|Year : 2007 | Volume
| Issue : 2 | Page : 106
Influence of multi-level anaesthesia care and patient profile on perioperative patient satisfaction in short-stay surgical inpatients: A preliminary study
Amarjeet Singh1, Amitabh Dutta2, Jayshree Sood3
1 M.D., Sr. Consultant, Department of Anesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060, India
2 M.D., Consultant, Department of Anesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060, India
3 M.D., FFARCS, PGDHHM, Sr. Consultant and Chairperson, Department of Anesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060, India
|Date of Acceptance||20-Jan-2007|
|Date of Web Publication||20-Mar-2010|
M.D., Consultant, Department of Anesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060
Source of Support: None, Conflict of Interest: None
Background and goals of study: Patient satisfaction in relation to perioperative anesthesia care represents essential aspect of quality health-care management. We analyzed the influence of multi-level anesthesia care exposure and patient profile on perioperative patient satisfaction in short-stay surgical inpatients.
Methods : 120 short-stay surgical inpatients who underwent laparoscopic surgery have been included in this prospective study. Pertaining to demographic parameters (age, gender, education, profession), duration of stay (preoperative room, recovery room), various patient problems and patient satisfaction (various levels, overall) were recorded by an independent observer and analyzed. Overall, adults, male and uneducated patients experienced more problems. Conversely, elderly, females and educated patients were more dissatisfied. Female patients suffered more during immediate postoperative recovery room stay and were more dissatisfied than their male counterparts (p<0.05). However, patient's professional status had no bearing on the problems encountered and dissatisfaction levels. Preoperative and early postoperative period accounted for majority of the problems encountered among the study population. There was a positive correlation between problems faced and dissatisfaction experienced at respective levels of anesthesia care (p<0.05).
Conclusion(s) : Patient's demographic profile and problems faced during respective level of anesthesia care has a correlation with dissatisfaction. Interestingly, none of the above stated factors had any effect on overall satisfaction level.
Keywords: Patient satisfaction, Anaesthesia care, Perioperative, Inpatients, Surgical
|How to cite this article:|
Singh A, Dutta A, Sood J. Influence of multi-level anaesthesia care and patient profile on perioperative patient satisfaction in short-stay surgical inpatients: A preliminary study. Indian J Anaesth 2007;51:106
|How to cite this URL:|
Singh A, Dutta A, Sood J. Influence of multi-level anaesthesia care and patient profile on perioperative patient satisfaction in short-stay surgical inpatients: A preliminary study. Indian J Anaesth [serial online] 2007 [cited 2020 Oct 30];51:106. Available from: https://www.ijaweb.org/text.asp?2007/51/2/106/61123
| Introduction|| |
Patient satisfaction represents an essential part of quality management. Many factors contribute to patient satisfaction including accessibility and convenience of services that depend upon institutional structure, interpersonal relationships, competence of health professionals and patient's own expectations and preferences.,,
In clinical settings, such as anaesthesia, using patient satisfaction as an indicator to monitor the quality of clinical care has potential merit. For patients, satisfaction represents an evaluation of the healthcare experience based on their own values, perceptions and interaction with the environment. For the service provider, patient satisfaction can be used to assess the actual impact of healthcare processes on the patients. Patients' ratings of their satisfaction can reflect many facets of care, such as, compassionate bedside skills, efficient attention to needs, participation in decision-making, adequate communication and information  which is not easily examined in any other manner.
Satisfaction with health care is usually very high (>85%). , Consequently, it is difficult to identify a representative sample of patients dissatisfied with care without studying a large population. Only a few studies in anaesthesia have assessed patient satisfaction, mostly restricted to day-case surgical patients. ,,,,
A renewed focus has been sought for patient satisfaction as a clinical end-point and a quality indicator of anesthesia care. Assessing minor outcomes (such as pain and nausea) pose significant methodological problems of uncertain case mix, inconsistent reporting compliance, imprecise definitions and under and over-reporting.
