Patient satisfaction with anaesthesia care: development of a psychometric questionnaire and benchmarking among six hospitals in Switzerland and Austria.

BACKGROUND: We describe the development and comparison of a psychometric questionnaire on patient satisfaction with anaesthesia care among six hospitals. METHODS: We used a rigorous protocol: generation of items, construction of the pilot questionnaire, pilot study, statistical analysis (construct validity, factor analysis, reliability analysis), compilation of the final questionnaire, main study, repeated analysis of construct validity and reliability. We compared the mean total problem score and the scores for the dimensions: 'Information/Involvement in decision-making', and 'Continuity of personal care by anaesthetist'. The influence of potential confounding variables was tested (multiple linear regression). RESULTS: The average problem score from all hospitals was 18.6%. Most problems are mentioned in the dimensions 'Information/Involvement in decision-making' (mean problem score: 30.9%) and 'Continuity of personal care by anaesthetist' (mean problem score: 32.2%). The overall assessment of the quality of anaesthesia care was good to excellent in 98.7% of cases. The most important dimension was 'Information/Involvement in decision-making'. The mean total problem score was significantly lower for two hospitals than the total mean for all hospitals (significantly higher at two hospitals) (P<0.05). Amongst the confounding variables considered, age, sex, subjective state of health, type of anaesthesia and level of education had an influence on the total problem score and the two dimensions mentioned. There were only marginal differences with and without the influence of the confounding variables for the different hospitals. CONCLUSIONS: A psychometric questionnaire on patient satisfaction with anaesthesia care must cover areas such as patient information, involvement in decision-making, and contact with the anaesthetist. The assessment using summed scores for dimensions is more informative than a global summed rating. There were significant differences between hospitals. Moreover, the high problem scores indicate a great potential for improvement at all hospitals.

Increase in cerebrospinal fluid pressure in normocapnic volunteers in response to nalbuphine.

We have carried out a double-blind randomized study of the effect of nalbuphine (0.2 mg.kg-1 i.v.) or placebo on mean lumbar cerebrospinal fluid (CSF) pressure, mean cerebral perfusion pressure (CPP), transcutaneous PCO2 (tcPCO2), mean arterial blood pressure (MAP), and heart rate (HR) in 10 spontaneously breathing volunteers using invasive CSF pressure measurement. Nalbuphine increased CSF pressure from 9.2 mmHg to 16.4 mmHg and decreased CPP from 83.6 mmHg to 74.4 mmHg without significantly changing tcPCO2, MAP, or heart rate. In the placebo group there were no significant changes in CSF pressure, CPP, tcPCO2, MAP, or heart rate. These findings suggest that nalbuphine should be used with caution in patients at risk of intracranial hypertension.