La satisfacción de los pacientes hospitalizados como indicador de la calidad asistencial

The Evolution of Patient Satisfaction in Postoperative Care: The Impact of Investments and the Algorithm for Assessing Significant Growth over the Last 5 Years

An analysis of patient satisfaction in the context of healthcare reflects the patient's perception of actual care through the prism of their expectations of ideal care. A study was conducted to investigate patient satisfaction with postoperative care in the context of improvements in hospital medical services (renovations and modernization of operating rooms and wards with beds, endowments in medical equipment for investigation and treatment, new work procedures, and revisions of existing procedures). Statistical analysis was performed based on the questionnaires distributed to patients hospitalized in the surgical wards of the Bihor County Emergency Clinical Hospital, between 2019 and 2023. A total of 4018 questionnaires were collected, and after the elimination of questionnaires with incomplete or incorrect data, 3985 remained in the analysis. Of the total of 2994 people who reported having undergone surgery, a total of 2090 responded to the questions that focused on postoperative care and overall impression of the hospital. No statistically significant differences in patient satisfaction by sociodemographic factors were found. A statistically significant increase in patient satisfaction with postoperative care and overall impression of the hospital was observed over the last 5 years. Correlation testing between postoperative care responses and overall impression, using the Sperman method, shows a directly proportional relationship between the two variables. In the future, it is necessary to extend the patient satisfaction questionnaire to comprehensively analyze the surgical component in order to identify gaps in postoperative care, helping decision makers to improve the medical services provided to patients.

Inhaled Methoxyflurane Provides Greater Analgesia and Faster Onset of Action Versus Standard Analgesia in Patients With Trauma Pain: InMEDIATE: A Randomized Controlled Trial in Emergency Departments

STUDY OBJECTIVE

The objective of the InMEDIATE study was to evaluate the change in intensity of traumatic pain over the first 20 min in adult patients treated with methoxyflurane versus standard analgesic treatment in Spain. This the first randomized, active-controlled, multicenter trial of methoxyflurane in the emergency setting in Europe.

METHODS

This was a randomized, controlled study that enrolled adult patients with acute moderate to severe (score ≥4 on the 11-point Numeric Rating Scale) trauma-associated pain in 14 Spanish emergency departments. Patients were randomized 1:1 to methoxyflurane (up to 2×3 mL) or standard analgesic treatment. Coprimary endpoints were the change from baseline in Numeric Rating Scale pain intensity score during the first 20 minutes of treatment and time to first pain relief.

RESULTS

Three hundred five patients were randomized (methoxyflurane 156; standard analgesic treatment 149). Most patients in the standard analgesic treatment group (70%) received intravenous first-step analgesics and 9.4% of patients were treated with opioids. Mean decrease from baseline in Numeric Rating Scale pain intensity score was greater for methoxyflurane than standard analgesic treatment at all points, with a significant treatment difference overall up to 20 minutes (repeated-measures model 2.47 versus 1.39; treatment difference 1.00; 95% confidence interval 0.84 to 1.32). Median time to first pain relief was significantly shorter for methoxyflurane than standard analgesic treatment (3 versus 10 minutes). Methoxyflurane achieved better patient and clinician ratings for pain control and comfort of treatment than standard analgesic treatment and exceeded patient and clinician expectations of treatment in, respectively, 77% and 72% of cases compared with 38% and 19% for standard analgesic treatment.

CONCLUSION

These results support consideration of methoxyflurane as a nonnarcotic, easy-to-administer, rapid-acting, first-line alternative to currently available analgesic treatments for trauma pain.

Factors associated with patients' and companions' satisfaction with a hospital emergency department: A descriptive, cross-sectional study

AIM

The aim was to study the level of satisfaction with an emergency department and to identify the factors associated with satisfaction.

DESIGN

This research consisted of a descriptive, cross-sectional study.

METHODS

The study population was composed of patients and companions who visited the emergency department during a three-month period. The patients were selected randomly from the register of visits to the emergency department during the period of study. Sociodemographic variables and variables related to the attention received were studied through questionnaires (response rate 33%).

