COMMENTARY

Patient Satisfaction With Anesthesia Care

Alex Macario, MD, MBA

Disclosures

August 06, 2013

Viewpoint

Patient satisfaction is often used as an index of the quality of healthcare provided. Such ratings are more often used for hospital marketing than for providing patients with useful information with which to choose a provider. The reason is that many commonly used scales are overly simple and inadequately reflect the complexity of measuring patient satisfaction.

These scales are unlikely to be sufficiently detailed either to detect changes in the quality of care provided when one anesthetic is selected over another or to compare different anesthesia groups with respect to satisfaction with anesthesia care.

In analyzing data from ambulatory surgical patients, it is not uncommon to find that 97% are satisfied with the overall perioperative experience, and 98%-99% are satisfied with the anesthesia care. This high baseline level of satisfaction with anesthesia may make it difficult to show improvements in quality because satisfaction scores can increase only marginally.

Another issue is that confounding variables can create problems when quality is judged by patient satisfaction. Patient satisfaction relies on a standard or expectation against which care is compared. Because patients' a priori expectations about surgery and anesthesia can differ, satisfaction may not be a reliable or valid way of detecting changes in care. Patients judge their care not only cognitively but also emotionally, based on unique personal expectations and standards.

I have had patients with severe nausea and pain after surgery who say that they are very satisfied with the anesthesia care that they received and others with no pain or nausea after the same surgery who voice complaints and dissatisfaction with their care. Patients with similar outcomes may differ greatly in their levels of satisfaction because quality may be defined as the difference between perception and expectation. In other words, patients who previously had bad healthcare experiences may be easier to please because their expectations are low. On the other hand, patients who have had great experiences often need to be warned about possible problems to lower their expectations and make them more realistic.

Other variables that can influence patient satisfaction with surgery and anesthesia include:

The affect of caregivers (how "nice" providers are to patients);

The environment of care (how attractive the physical plant of the facility is); and

The overwhelming sense of relief when the surgery and anesthesia are over.

Friendliness of operating room staff is a top determinant of patient satisfaction with outpatient surgery. Another difficult methodologic issue is finding the best time to ask patients about satisfaction. The response rate if asked in the recovery room will be high, but the patient may not have had enough time to judge the experience.

Surveys should explicitly tell patients the time interval that is being evaluated. Patients may have different ideas about when anesthesia care begins (eg, with the telephone call the night before surgery or placement of the intravenous line?) and ends (eg, dropping patient off in recovery room or discharge from the recovery area?).

Nonetheless, now more than ever, patient satisfaction is being used to assess physician performance, so it is important to measure it as accurately as possible.

Abstract

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