Role clarity and clinical governance: keeping irish hospitals efficient and effective.

The notion of role clarity, and its impact on clinical governance, has not been previously considered within academic literature. The purpose of this research article was to add to theoretical knowledge surrounding the clinical governance and the effect that role clarity has on governance operationally. The context of Irish health care and Irish hospital boards is used to explore this phenomenon. A mixed-methods approach was used to appreciate the central phenomenon. The doctoral dissertation this article was drawn from identified that the adoption of similar or consistent structures and processes between Irish acute care hospitals would aid efficiencies, both human and cost, on multiple levels. Ultimately, the article concludes that role clarity is a significant component in the determination of effective health care. Hospital boards and their individual members should be cognizant of the implications of role clarity and its impact on effective and efficient clinical governance.

Can the Iowa Satisfaction with Anesthesia Scale be used to measure patient satisfaction with cataract care under topical local anesthesia and monitored sedation at a community hospital?

Patient satisfaction ratings provide a means to evaluate and monitor quality of health care. We tested the ability of the Iowa Satisfaction with Anesthesia Scale (ISAS) to measure satisfaction with cataract care under topical local anesthesia and monitored sedation given by an anesthesiologist at a community hospital. Three hundred six patients were administered the ISAS along with alternate ratings of quality of care and patient satisfaction. There were no incomplete questionnaires. The ISAS demonstrated reasonable reliability (Cronbach's alpha = 0.68; test-retest = 0.48-0.67). The ISAS had excellent construct validity; ISAS scores were lower in patients who gave lower ratings of quality (4.98 versus 5.64), who had lower satisfaction visual analog scale scores (5.12 versus 5.65), who wanted changes in their care (4.76 versus 5.67), who had suggestions to improve care (5.08 versus 5.63), or who preferred more sedation (4.85 versus 5.66) (P < 0.0001). Our results indicate that the ISAS questionnaire is a feasible, reliable, and valid tool to measure patient satisfaction in patients undergoing cataract surgery under topical anesthesia and monitored sedation.

What determines patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a community hospital setting?

The Iowa Satisfaction with Anesthesia Scale (ISAS) is a reliable and valid tool to measure patient satisfaction with monitored anesthesia care. We used the ISAS to discover determinants of patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a small community hospital. The ISAS (scored 1 to 6) was administered to 306 patients immediately after cataract surgery. All patients received topical local anesthesia and IV sedation administered by an anesthesiologist. Patient satisfaction was high: mean ISAS was 5.6 (sd 0.46; range: 3.3-6.0). The incidence of intraoperative and postoperative pain was 13% and 37%; other adverse events were infrequent (<5%). In multivariable logistic regression, significant predictors of satisfaction were postoperative pain (odds ratio [OR]: 4.84; 99% confidence interval [CI]: 2.21, 10.60), surgeon (OR: 0.21; 99% CI: 0.05, 0.91), and preoperative anxiety (OR: 1.17; 99% CI: 1.03, 1.34). ISAS mean scores (OR = 0.28; 99% CI: 0.13, 0.59) and preoperative anxiety (OR = 1.12; 99% CI: 0.99, 1.28) emerged as significant predictors of low rating of quality of experience. Our results indicate that the ISAS can be used to track patient satisfaction with monitored cataract care. Pain during and after cataract surgery is common and is a major reason for lower patient satisfaction with their cataract care.