesthesia, patient satisfaction is primarily determined by information and communication. There is great potential for improvement in this area. However, we do not know the best way to continuously improve patient satisfaction with anaesthesia care, or to what extent decisions should be shared between the anaesthetist and the patient.

Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence

PURPOSE

Although the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia.

METHODS

We adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts.

RESULTS

We noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake.

CONCLUSION

Communication at induction and emergence tends to fall into specific patterns with different emphases but similar functions. This communication work is shared across the anesthetic team. Further work could usefully explore the relationship between communication styles and team performance or indicators of patient safety or well-being.

Educating patients about anaesthesia: effect of various modes on patients' knowledge, anxiety and satisfaction

PURPOSE OF REVIEW

This review summarizes the current research on the effects of preoperative education about anaesthesia on patient knowledge, anxiety, and satisfaction.

RECENT FINDINGS

Misconceptions about the process and the risks of general and regional anaesthesia are common. Information leaflets should be formally assessed to ensure that patient knowledge is increased. Patients should be surveyed to see what information they want, rather than just providing what healthcare professionals think is appropriate. The amount of information requested by patients can vary considerably. Providing detailed drug information leaflets for anaesthetic drugs was not thought necessary by many patients, but was not associated with increased preoperative state anxiety. Information sessions to small groups of patients by multidisciplinary healthcare professionals were useful for patients undergoing total hip arthroplasty, with a small reduction in preoperative state anxiety, but patient satisfaction levels remained unchanged. Patient satisfaction should be measured by a valid and reliable questionnaire. When this was done, the introduction of pamphlets did not improve patient satisfaction. The evidence for better patient outcomes after patient education interventions is not convincing.

SUMMARY

Preoperative patient education should recognize that different patients have various misconceptions, expectations and needs. Multiple modes may be required to increase knowledge for informed consent and decrease patient anxiety. Patient satisfaction is generally high irrespective of the mode of patient education.

Teaching Emergency Airway Management Using Medical Simulation: A Pilot Program

OBJECTIVE

Simulation is a tool that has been used successfully in many high performance fields to permit training in rare and hazardous events. Our goal was to develop and evaluate a program to teach airway crisis management to otolaryngology trainees using medical simulation.

METHODS

A full-day curriculum in the management of airway emergencies was developed. The program consists of three airway emergency scenarios, developed in collaboration between attending otolaryngologists and faculty from the Center for Medical Simulation. Following each scenario, the participants are led in a structured, video-assisted debriefing by a trained debriefer. Didactic material on team leadership and crisis management is built into the debriefings. Pediatric otolaryngology fellows, residents, and medical students have participated in the four courses that have been held to date. Participants evaluated the program on a five-point Likert scale.

RESULTS

A total of 17 trainees participated in four pilot training courses. The survey data are as follows: overall program, 5.0 (SD, 0.00); course goals, 4.79 (SD, 0.43); realism, 4.36 (SD, 0.63); value of lecture, 4.71 (SD, 0.47); and quality of debriefings, 4.92 (SD, 0.28). Sample comments include: "This is a valuable tool for students and residents since true emergencies in ORL are often life-threatening and infrequent," and "This is a great course-really all physicians should experience it." Overall evaluation was extremely positive and both residents and fellows described the course as filling an important void in their education.

CONCLUSION

Medical simulation can be an extremely effective method for teaching airway crisis management and teamwork skills to otolaryngology trainees at all levels.

Effect of timing on the response to postal questionnaires concerning satisfaction with anaesthesia care † ‡

BACKGROUND

There is little information on the effect of time on the assessment by the patient of quality of anaesthesia care. This study compared the patient's assessment of anaesthesia care after three different periods of time following discharge from hospital. Materials. Three groups of patients were assigned to receive a standardized, validated psychometric questionnaire either 1, 5, or 9 weeks after discharge from hospital. We measured response rate and the total mean problem score of six dimensions.

RESULTS

Groups 1, 2, and 3 received 748, 743, and 723 questionnaires, respectively. The response rates including one reminder were 67.3 (95% confidence interval [CI] 63.9-70.6%), 64.5% (CI 61.1-67.9%), and 58.9% (CI 55.5-62.4%), respectively (Group 1 vs Group 3, P<0.001, and Group 2 vs Group 3, P<0.05). The total mean problem scores were not significantly different with 17 (CI 1.4%), 17 (CI 1.4%), and 15% (CI 1.3%), respectively. In two out of six dimensions ('Continuity of personal care by anaesthetist' and 'Nursing care in recovery room') significantly less problems were reported after 9 weeks. The other dimensions of the questionnaire showed no consistent differences between groups.

CONCLUSIONS

The response rate is significantly lower at 9 weeks compared with 1 and 5 weeks after discharge. The total mean problem score remains unchanged but certain fields show fewer problems after 9 weeks compared with 1 and 5 weeks. Questionnaires on patient satisfaction with anaesthesia care should be sent within 5 weeks of discharge.

A quantitative analysis of anaesthetist-patient communication during the pre-operative visit

Previous communication research in general medical practice has shown that effective communication enhances patient compliance, satisfaction and medical outcome. It is expected that communication is equally important in anaesthesia, since patients often suffer from anxiety and lack of knowledge about anaesthetic procedures. However, little is known about the nature of communication during routine anaesthetic visits. The present study of 57 authentic anaesthetic visits provides the first results on the structure and content of communication in the pre-operative setting using the Roter Interaction Analysis System (RIAS). Patient-centred communication behaviours of anaesthetists and the extent of patient involvement were particularly investigated. From the 57 pre-operative visits, 18 267 utterances were coded. The mean (SD) [range] duration of the visit was 16.1 (7.8) [3.7-42.7] min. Anaesthetists provided 169 (68) and patients 153 (82) utterances per visit (53.5% vs. 46.5%). Physician and patient gender had no impact on the distribution of utterances and the duration of the visit. Conversation mainly focussed on biomedical issues with little psychosocial discussion (< 0.1% of all anaesthetist utterances). However, anaesthetists quite frequently used emotional comments toward patients (7%) and involved them in the conversation. The use of facilitators, open questions and emotional statements by the anaesthetist correlated with high patient involvement. The amount of patient participation in anaesthetic decisions was assessed with the Observing Patient Involvement Scale (OPTION). Compared with general practitioners, anaesthetists offered more opportunities to discuss treatment options (mean (SD) OPTION score 26.8 (16.8) vs. 16.8 (7.7)).