Keeping in view that surgical inpatients with longer stay in hospital have associated morbidity that renders patient satisfaction an unimportant issue whereas the day-case surgical patients have little time to observe, adjust and feel the care that is given to them. Therefore, we undertook this preliminary study in short stay surgical patients (~ 48 hr stay) to analyse;
- Patient satisfaction in relation to multilevel anaesthesia care services.
- To correlate patient satisfaction (overall and multilevel) with various patient parameters (age, sex, education, profession, duration of stay).
| Material and methods|| |
The study was carried out in a super-speciality referral hospital (Sir Ganga Ram Hospital, New Delhi) having an annual turnover of over 20,000 surgical procedures of which inpatients and outpatients contribute 65% and 35% respectively. Among inpatients, short stay patients (admission < 48 hrs) account for 40% of the cases.
120 short-stay surgical inpatients were included in this prospective investigation. All the patients were electively scheduled for laparoscopic procedures (gynaecologic, cholecystectomy, hernia repair, appendicectomy, etc). Anaesthesia care was divided into five discrete levels: i) preanaesthetic checkup (PAC) visit, ii) preoperative holding area stay, iii) stay inside operation room (OR), iv) immediate postoperative recovery room stay and v) the patient's room on the following morning. They were interviewed by a dedicated anaesthesia physician on the first morning after the operation, before the routine surgical rounds. The physician (blinded to anesthesia care) completed a *questionnaire (both objective and subjective responses) (Appendix I) pertaining to various levels of perioperative anesthesia care which was finally handed to the patient for verification (or in case they wanted to add anything). The following data were recorded:
Demographic data: Age [adult (<60 yr), elderly (> 60 yr)], gender (male / female), educational background (uneducated / educated), profession (working / non-working) and duration of procedure, preoperative room stay and recovery room stay.
Patient Problems : Various problems encountered during PAC, in preoperative holding area, in OR, in the recovery room area and the morning after first postoperative visit, were recorded.
Patient Satisfaction: Patient satisfaction (satisfied / unsatisfied) was assessed at designated levels of anesthesia care. Besides the respective satisfaction levels, an overall satisfaction profile was also obtained.
The collected data were subjected to statistical analysis utilizing SPSS 9.0 software (Michigan, USA) for the windows. Comparison of demographic data, duration of stay with level of satisfaction and problems faced during perioperative period was carried out by crosstab analysis (Pearson's-Chi square test or Fisher exact test as appropriate). Various correlation parameters were analysed using Kendall's tau correlation coefficient. A p-value less than 0.5 was considered significant.
| Results|| |
120 patients completed the questionnaire over the study period. Majority of them were adults (age 20-60 yrs; n=91) and educated (n=99). However, they were equivalent in regard to gender (Male; n=56 / Female; n=64) and work status (working; n=58 / non-working; n=62) [Table 1].
There were more working males (n=40) than females (n=18) (p <0.05). Gender wise, males and females were comparable in respect to education and age (p>0.05) [Table 2].
| Problems Encountered|| |
Age: Problems faced during preoperative checkup, preoperative stay and postoperative period were expressed more clearly by adults than elderly people (p >0.05). However, elderly patients faced more problems during the intraoperative and recovery period.
Work status : The problems experienced during various levels of care were comparable.
Education : Uneducated patients complained more than their educated counterpart in the postoperative period (p > 0.05). At other stages of anaesthesia the problems faced by educated versus uneducated patients were equivocal.
