Chief complaints and feedback from clinic satisfaction tool: Thematic analysis of a new outpatient communication tool.

OBJECTIVES: Up to half of all patients leave their outpatient clinic visit with an uncommunicated need. We designed the clinic satisfaction tool (CST) as a low-cost, highly utilised assessment of the spine clinic experience that improved communication in our multidisciplinary spine practice. The purpose of this study was to qualitatively analyse chief complaints and feedback from the CSTs to determine how spine clinic patients used the form, identify the most prevalent concerns and mark areas for improvement. METHODS: Institutional retrospective review of CSTs. Chief complaints and feedback were inductively coded to create a framework for patient complaints. RESULTS: 832 patients presented to clinic, and 100 sets of chief complaints coded before reaching thematic saturation. Patients used the chief complaint section of CST to canvas four themes: symptoms, questions about their disease, management and treatment. Twenty-nine patients left mostly positive feedback but also wrote additional concerns about care. CONCLUSION: Spine patients have a predictable pattern of chief complaints and with the CST were able to have all these complaints addressed. The CST efficiently collects practice-specific chief complaints that can be used to guide physician behaviour and design educational clinical tools that are useful for patients.

The limited influence of neurosurgeons' behavior on inpatient satisfaction: a retrospective multihospital analysis.

OBJECTIVE: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a survey that assesses patient satisfaction, which is an important measure of the quality of hospital care and ultimately the overall hospital rating (OHR). However, the survey covers several elements of patient satisfaction beyond the patient-surgeon interaction. In this study, authors investigated which admission and experience factors had the highest impact on the OHR. METHODS: This was a retrospective cohort analysis of HCAHPS surveys from patients who, in the period between August 1, 2016, and January 31, 2018, had been discharged from the neurosurgical or orthopedic service at three hospitals serving a single metropolitan area. The top-box score was defined as the highest rating obtainable for each survey question. Baseline admission attributes were obtained, and multivariate logistic regression was used to determine predictors of the top-box OHR. RESULTS: After application of the inclusion and exclusion criteria, 1470 patients remained in the analysis. Categories on the HCAHPS included OHR, communication, education, environment, pain management, and responsiveness. After excluding identifying questions from the survey and adjusting for subspecialty and hospital, 7 of 17 HCAHPS survey items were significant predictors of OHR. Only 2 of these were related to the surgeon: 1) discharge, "Did you get information in writing about what symptoms or health problems to look out for after you left the hospital?" (OR 5.93, 95% CI 2.52-13.94); and 2) doctor, "Did doctors explain things in a way you could understand?" (OR 2.78, 95% CI 1.73-4.46). The top three strongest correlating items were 1) discharge; 2) nursing, "Did nurses treat you with courtesy and respect?" (OR 3.86, 95% CI 2.28-6.52); and 3) hospital environment, "Were your room and bathroom kept clean?" (OR 2.86, 95% CI 1.96-4.17). CONCLUSIONS: The study findings demonstrated that there are several nonmodifiable factors (i.e., specialty, experience) and items that are not under the direct purview of the neurosurgeon (e.g., nursing communication, hospital environment) that are significant influences on overall inpatient satisfaction on the HCAHPS survey. Furthermore, components of the survey that ultimately influence the OHR vary across different hospitals. Hence, HCAHPS survey results should be broadly interpreted as a way to make health systems more aware of the overall hospital factors that can improve quality of care and patient experience.

The true penalty of the waiting room: the role of wait time in patient satisfaction in a busy spine practice.

