Patient concerns at hospital admission

How do National Health Service (NHS) organisations respond to patient concerns? A qualitative interview study of the Patient Advice and Liaison Service (PALS)

OBJECTIVES

To describe the current work of the Patient Advice and Liaison Service (PALS) and assess the service's potential to resolve concerns and contribute to organisational learning.

DESIGN

A qualitative study using semistructured interviews.

SETTING

Four mental health trusts and four acute trusts in the English National Health Service, a total of eight PALS across different trusts.

PARTICIPANTS

Twenty-four participants comprising of PALS staff and clinicians working with PALS teams.

METHODS

Semistructured interviews were undertaken with participants using video conferencing software. The framework method was used for the analysis of the large qualitative dataset, which is a conventional method of analysis, similar to thematic or qualitative content analysis.

RESULTS

PALS teams fulfil their core responsibilities by acting as point of contact for patients, providing information and resolving a variety of recurrent problems, including PALS staff communication, staff attitudes and waiting times. The remit and responsibilities of each PALS has often broadened over time. Barriers to resolving concerns included a lack of awareness of PALS, limited to no policies informing how staff resolve concerns, an emphasis on complaints and the attitude of clinical staff. Senior management had widely differing views on how the PALS should operate and the management of complaints is a much higher priority. Few PALS teams carried out any analysis of the data or shared data within their organisations.

CONCLUSIONS

PALS teams fulfil their core responsibilities by acting as point of contact for patients, providing information and resolving concerns. PALS staff also act as navigators of services, mediators between families and staff and, occasionally, patient advocates in supporting them to raise concerns. PALS has the potential to reduce complaints, increase patient satisfaction and provide rapid organisational feedback. Achieving this potential will require more awareness and support within organisations together with updated national policy guidance.

Assessment of patient concerns: a review

BACKGROUND

Patient-centred communication is the mainstay of the medical consultation. It includes the assessment of patient concerns and is important in building the doctor-patient therapeutic relationship. Our aim was to perform a literature review to identify relevance of patient concern assessment, to identify what concerns are encountered in various clinical settings and to explore the different methodologies used to obtain them.

METHODS

A narrative review was performed.

RESULTS

Addressing patient concerns is associated with increased patient satisfaction. Unvoiced concerns are associated with unresolved health issues and poor doctor-patient relationships. Different specialities have focused on different aspects of concern assessment. Patient concern assessment studies are mostly qualitative in nature. Not all qualitative methods give similar results. Interviews are more reliable sources of information than questionnaires as no one questionnaire captures all patient concerns. The location where interviews take place is also relevant.

CONCLUSIONS

Assessing patient concerns is associated with positive outcomes. Patient concerns are handled differently by different clinical specialties. Various methodologies have been used for concern assessment. Interviews and questionnaires can often yield different results.

Associations of Physician Empathy with Patient Anxiety and Ratings of Communication in Hospital Admission Encounters

OBJECTIVE

To assess the association between the frequency of empathic physician responses with patient anxiety, ratings of communication, and encounter length during hospital admission encounters.

DESIGN

Analysis of coded audio-recorded hospital admission encounters and pre- and postencounter patient survey data.

SETTING

Two academic hospitals.

PATIENTS

Seventy-six patients admitted by 27 attending hospitalist physicians.

MEASUREMENTS

Recordings were transcribed and analyzed by trained coders, who counted the number of empathic, neutral, and nonempathic verbal responses by hospitalists to their patients' expressions of negative emotion. We developed multivariable linear regression models to test the association between the number of these responses and the change in patients' State Anxiety Scale (STAI-S) score pre- and postencounter and encounter length. We used Poisson regression models to examine the association between empathic response frequency and patient ratings of the encounter.

RESULTS

Each additional empathic response from a physician was associated with a 1.65-point decline in the STAI-S anxiety scale (95% confidence interval [CI], 0.48-2.82). Frequency of empathic responses was associated with improved patient ratings for covering points of interest, feeling listened to and cared about, and trusting the doctor. The number of empathic responses was not associated with encounter length (percent change in encounter length per response 1%; 95% CI, -8%-10%).

CONCLUSIONS

Responding empathically when patients express negative emotion was associated with less patient anxiety and higher ratings of communication but not longer encounter length.

Patient expectations of emergency hospital admission: a cross-sectional questionnaire survey

OBJECTIVES

Emergency admissions are rising, but little is known about the patient perspective. We aimed to explore the views of patients assessed for admission in terms of (i) whether they expected to be admitted, (ii) the comfort, convenience and safety of admission and (iii) whether satisfaction with care was influenced by expectations of admission being met.

PATIENTS AND METHODS

We undertook a cross-sectional survey of 200 patients who arrived by emergency ambulance and were assessed for the need for admission. Patients completed a questionnaire that recorded their expectations of hospital admission before a decision was made to admit or discharge and their satisfaction with the decision when it was made.

RESULTS

The study population was 63% (127/200) female, with a mean age of 61 years. Around 45 of 200 (22.5%) patients expected themselves to be admitted, whereas 85/200 (42.5%) were actually admitted. Responses indicated that 74.5% [95% confidence interval (CI) 68.0-80.0%] agreed or strongly agreed that they felt safer in hospital than at home, 47.5% (95% CI 40.7-54.4%) felt more comfortable in hospital and 86.0% (95% CI 81.1-90.6%) agreed that it would be easier to provide treatment for them if they were admitted. We found no evidence of an association between patient satisfaction and expectations being met in those expecting admission (P=0.301) or expecting discharge home (P=0.885).

CONCLUSION

Most patients being assessed for admission do not expect to be admitted, but most report positive views about the safety, comfort and convenience of hospital admission. We found no evidence of reduced satisfaction if expectations about admission are not met.