RESULTS

Older age was associated with greater satisfaction (p = 0.002), as was female sex (p = 0.013) and greater optimism (p < 0.001). Greater control of pain was a factor associated with satisfaction (p = 0.033), as was the perception of a shorter waiting time before the medical visit (p < 0.001).

Satisfaction of surgical patients with perioperative nursing care in a Spanish tertiary care hospital

OBJECTIVE

Although numerous studies have assessed patient satisfaction in diverse settings, in the realm of nursing surgical care, standardization of measurement for patient experience and satisfaction is lacking. Therefore, the aim of this study was to assess the satisfaction of surgical patients with perioperative nursing care.

METHOD

A descriptive cross-sectional survey was conducted. Sociodemographic characteristics and clinical data were recorded. Patient satisfaction was measured with a modified version of the La Monica-Oberst Patient Satisfaction Scale (LOPSS-12).

RESULTS

150 patients (73 women, 49% and 77 men; 51%) completed the survey. The mean age was 63 years (standard deviation, 16 years). The mean overall satisfaction score on the La Monica-Oberst Patient Satisfaction Scale was 3.17 (standard deviation, 0.21). The scale showed adequate content validity (Lawshe's Content Validity Index was 0.76) and moderate reliability (Cronbach's alpha = 0.70). Two variables-patient sex and the presence of comorbidities-were significantly associated with overall satisfaction: men and patients with comorbidities were more satisfied with the care received. Patients with university studies were significantly more likely than patients with less education to consider nurses "impatient," but also considered the nurses' advice to be "useful." Patients with hospital-acquired complications were more likely to perceive nurses to be "more interested in completing tasks than in listening," although they also felt that nurses worked "conscientiously."

CONCLUSION

Overall, patient satisfaction with perioperative nursing care was good. This study identified several areas of nursing care in need of improvement, particularly the need to spend more time with patients and to keep them better informed about the perioperative process. The modified La Monica-Oberst Patient Satisfaction Scale is suitable for measuring surgical patient satisfaction with perioperative nursing care. The findings presented here may be of value to nursing administrators, educators, and nursing care providers to improve patient satisfaction and to develop strategies to prevent patient dissatisfaction.

Patient Satisfaction with Spanish Pain Centers: Observational Study with More than 3,000 Patients

Chronic pain is a serious problem in Spain. This multicenter, epidemiological 3-month follow-up study investigates pain management efficacy in Spanish centers using patient satisfaction criteria. 3,414 eligible adult patients (65,6% female) with moderate to severe chronic pain from 146 pain centers were included. Patient satisfaction was assessed based onto question 18 of Spanish healthcare barometer-CSI. Pain evolution (Brief Pain Inventory-Short Form (BPI-SF) and visual analog scale (VAS)), quality of life/EuroQol-5, and pain control expectations fulfillment were also assessed. Mean age was 61.3 years. 64.4% of participating centers employed multidisciplinary pain management approach. After 3 months, mean patient satisfaction was 7.8 (1-10) on the CIS barometer. Medical staff received the highest scores, whereas waiting for tests, appointment request to appointment date time, and waiting times at the center the lowest. Mean pain decreased from 7.4 to 4.0; BPI-SF intensity decreased from 6.5 to 3.8; pain control expectations were met in 78.7% of patients; EuroQoL-5D utility index increased from 0.37 to 0.62, p < 0.001, and health status (VAS) from 40.6 to 61.9, p < 0.001. Chronic pain patients (90%) are satisfied with Spanish centers care; 80% had their pain control expectations met. Quality of life improved remarkably: 71% felt moderately to significantly better. However, waiting times need improvement.

[Implementation of a best practice guideline for the prevention of falls: Perception among hospitalized patients and its caregivers]

OBJECTIVE

To analyze the influence that the implementation of a fall prevention Best Practice Guideline (BPG) could have on the perception of patients and their caregivers about the utility of the activities implemented, about the care provided during admission and the adherence (the level of follow-up) to the recommendations received at discharge.

