Elsevier

Advances in Anesthesia

Volume 36, Issue 1, December 2018, Pages 23-37
Advances in Anesthesia

Patient Satisfaction in Anesthesia: Implementation, Relevance, and Identification of Meaningful Measures

https://doi.org/10.1016/j.aan.2018.07.012Get rights and content

Section snippets

Key points

  • Measurement of patient satisfaction is an important new requirement for hospitals and anesthesia practices.

  • Measurement of patient satisfaction is complex, with multiple interacting factors. Few published studies have provided definitive information on how satisfaction is achieved.

  • In anesthesiology, there are recommendations for best practice in measuring patient satisfaction; however, to date, there are no validated studies assessing those recommendations.

  • American Society of Anesthesiologists

Introduction: why patient satisfaction is important

After generations of health care financing driven by third-party employers and insurance companies, individual patient responsibility is gradually on the increase. Patients bear an increasing share of the costs of their care, both through choice of insurance plan and increased direct responsibility for deductibles and copays. The result of this evolution is a shift in public mindset from passive patient to active consumer. Hospitals and physicians are shifting in response, toward

Theories of patient satisfaction

There is no universally accepted understanding of what creates patient satisfaction with health care; however, there are 3 main theories to explain why a patient may be satisfied or dissatisfied [3]. Disconfirmation theory asserts that patient satisfaction is based on the gap between the patient’s expectations and the patient’s perception of the events that transpired. The net disparity between these creates either dissonance or gratification. Equity theory speculates that patient satisfaction

Federal efforts

Governmental efforts to measure patient satisfaction began in 1995 with development of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. CAHPS was developed and applied as a tool to study the performance of managed care insurance plans and benchmark them against each other. The Hospital CAHPS (HCAHPS) survey was developed thereafter to specifically measure satisfaction with inpatient care [12]. HCAHPS was released as a standard and validated tool in 2005 [13] and has

Anesthesia patient satisfaction

Specific to anesthesia patient satisfaction there are relatively few published studies. One of the best was an overview by Barnett and colleagues [15], in 2013, summarizing an assortment of individual efforts in this field. They were unable to identify or recommend any single validated instrument or set of questions. The ASA Committee on Performance and Outcome Measures took up the topic in 2013. They conducted a careful systematic review of research into anesthesia patient satisfaction and

Implementation in anesthesia

Commercial tools for surveying anesthesia patient satisfaction appeared on the market in 2012 and were adopted to the Committee’s recommended standards in 2013, when the white paper was published. Surveys were intended for voluntary use by anesthesia practices hoping to better themselves through quality improvement efforts directed at actionable, anesthesia-specific patient satisfaction data. The first, and currently largest, company in this space was SurveyVitals. In their current Anesthesia

Early observations

The senior author’s large group practice, US Anesthesia Partners (USAP), uses the APSQ-2 nationwide as an important driver of ongoing quality improvement. At the national, regional, divisional, facility, and practice level, aggregated numerical results from the APSQ-2 are presented as part of the regular delivery of performance scorecards. Fig. 3 is a sample graphic based on 6 individual domains (ie, privacy, communication, decision making, pain, anxiety, and providers) as well as a composite

Open questions and future research

There remain several unanswered questions regarding anesthesia patient satisfaction. The recommendations of the ASA Committee, although sensible and now widely adopted, were derived based mostly on expert opinion and have never been formally validated. The ideal time, or times, to measure satisfaction in the postoperative period are unknown. The impact of the method for survey delivery is also poorly understood, with each current approach likely carrying its own risks and biases. It is not

Summary

With the shift toward patient consumerism in health care, PROs are becoming increasingly valuable metrics. Patient satisfaction, an important PRO, is a complex variable influenced by a plethora of factors that can be categorized into 3 main domains: patient-related, physician-related, and process-of care–related. Research is underway to elucidate the determinants of satisfaction. However, there are limitations to most work published to date, namely the lack of valid instruments for measurement.

First page preview

First page preview
Click to open first page preview

References (17)

  • C. Wu et al.

    Measurement of patient satisfaction as an outcome of regional anesthesia and analgesia: a systematic review

    Reg Anesth Pain Med

    (2001)
  • R.J. Widmer et al.

    Online physician reviews do not reflect patient satisfaction survey responses

    Mayo Clin Proc

    (2018)
  • T.C. Tsai et al.

    Patient satisfaction and quality of surgical care in US hospitals

    Ann Surg

    (2015)
  • S.M. Stein et al.

    Patients’ perceptions of care are associated with quality of hospital care: a survey of 4605 hospitals

    Am J Med Qual

    (2014)
  • E.M.K. Walker et al.

    Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study

    Br J Anaesth

    (2016)
  • B. Prakash

    Patient satisfaction

    J Cutan Aesthet Surg

    (2010)
  • T. Tateke et al.

    Determinants of patient satisfaction with outpatient health services at public and private hospitals in Addis Ababa, Ethiopia

    Afr J Prim Health Care Fam Med

    (2012)
  • E. Goldstein et al.

    Racial/ethnic differences in patients’ perceptions of inpatient care using the HCAHPS survey

    Med Care Res Rev

    (2010)
There are more references available in the full text version of this article.

Cited by (6)

  • Patient satisfaction in ambulatory anesthesia assessed by the Heidelberg Peri-anaesthetic Questionnaire: a cross-sectional study

    2023, Brazilian Journal of Anesthesiology (English Edition)
    Citation Excerpt :

    The previous concept of the patient as passive and uninformed has changed to one of a patient/client who is demanding, critical, and a better evaluator, who interacts in ways to defend their interests. Evaluation of results has traditionally focused on measures of morbidity and mortality and taken less into account measurements based directly on patient observations.2 In modern anesthesia, the anesthesiologist should be capable of building relationships with patients, providing understandable information, involving patients in decisions about their anesthesia, and clarifying their concerns.3,4

  • Anesthesia Informatics in 2018

    2019, Advances in Anesthesia
    Citation Excerpt :

    Research, quality improvement initiatives, and other efforts that rely on anesthesia data must take into account these artifacts to avoid faulty conclusions referred to colloquially as garbage in, garbage out [67]. Clear, consistent definitions of perioperative events and outcomes facilitate valid, reliable documentation; these definitions routinely vary across, and sometimes even within, institutions [18,68]. Anesthesia departments and practices that have migrated from an AIMS to an integrated EHR must also deal with the issue of storing data from the older legacy system in a separate perioperative data “warehouse” if the data are to be used for secondary purposes, because EHRs are typically not designed to store and make the legacy data easily available to users [69].

  • Scaling up quality in an anesthesia practice

    2022, International Journal for Quality in Health Care

Financial Support: Support was provided solely from institutional and/or departmental sources.

View full text