Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology

Extent: 7p.Background: Subjective parameters such as quality of life or patient satisfaction gain importance as outcome parameters and benchmarks in health care. In many countries hospitals are now undergoing accreditation as mandatory or voluntary measures. It is believed but unproven that accreditations positively influence quality of care and patient satisfaction. The present study aims to assess in a defined specialty (cardiology) the relationship between patient satisfaction (as measured by the recommendation rate) and accreditation status. Methods: Consecutive patients discharged from 25 cardiology units received a validated patient satisfaction questionnaire. Data from 3,037 patients (response rate > 55%) became available for analysis. Recommendation rate was used as primary endpoint. Different control variables such as staffing level were considered. Results: The 15 accredited units did not differ significantly from the 10 non-accredited units regarding main hospital (i.e. staffing levels, no. of beds) and patient (age, gender) characteristics. The primary endpoint "recommendation rate of a given hospital" for accredited hospitals (65.6%, 95% Confidence Interval (CI) 63.4 - 67.8%) and hospitals without accreditation (65.8%, 95% CI 63.1 - 68.5%) was not significantly different. Conclusion: Our results support the notion that - at least in the field of cardiology - successful accreditation is not linked with measurable better quality of care as perceived by the patient and reflected by the recommendation rate of a given institution. Hospital accreditation may represent a step towards quality management, but does not seem to improve overall patient satisfaction.Cornelia Sack, Peter Lütkes, Wolfram Günther, Raimund Erbel, Karl-Heinz Jöckel and Gerald J Holtman

Barriers to the use of morphine for the management of severe postoperative pain - A before and after study

Aim To reduce the number of patients experiencing severe postoperative pain by prescribing 10 mg Morphine either as oral solution or by IM injection as an alternative to Tramadol Hydrochloride in an analgesic protocol. Materials and methods Patients who received in-patient oral and maxillofacial surgery under general anaesthesia were included. Complex intervention analgesic protocols were developed including staff education, patient educations and analgesic protocols. 80 patients were treated under the original protocol (tramadol hydrochloride for pain unmanaged by other drugs in protocol) over 4 months. 75 patients were treated under the second protocol (oral or intravenous morphine for pain unmanaged by other drugs in protocol). Patient perceptions to their pain management were then assessed. Results Proportion of patients reporting ‘no pain’ increased from 5% of 80 patients to 28% of 75 patients (p < 0.001). Report of severe pain reduced from 37% to 31% and not significant. Pain duration reduced from 18% to 12% for 75–100% time from surgery to discharge and not significant. Staff used protocols for 96% patients. Nurses provided patient information leaflets for 85%–80% patients. Nearly all patients (96% and 95%) reported overall satisfaction with their pain management. Conclusions The use of morphine given orally or my IM injection rather than tramadol was associated with a significant increase in the number of patients reporting ‘no pain’. However the number of patients experiencing severe pain was not significantly reduced. Despite this, most patients reported high levels of satisfaction which suggested that satisfaction questionnaires should not be used in isolation. Most patients received morphine orally rather than by IM injection but the oral dose may not have been high enough in this study

A survey of community members' perceptions of medical errors in Oman

<p>Abstract</p> <p>Background</p> <p>Errors have been the concern of providers and consumers of health care services. However, consumers' perception of medical errors in developing countries is rarely explored. The aim of this study is to assess community members' perceptions about medical errors and to analyse the factors affecting this perception in one Middle East country, Oman.</p> <p>Methods</p> <p>Face to face interviews were conducted with heads of 212 households in two villages in North Al-Batinah region of Oman selected because of close proximity to the Sultan Qaboos University (SQU), Muscat, Oman. Participants' perceived knowledge about medical errors was assessed. Responses were coded and categorised. Analyses were performed using Pearson's χ², Fisher's exact tests, and multivariate logistic regression model wherever appropriate.</p> <p>Results</p> <p>Seventy-eight percent (n = 165) of participants believed they knew what was meant by medical errors. Of these, 34% and 26.5% related medical errors to wrong medications or diagnoses, respectively. Understanding of medical errors was correlated inversely with age and positively with family income. Multivariate logistic regression revealed that a one-year increase in age was associated with a 4% reduction in perceived knowledge of medical errors (CI: 1% to 7%; p = 0.045). The study found that 49% of those who believed they knew the meaning of medical errors had experienced such errors. The most common consequence of the errors was severe pain (45%). Of the 165 informed participants, 49% felt that an uncaring health care professional was the main cause of medical errors. Younger participants were able to list more possible causes of medical errors than were older subjects (Incident Rate Ratio of 0.98; p < 0.001).</p> <p>Conclusion</p> <p>The majority of participants believed they knew the meaning of medical errors. Younger participants were more likely to be aware of such errors and could list one or more causes.</p

The National Adult Inpatient Survey conducted in the English National Health Service from 2002 to 2009: how have the data been used and what do we know as a result?