MATERIAL AND METHOD

Design. Quasi-experimental study. Patients >65 years admitted≥48h to the Medical Area of the General Hospital of Albacete.

SAMPLE

104 subjects (consecutive sampling January-March 2013). Experimental group (EG). Patients admitted to BPG implementation units. Control group (CG). Usual care units.

VARIABLES

Sociodemographic characteristics; previous and during admission falls, cognitive status (Pfeiffer); independence in daily life activities (ADLs); satisfaction with care and information provided, utility perceived, adherence to recommendations at discharge.

DATA SOURCES

Interview and clinical history. Statistical analysis (SPSS 15.0). Descriptive and bivariant. Relative Risk. CI95%.

RESULTS

104 patients, EG 46.2% (48) and CG 53.8% (56). Women 51.9%, average age 79.9 years (s.d.=7.8). Pfeiffer 4,3 (s.d.=3.7). Previous falls 31.1%. In process, 1 fall in each group. There were statistically significant differences between EG/CG: age, cognitive status and independence in ADLs. In the EG was higher the percentage of perception about the usefulness of the recommendations to prevent falls (P<.001), greater adherence to them (P=0.0002), and to be very or quite satisfied with the information (P<.00004) and care received (P=.002).

CONCLUSION

To implement recommendations according to an Evidence-based BPG to prevent falls in older people has shown, in users and caregivers, greater satisfaction, better perception of its usefulness and greater adherence to the recommendations.

[Perception of UCI nurses in relation with satisfactory care: convergences and divergences with the perception of critical patients]

OBJECTIVE

Explore convergences and divergences between perception of nurses and of critically ill patients, in relation to the satisfactory care given and received.

METHODS

It is part of a larger qualitative study, according to the Grounded Theory. Carried out in 3 intensive care units with 34 boxes. Sampling theoretical profiles with n=19 patients and n=7 nurses after data saturation. Recruitment of patients included in the profiles of elderly and long-stay got stretched over some time due to the low incidence of cases. Data collection consisted of: in-depth interview to critically ill patients, group discussion of expert nurses in the critical care patient and field diary. Analysis themed on Grounded Theory according Strauss and Corbin: open coding, axial and selective. Analysis followed criteria of Guba and Lincoln rigor, Calderón quality and Gastaldo and McKeever ethical reflexivity. There was a favorable report from the ethical committee of the Hospital and informed consent of the participants.

RESULTS

Four matching categories were found: professional skills, human, technical and continued care. Combination of these elements creates feelings of security, calmness and feeling like a person, allowing the patient a close and trusting relationship with the nurse who takes individualized care. Not divergent categories were found.

CONCLUSIONS

Perceptions of nurses in relation to care match perceptions of critically ill patients in both the definition and dimensions upon satisfactory care.

[Factors related to dissatisfaction and anger in parents of children treated at paediatric emergency services]

AIM

Anger in patients and relatives is very frequent in health emergency services and is often associated with aggressiveness and emotional alterations. The aim of the present study is to explore anger in parents while their children are receiving care in paediatric emergency services, seeking the specific dimensions of dissatisfaction that may predict the onset of anger in parents.

MATERIALS AND METHODS

A cross-sectional descriptive study using a self-report questionnaire in 711 parents of children seen in paediatric emergency departments. The self-report questionnaires used were the State-Trait Anger Expression Inventory-2 (STAXI-2) and the Satisfaction with Healthcare Services Scale. The statistical analysis included descriptive, correlational, variance and multiple linear regression models.

RESULTS

A total of 53 parents (7,5%) showed a moderate or high anger level. The mean score for satisfaction was 37.12 (SD=7.33). It was found that higher levels of overall satisfaction were significantly associated with lower levels of anger (r=-.29, p=.00). Among the variables studied, dissatisfaction with access to the service (β=-.172, p=.00), with the healthcare staff (β=-.121, p=.01), and perceived severity of the child's health status (β=.157, p=.00) predicted higher levels of anger.