Gender : The m ale patients expressed more than the females during PAC (p > 0.05). Conversely, the females complained more than the males in the postoperative period (p <0.05) [Table 3]. However, they were comparable during preoperative stay, intraoperative period and the recovery room stay.
| Satisfaction|| |
Females were significantly more dissatisfied than males during the postoperative period (p < 0.05). Although, females were more dissatisfied during the other levels of anaesthesia care, yet it was not statistically significant (p >0.05). The patients were comparable in regard to their work status for the level of dissatisfaction during the perioperative care stages. The educated people showed greater dissatisfaction than the uneducated patients at all levels of anaesthesia care except for the postoperative period where they were comparable (p >0.05). Similarly, elderly patient population showed lack of satisfaction over that of adult patients, which was not significant (p>0.05) [Table 4].
| Duration of stay|| |
Duration of stay in the preoperative holding area significantly correlated with the preoperative period problems and satisfaction levels. Overstay in preoperative holding area was more dissatisfying. However, neither the duration of surgery nor the duration of stay in the recovery room had any effect on problems faced and corresponding satisfaction at various levels [Table 5].
The problems faced by patients during various levels of anaesthesia care (PAC, pre-operative holding area, in the OR recovery room, post-operative period) had significant correlation to respective dissatisfaction levels (p < 0.05) [Table 6].
| Discussion|| |
The study of patient satisfaction involves difficult basic issues, including the diversity of definitions and patient perception. Patient satisfaction has been outlined by objective and subjective measures. Objective measures are defined by the care provider; which involve patient progress and treatment outcome. ,, Subjective measures evaluate patient satisfaction by determining "the provider's success at meeting client's expectations.  Often, patients have been found to be more concerned with the interpersonal skills of hospital staff than with their technical skills and competence.  In addition, expressions of patients are usually biased to please staff and to avoid repercussions for negative care appraisal. , Thus, in defining the quality of care as perceived by patients, assessment of all three aspects, i.e., the structure of the institution, the processes that enable the services to be delivered and the outcome (including patient satisfaction) is essential to obtain a reliable result.
Traditionally, the previous studies on patient's satisfaction have focussed primarily on the recovery indices i.e, postoperative problems, duration of recovery room stay and discharge profile, etc. ,,, Some of the negative experiences, which are albeit transient, may be of significant concern to the patients, but may not always amount to global dissatisfaction. ,, In addition, patient's experiences of human contact (professional and nonprofessional) from the point of admission to the actual day of surgery may have an impact on overall satisfaction. This can result in patient dissatisfaction and / or negative recollections.
Our self-designed questionnaire included certain objective and subjective items which the patient could easily answer without getting unduly stressed up. It was filled up via a personal interview conducted by an anaesthesia physician not involved in anaesthesia care. The questionnaire included structured items that related directly or indirectly to the patient care at various stipulated levels of exposure to anaesthesia care. Notably, the personal interview was conducted and questionnaire was filled up on the first postoperative morning well before the surgical team visited the patient. This was undertaken to rule out any surgical outcome related influences that may affect patient's response. Moreover, this may have also excluded the effects of the surgeon's opinion on anaesthesia contribution to negative surgical outcome, if any.
Patient satisfaction with perioperative care remains largely undiscovered. With only preliminary investigation available, whole results are modified by several confounding variables, which include assessment of satisfaction at the end of postoperative period when patient's judgments are clouded by outcome of surgery, interaction with attendants and various health-care professionals and other environmental factors. Patients may often modify the responses to the anaesthesia care provided along the run-up to the actual surgical procedure (false positive patient satisfaction). Alternatively sometimes the patients may be unwilling to criticize their doctors and nurses, because they are so relieved that they have "got over" with the operation. Since the problems faced during various levels of anaesthesia care may have significant correlation to respective dissatisfaction levels, the strategic corrective measures are desirable for different levels of care.
In our study, the patients complained of some problem or other during the perioperative anesthesia care: postoperative period (75%), preoperative assessment (24%), preoperative holding area (14%) and recovery room stay (5%). Conversely, overall 65% of patients were quite satisfied. Majority of problems encountered during postoperative stay were secondary to non-anaesthesia issues reflected upon it because of negative patient outburst.
