The Impact of Nursing on Trauma Patient Satisfaction: An Analysis of HCAHPS From 112,283 Patients.

BACKGROUND: Assessment of patient satisfaction is central to understanding and improving system performance with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) national standard survey. However, no large, multi-institutional study exists, which examines the role of nurses in trauma patient satisfaction. OBJECTIVE: To assess the impact of nurses on trauma patient satisfaction. METHODS: This retrospective, descriptive study of Level I-IV trauma centers in a multistate hospital system evaluated patients 18 years and older admitted with at least an overnight stay. Data were obtained electronically for patients discharged in 2018-2019 who returned an HCAHPS survey. Surveys were linked by an honest broker to demographic and injury data from the trauma registry, and then anonymized prior to analysis. Patients were categorized as "trauma" per the National Trauma Data Standard (NTDS) definition or as "medical" or "surgical" per the HCAHPS definition. RESULTS: Of 112,283 surveys from 89 trauma centers, "trauma" patients (n = 5,126) comprised 4.6%, "surgical" 39.0% (n = 43,763), and "medical" 56.5% (n = 63,394). Nurses had an overwhelming impact on "trauma" patient satisfaction, accounting for 63.9% (p < .001) of the variation (adjusted R2) in the overall score awarded the institution-larger than for "surgery" (59.6%; p < .001) or "medical" (58.4%; p < .001) patients. The most important individual domain contributor to the overall rating of a facility was "nursing communication." CONCLUSIONS: The magnitude of the effect of trauma nurses was noteworthy, with their communication ability being the single biggest driver of institutional ratings. These data provide insight for future performance benchmark development and emphasize the critical impact of trauma nurses on the trauma patient experience.

Critical Role of Trauma and Emergency Surgery Physicians in Patient Satisfaction: An Analysis of Consumer Assessment of Healthcare Providers and Systems, Hospital Version Data from 186,779 Patients and 168 Hospitals in a National Healthcare System.

BACKGROUND: Trauma and emergency surgery patients are unique with regard to the sudden and unexpected nature of their hospitalization and this can adversely affect patient satisfaction, but, to our knowledge, no large study exists examining this issue. The purpose of this study was to investigate the major factors that affect satisfaction scores in trauma and emergency surgery patients. STUDY DESIGN: Consumer Assessment of Healthcare Providers and Systems, Hospital Version survey data from patients discharged in 2018-2019 from facilities in a national hospital system were obtained. Patients were categorized as trauma, emergency surgery, or direct admit surgery (elective surgery). Individual Consumer Assessment of Healthcare Providers and Systems, Hospital Version question scores were regressed on the score for "overall rating" to determine the primary, secondary, and tertiary satisfaction drivers. RESULTS: There were 186,779 patients from 168 hospitals included. As expected, the primary determinant of patient satisfaction was nursing communication for all groups. However, trauma and emergency surgery patients differed from elective surgery patients in that physician communication was the second most important factor in patient satisfaction, accounting for 12.0% (trauma) and 8.6% (emergency surgery) of the total variability in the overall rating beyond the variability explained by the primary driver. If physician communication received low ratings, it was unlikely that high scores in other metrics could compensate to bring the overall score above the 50th percentile. CONCLUSIONS: Acute care surgeons appear to play a uniquely important role in support of Consumer Assessment of Healthcare Providers and Systems, Hospital Version scores. These data emphasize the importance of physician communication, particularly when a prehospital physician-patient relationship does not exist. Future research should explore specific mechanisms by which physicians effectively communicate with patients.

Fine mapping for Weaver syndrome in Brown Swiss cattle and the identification of 41 concordant mutations across NRCAM, PNPLA8 and CTTNBP2.

Bovine Progressive Degenerative Myeloencephalopathy (Weaver Syndrome) is a recessive neurological disease that has been observed in the Brown Swiss cattle breed since the 1970's in North America and Europe. Bilateral hind leg weakness and ataxia appear in afflicted animals at 6 to 18 months of age, and slowly progresses to total loss of hind limb control by 3 to 4 years of age. While Weaver has previously been mapped to Bos taurus autosome (BTA) 4∶46-56 Mb and a diagnostic test based on the 6 microsatellite (MS) markers is commercially available, neither the causative gene nor mutation has been identified; therefore misdiagnosis can occur due to recombination between the diagnostic MS markers and the causative mutation. Analysis of 34,980 BTA 4 SNPs genotypes derived from the Illumina BovineHD assay for 20 Brown Swiss Weaver carriers and 49 homozygous normal bulls refined the Weaver locus to 48-53 Mb. Genotyping of 153 SNPs, identified from whole genome sequencing of 10 normal and 10 carrier animals, across a validation set of 841 animals resulted in the identification of 41 diagnostic SNPs that were concordant with the disease. Except for one intergenic SNP all are associated with genes expressed in nervous tissues: 37 distal to NRCAM, one non-synonymous (serine to asparagine) in PNPLA8, one synonymous and one non-synonymous (lysine to glutamic acid) in CTTNBP2. Haplotype and imputation analyses of 7,458 Brown Swiss animals with Illumina BovineSNP50 data and the 41 diagnostic SNPs resulted in the identification of only one haplotype concordant with the Weaver phenotype. Use of this haplotype and the diagnostic SNPs more accurately identifies Weaver carriers in both Brown Swiss purebred and influenced herds.