CONCLUSIONS

On the basis of our results, it is important to continue working to substantially improve access for patients and their families to the emergency department, as well as the information and communication process with the healthcare staff should be included in intervention initiatives.

Development of an instrument to measure the degree of critical patient's satisfaction with nursing care: research protocol

AIM

To investigate and understand patient's satisfaction with nursing care in the intensive care unit to identify the dimensions of the concept of 'satisfaction' from the patient's point of view. To design and validate a questionnaire that measures satisfaction levels in critical patients.

BACKGROUND

There are many instruments capable of measuring satisfaction with nursing care; however, they do not address the reality for critical patients nor are they applicable in our context.

DESIGN

A dual approach study comprising: a qualitative phase employing Grounded Theory and a quantitative and descriptive phase to prepare and validate the questionnaire.

METHODS

Data collection in the qualitative phase will consist of: in-depth interview after theoretical sampling, on-site diary and expert discussion group. The sample size will depend on the expected theoretical saturation n = 27-36. Analysis will be based on Grounded Theory. For the quantitative phase, the sampling will be based on convenience (n = 200). A questionnaire will be designed on the basis of qualitative data. Descriptive and inferential statistics will be used. The validation will be developed on the basis of the validity of the content, the criteria of the construct and reliability of the instrument by the Cronbach's alpha and test-retest approach. Approval date for this protocol was November 2010.

DISCUSSION

Self-perceptions, beliefs, experiences, demographic, socio-cultural epistemological and political factors are determinants for satisfaction, and these should be taken into account when compiling a questionnaire on satisfaction with nursing care among critical patients.

Parental stress and satisfaction during children's hospitalization: differences between immigrant and autochthonous population

This study explored the relation between parents' stress and satisfaction during children's hospitalization, seeking possible differences between immigrant and autochthonous population and also as a function of gender in a sample of parents of hospitalized children in Andalusia, Spain. A total of 1347 parents participated in this study. Of the sample, 50% were immigrants and the other 50% were autochthonous. The assessment instruments were the Hospitalization Stress Scale and the Satisfaction with Hospitalization Scale. The results show that stress was associated with the manifestations of the child's illness, the alteration of family life or of parental roles during the process and some aspects of the clinical staff's work. General satisfaction in immigrant parents was higher than in the autochthonous population and the levels of satisfaction were higher in men than in women. Small changes and initiatives in relation to care could substantially improve the satisfaction of patients and their relatives during the process of hospitalization.

[Perception of the critical patient on nursing cares: an approach to the concept of satisfaction]

INTRODUCTION

Level of satisfaction is a key indicator of quality of care. There are many tools that measure satisfaction with nursing care, however they do not respond to the reality of the critical care patient or to our context.

OBJECTIVES

To define and to identify the dimensions of the satisfaction of patients admitted to the intensive care unit of a tertiary hospital with nursing cares and to define and identify the dimensions of the concept of satisfaction from their point of view.

MATERIAL AND METHODS

A qualitative research study was conducted according to the Grounded Theory Method in three Intensive Care Units with 34 individual boxes, with theoretical sampling. Nineteen patients remained after data saturation sampling. Data collection was obtained through recorded in-depth interviews and field logbook. Contents analysis was made according to the Grounded Theory. Guba and Lincoln rigor's criteria were followed. There was a favorable report from the Hospital's Ethics Committee and informed consent was obtained from the patients.

RESULTS

Four categories were found: The definition and dimensions of the satisfaction concept, expectations and life experiences. The participants included the following dimensions in their satisfaction definition: professional competences, human, technical and continuous cares. The combination of these elements produces feelings of security, calmness, being monitored, feeling like a person, perceiving a close relationship and trustfulness with the nurse who performs the individualized cares.

CONCLUSIONS

The definition and dimensions of satisfaction concept from the patient's point of view show the important aspects of the person and also clarify their dimensions, allowing the construction of tools more in line with the context and real perception.