The input derived from above stated observations revealed that elderly, females and uneducated patients suffered more during the recovery room stay and postoperative period than their counterparts. However, the work background of the patients did not contribute significantly to the ultimate dissatisfaction levels. Peculiarly, although the problems faced by patients correlated significantly to the level of dissatisfaction, it had no effect over the overall outcome. This may be due to overall outcome being largely dependent on the surgical outcome. Once the patient gets reassured of a correct / optimal outcome of surgery, he/she forgets the hardship faced during different levels of anaesthesia care. Of course it is uncertain whether this questionnaire would be suitable for other institutions or different settings. In addition, the simple ratings of patient satisfaction used in the anaesthesia survey form may be inadequate to address the complexity of the problems.
This preliminary study was carried out over a period of six months only because at our institution the continual policy review and changes in regard to perioperative surgical patients care take place biannually and that the implementation of improved newer directions (keeping in view the feedback our study yielded) were not consistent with our study design in terms of applicability. We, therefore, recommend based on our study, a larger prospective trial to substantiate the results and enhancement of care as desirable.
A traditional definition of satisfaction is "the degree of congruence between expectation and accomplishment". From the patient's point of view, quality of outcome is of major importance and satisfaction is part of it. Therefore, the subjective perception of the patients about the care they received should be an integral part of satisfaction profile measurement. Furthermore, one should consider the confounding factors that may influence outcome though not directly related to causal elements.  Most surveys about patient satisfaction focus only on single item or cover management aspects, side effects like, PONV and postoperative pain, in which data from different studies showed wide difference between dimensions of satisfaction with anaesthesia care in relation to various graded responses given in questionnaires. ,
As per very recent landmark studies, the questionnaire measuring anaesthesia satisfaction, apart from the conventional question "are you satisfied with the anaesthetic"? needs to cover areas relating to 'patients information,' 'continuity of care by anaesthetist,' 'delay management,' 'nursing care,' 'pain management' and 'respect'. , Importantly, 'follow up timing' and 'social desirability' influence overall satisfaction.  We therefore, chose a questionnaire (appendix) that included stage-wise anaesthesia care and patient responses involving variable intermix of subjective and objective indices. Keeping in view the validity of follow-up time, we undertook the process of questionnaire answered on the first postoperative day or 24 hours post surgery time whichever was later. We deliberately carried out the assessment via personal communication  undertaken by an independent anaesthesia physician.
| Conclusion|| |
In future, anaesthesiologists should get more and more intricate with the patient care during the preoperative visit, patient preparation and subsequent postoperative care while actively getting out of their perceived role of being restricted to immediate preoperative and intraoperative care. Our study strengthens this viewpoint and these endeavours may result in greater satisfaction among the patients towards perioperative anaesthesia care.
| References|| |
|1.||Ward SE, Gordon D. Application of the American Pain Society quality assurance standards. Pain 1994; 56: 299-306. [PUBMED] |
|2.||Westbrook JII. Patient satisfaction. Methodological issues and research findings. Aust Health Rev 1993; 16: 75-88. |
|3.||Hall JA, Dornan Me. What patients like about their medical care and how often they are asked. A meta-analysis of the satisfaction literature. Soc Sci Med 1988; 27: 935-39. |