<p>Abstract</p> <p>Background</p> <p>When it was initiated in 2001, England's national patient survey programme was one of the first in the world and has now been widely emulated in other healthcare systems. The aim of the survey programme was to make the National Health Service (NHS) more "patient centred" and more responsive to patient feedback. The national inpatient survey has now been running in England annually since 2002 gathering data from over 600,000 patients. The aim of this study is to investigate how the data have been used and to summarise what has been learned about patients' evaluation of care as a result.</p> <p>Methods</p> <p>Two independent researchers systematically gathered all research that included analyses of the English national adult inpatient survey data. Journals, databases and relevant websites were searched. Publications prior to 2002 were excluded. Articles were also identified following consultation with experts. All documents were then critically appraised by two co-authors both of whom have a background in statistical analysis.</p> <p>Results</p> <p>We found that the majority of the studies identified were reports produced by organisations contracted to gather the data or co-ordinate the data collection and used mainly descriptive statistics. A few articles used the survey data for evidence based reporting or linked the survey to other healthcare data. The patient's socio-demographic characteristics appeared to influence their evaluation of their care but characteristics of the workforce and the. At a national level, the results of the survey have been remarkably stable over time. Only in those areas where there have been co-ordinated government-led campaigns, targets and incentives, have improvements been shown. The main findings of the review are that while the survey data have been used for different purposes they seem to have incited little academic interest.</p> <p>Conclusions</p> <p>The national inpatient survey has been a useful resource for many authors and organisations but the full potential inherent in this large, longitudinal publicly available dataset about patients' experiences has not as yet been fully exploited.</p> <p>This review suggests that the presence of survey results alone is not enough to improve patients' experiences and further research is required to understand whether and how the survey can be best used to improve standards of care in the NHS.</p

Impact of a hospital improvement initiative in Bangladesh on patient experiences and satisfaction with services: two cross-sectional studies

<p>Abstract</p> <p>Background</p> <p>The Bangladesh government implemented a pilot Hospital Improvement Initiative (HII) in five hospitals in Sylhet division between 1998 and 2003. This included management and behaviour change training for staff, waste disposal and procurement, and referral arrangements. Two linked cross-sectional surveys in 2000 and 2003 assessed the impact of the HII, assessing both patients' experience and satisfaction and public views and use of the hospitals.</p> <p>Methods</p> <p>In each survey we asked 300 consecutive outpatients and a stratified random sample of 300 inpatients in the five hospitals about waiting and consultation time, use of an agent for admission, and satisfaction with privacy, cleanliness, and staff behaviour. The field teams observed cleanliness and privacy arrangements, and visited a sample of households in communities near the hospitals to ask about their opinions and use of the hospital services. Analysis examined changes over time in patients' experience and views. Multivariate analysis took account of other variables potentially associated with the outcomes. Survey managers discussed the survey findings with gender stratified focus groups in each sample community.</p> <p>Results</p> <p>Compared with 2000, an outpatient in three of the hospitals in 2003 was more likely to be seen within 10 minutes and for at least five minutes by the doctor, but outpatients were less likely to report receiving all the prescribed medicines from the hospital. In 2003, inpatients were more likely to have secured admission without using an agent. Although patients’ satisfaction with several aspects of care improved, most changes were not statistically significant. Households in 2003 were significantly more likely to rate the hospitals as good than in 2000. Use of the hospitals did not change, except that more households used the medical college hospital for inpatient care in 2003. Focus groups confirmed criticisms of services and suggested improvements.</p> <p>Conclusion</p> <p>Improvements in some aspects of patients' experience may have been due to the programme, but the decreased availability of medicines in government facilities across the country over the period also occurred in these hospitals. Monitoring patients’ experience and satisfaction as well as public views and use of hospital services is feasible and useful for assessing service interventions.</p

Does Observational Learning Influence Spatial Pattern Learning for Humans?

Recent research has been interested in the influence of social information on spatial learning tasks (for a review, see Brown, 2011). The present experiment examined the effect of observational learning on the performance of humans in a spatial pattern learning task. One group of participants (i.e., Optimal Observation) watched a virtual character complete a spatial pattern learning task using an optimal search strategy whereas another group of participants (i.e., Random Observation) watched a virtual character complete the spatial pattern learning task using a random search strategy. Both groups then completed a spatial pattern learning task. To the extent that observational learning occurs and influences completion of the spatial pattern learning task, measures of learning for participants in the Optimal Observation group should be superior relative to those of the Random Observation group. Results and implications will be discussed

Observation of Search Strategies Facilitates and Inhibits Subsequent Learning of Spatial Relations Among Locations

Recent comparative research has investigated the influence of social information on spatial learning (see Brown, 2011). Previous work from our lab found evidence that observational learning influenced human learning of spatial relations among locations in virtual environment search task. A group of participants watching an avatar complete a spatial pattern learning task in an optimal fashion made fewer errors and more search moves consistent with the hidden spatial pattern compared to a group of participants watching an avatar complete the spatial pattern learning task in a random fashion. In the present experiment, one group of participants watched a virtual character complete a spatial pattern learning task using an optimal search strategy (Optimal) while a second group watched a virtual character complete the spatial pattern learning task using a random search strategy (Random). A third group was not exposed to any search strategy (Control). All participants then completed the spatial pattern learning task. Results indicate a combination of facilitation of learning in the Optimal Group and an inhibition of learning in the Random Group relative to the Control Group. Collectively, these results are conceptually consistent with those obtained with rat subjects and have comparative implications for social influences on spatial behavior