[Health care quality perceived by the patients in an urban health centre in A Coruña]

OBJECTIVE

The aim of this study is to explore the reliability and validity of the adapted questionnaire SERVPERF in primary care and to obtain a measure of perceived quality from the patient point of view in an urban health centre.

METHOD

A cross-sectional descriptive study.

PARTICIPANTS

One in five of all the patients who visited the health centre during one week in March 2010 were systematically selected until completing the required sample size.

MAIN MEASUREMENTS

Personal data were collected (age, sex, nationality, marital status, level of studies, working status and their own perception on their health status). To measure the perceived quality the adapted questionnaire SERVPERF was used, with 22 items measured using a Likert scale (1-7), to which was added three open questions.

RESULTS

Out of a total of 132 patients, 67% of those who completed the questionnaire were women. All the interscale correlations were positive and significant. The overall statistical value for Cronbach́s-α was equal to 0.90 (95% CI: 0.87-0.93), and in all domains this value ranged from 0.71 to 0.90. The factor analysis identified 5 factors that explained 69.8% of the total variance. Of the studied items, the "Individualized follow up of each patient by the doctor", with an average of 6.66 ± 0.79 (95% CI: 6.53-6.79), was the best valued.

CONCLUSIONS

The questionnaire (adapted SERVPERF) is reliable and valid for measuring perceived quality in primary care, and patients felt that the service offered is of good quality.

[Personalized nursing care and perceived quality of care in hospitals]

OBJECTIVE

To determine whether there is an association between the Primary Nursing Model and perceived quality of care.

METHOD

An observational, descriptive, cross-sectional study in four hospital wards with Primary Nursing organization. Over a 12-month period, all the patients discharged from each ward were included in this study. The degree of development of Primary Nursing was measured by using the Personalization of Nursing Care Index and the perceived quality of care was measured with the LOPSS-12. Bivariate statistical analysis was carried out through ANOVA and Student's t-tests. Multivariate linear regression analysis was then applied to correlated variables (p < 0.05).

RESULTS

817 patients were included, 447 from two medical wards and 370 from two surgical wards. After a preliminary data analysis performed 6 months after the start of the study, four items were removed from the LOPSS-12 and each of the remaining items were analyzed separately. Scores for both patient satisfaction and the introduction of the Primary Nursing Model were higher in the surgical wards. Bivariate and multivariate regression analyses showed a statistically significant (p < 0.05) association between implantation of the model and all except one of the items included in the questionnaire.

CONCLUSIONS

The introduction of the Primary Nursing Model in hospital wards allows the presence of a primary nurse for each patient and consequently improves the nurse-patient relationship, increasing perceived quality of care among patients.

[Patient satisfaction with emergency care nurses]

OBJECTIVE

To measure the overall satisfaction of patients with nursing care during their stay in the emergency unit, evaluating the satisfaction with specific professional skills and the degree of information provided by nurses at discharge.

METHOD

A descriptive cross-sectional study conducted at the Ramon y Cajal University Hospital. The subjects of study are those patients who come to the emergency unit and met the inclusion criteria. A mean of 840 people were seen weekly, and it was estimated to collect 200 questionnaires over a period of one week. The questionnaire was self-administered. The variables analyzed were: clinical, sociodemographic, satisfaction and problem solving. The instrument used was the Consumer Emergency Care Satisfaction Scale (CECSS). The Statistical analysis was performed using SPSS 16.0 software package. Categorical variables are expressed in absolute and relative frequency; and continuous variables are expressed as the mean and the standard deviation. Asymmetric behavioral variables are described by their median, the interquartile interval and the non-parametric test of Kruskal-Wallis.

RESULTS

We surveyed 200 patients and we studied 198 patients who expressed high levels of overall satisfaction and satisfaction with professional competence. The degree of information at discharge is the dimension worst noted. No association was found between patient satisfaction and sociodemographic variables. The satisfaction was higher in patients who returned home than in those who were admitted in the hospital, the dimension of information at discharge being very significant.

CONCLUSIONS

We need to improve the information provided by the nursing staff to patients at discharge.