|4.||Allshouse K. Treating patients as individuals. In: Gerteis M, Edgman-Levitan S, Daley J, Debanco T, editors. Through the patient's eyes. 2nd ed. San Franscisco: Jossey-Bass 1993: 19-43. |
|5.||Fitzpatrick R. Surveys of patient satisfaction: II-designing a questionnaire and conducting a survey. BMJ 199;302:1129-32. |
|6.||Tong D, Chung F, Wong D. Predictive factors in global and anesthesia satisfaction in ambulatory surgical patients. Anesthesiology 1997; 87: 856-64. [PUBMED] [FULLTEXT] |
|7.||Osborne GA, Rudkin GE. Outcome after day-care surgery in a major teaching hospital. Anaesth Intensive Care 1993;21: 822-27. [PUBMED] |
|8.||O'Connor SJ, Gibberd RW, West P. Patient satisfaction with day surgery. Aust Clin Rev 1991; 11: 143-49. [PUBMED] |
|9.||Harju E. Patient satisfaction among day surgery patients in a central hospital. Qual Assur Health Care 1991; 3: 85-88. [PUBMED] |
|10.||PineauIt R, Contandriopoulos AP, Valoris M, et al. Randomised clinical trial of one day surgery: patient satisfaction, clinical outcomes and costs. Med Care 1985; 23: 171-82. |
|11.||Bond S, Thomas LH. Measuring patient's satisfaction with nursing care. J Adv Nurs 1992; 17: 52-63. [PUBMED] |
|12.||Abdellah F, Levine E. Developing a measure of patient and personnel satisfaction with nursing care. Nurs Res 1957; 5: 100-08. |
|13.||Locker D, Dunt D. Theoretical and methodological issues in sociological studies of consumer satisfaction with medical care. Soc Sci Med 1978; 12: 283-92. [PUBMED] |
|14.||Donabedian A. The definition of quality and approaches to its measurement. Ann Arbor, Michigan, Health Administration Press. 1980. |
|15.||Sira ZB. Affective and instrumental components in the physician-client relationship. J Health Soc Behav 1980; 21: 170-80. |
|16.||Pearson A, Durand I, Punton S. Determining quality in a unit where nursing care is the primary intervention. J Adv Nurs 1989; 14: 269-73. |
|17.||Raphael W. Do we know what the patients think? A survey comparing the views of patients, staff and committee members. Int J Nurs Stud 1967; 4: 209-23. [PUBMED] [FULLTEXT] |
|18.||Forrest JB, Cahalan MK, Rehder K et al. Multicenter study of general anesthesia. II. Results. Anesthesiology 1990; 72: 262-68. |
|19.||Cohen MM, Duncan DG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994; 78: 7-16. |
|20.||Lee A, Lum ME. Measuring anesthetic outcomes. Anaesth Intens Care 1996; 24: 685-93. |
|21.||Cohen MM, Duncan DG, Pope WDB, Wolkenstein C. A survey of 112,000 anaesthetics at one teaching hospital (1975-1983). Can J Anaesth 1987; 33: 22-31. |
|22.||Moerman N, van Dam FSAM, Costing J. Recollections of general anaesthesia: a survey of anaesthesiological practice. Acta Anaesthesiol Scand 1992; 36: 767-71. |
|23.||Dexter F, Aker J, Wright WA. Development of a measure of patient satisfaction with monitored anaesthesia care. Anesthesiology 1997; 87: 856-64. |
|24.||Grimes DA, Schulz KF. Bias and causal associations in observational studies. Lancet 2002; 359: 248-52. [PUBMED] [FULLTEXT] |
|25.||Jenkinson C, Coulter A, Bruster S et al. Patients experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Qual Saf Health Care 2002; 11: 335-39. |
|26.||Heidegger T, Nuebling M et al. Patients satisfaction with anaesthesia care: information alone dose not lead to improvement. Can J anaesth 2004; 51: 8015. |
|27.||Myeles PS, Williams DL, Hendrata M et al. Patient satisfaction after anaesthesia and surgery: results of prospective survey of 10811 cases. Br J Anaesth 2000; 84: 6-10. |
|28.||Heidegger T, Husemann Y, Nuebling H et al. Patients satisfaction with anaesthesia care: development of a psychometric questionnaire and benchmarking among six hospitals in Switzerland and Austria. Br J Anaesth 2002; 89: 863-72. |
|29.||Harms C, Young JR, Amsler F et al. Improving anesthetists communication skills. Anaesthesia 2004; 59: 166-72. |
|30.||Saal D, Nuebeling M, Husemann Y et al. effect of timing on the response to postal questionnaire concerning satisfaction with anaesthesia care. Br J Anaesth 2005; 94(2): 206-10. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]