OBJECTIVE: Most clinics collect routine data on performance metrics on physicians for outpatient visits. However, the relationship of these metrics with patient experience is unclear. The goal of this study was to investigate the relationships between the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CG-CAHPS), the standard patient experience survey, and clinic performance metrics to understand the determinants of patient satisfaction and identify targets for improving patient experience. METHODS: The authors performed a retrospective single-institution cohort review of spine surgeon metrics over 15 months including demographics, waiting-room times, in-room times, lead times, timely note closure, timely MyChart responses, and monthly patient volume. Kruskal-Wallis tests and mixed-model regression were used to determine the predictors of 3 domains of patient satisfaction-Global, Access, and Communication. RESULTS: Over 15 months, 22 surgeons conducted 27,090 visits. The average clinic visit total time was 85.17 ± 25.75 minutes. Increased wait times were associated with poor Global (p = 0.008), Access (p < 0.001), and Communication scores (p = 0.003) in univariate analysis. Every 10-minute increase in waiting time was associated with a 3%, 9.8%, and 2.4% decrease in Global, Access, and Communication scores, respectively. Increased in-room time was also an independent predictor of poor Access scores (p < 0.001). In multivariate analysis, increased wait times were negative predictors of Global (p = 0.005), Access (p < 0.001), and Communication (p = 0.002) scores. CONCLUSIONS: Excessive waiting-room time significantly impacts unexpected dimensions of the patient experience and impacts communication with patients. Understanding the complex relationship between the factors that inform the patient experience will help target effective interventions to improve clinic efficiency and patient satisfaction.

Institutional review of predictors of in-hospital and 30-day discharge mortality in neurosurgical patients.

OBJECTIVE: Risk of adverse events from neurosurgical diagnoses is high. It is not well described whether there are any demographic, admission, or discharge factors that are associated with inpatient or post-discharge mortality outcomes in neurosurgical patients. The aim of this study is to identify the differences in predictors of mortality during inpatient stay and within 30 days of discharge. METHODS: This was a single-institution, retrospective cohort analysis of mortality. Our patient cohort of 11,477 was defined as all adult patients who were discharged (dead or alive) from an inpatient stay between January 1, 2014, and December 31, 2018, and were either admitted to a neurosurgical service or underwent a neurosurgical procedure during that admission. RESULTS: Out of 11,477 patients, 224 (1.95 %) and 290 (2.53 %) died inpatient and within 30 days of discharge, respectively. In multivariate analysis, the independent predictors of inpatient mortality were older age, female gender, diagnostic group, high present on admission severity of illness (POA-SOI) and present on admission risk of mortality (POA-ROM), intensive care unit (ICU) care, and palliative care consult (all p < 0.05). The predictors of mortality within 30-day discharge were older age, admission urgency, admission specialty type, palliative care consult, and discharge disposition (all p < 0.01). CONCLUSION: Older age and palliative care consult were significant predictors of both inpatient and within 30 days of discharge mortality. Admission SOI (>3) and ROM (>3) and ICU care were significant predictors for inpatient mortality while discharge disposition (home health, skilled nursing facility) was important for 30-day mortality.

Clinic Satisfaction Tool Improves Communication and Provides Real-Time Feedback.

BACKGROUND: Patient-reported assessments of the clinic experience are increasingly important for improving the delivery of care. The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is the current standard for evaluating patients' clinic experience, but its format gives 2-mo delayed feedback on a small proportion of patients in clinic. Furthermore, it fails to give specific actionable results on individual encounters. OBJECTIVE: To develop and assess the impact of a single-page Clinic Satisfaction Tool (CST) to demonstrate real-time feedback, individualized responses, interpretable and actionable feedback, improved patient satisfaction and communication scores, increased physician buy-in, and overall feasibility. METHODS: We assessed CST use for 12 mo and compared patient-reported outcomes to the year prior. We assessed all clinic encounters for patient satisfaction, all physicians for CG-CAHPS global rating, and physician communication scores, and evaluated the physician experience 1 yr after implementation. RESULTS: During implementation, 14 690 patients were seen by 12 physicians, with a 96% overall CST utilization rate. Physicians considered the CST superior to CG-CAHPS in providing immediate feedback. CG-CAHPS global scores trended toward improvement and were predicted by CST satisfaction scores (P < .05). CG-CAHPS physician communication scores were also predicted by CST satisfaction scores (P < .01). High CST satisfaction scores were predicted by high utilization (P < .05). Negative feedback dropped significantly over the course of the study (P < .05). CONCLUSION: The CST is a low-cost, high-yield improvement to the current method of capturing the clinic experience, improves communication and satisfaction between physicians and patients, and provides real-time feedback to physicians.