Trends in patient perception of hospital care quality.

PURPOSE: The purpose of this paper is to investigate trends in patient hospital quality perceptions between 1999 and 2010. DESIGN/METHODOLOGY/APPROACH: Original data from 11 cross-sectional surveys carried out in a French single university hospital were analyzed. Based on responses to a 29-item survey instrument, overall and subscale perception scores (range 0-10) were computed covering six key hospital care quality dimensions. FINDINGS: Of 16,516 surveyed patients, 10,704 (64.8 percent) participated in the study. The median overall patient perception score decreased from 7.86 (25th-75th percentiles, 6.67-8.85) in 1999 to 7.82 (25th-75th percentiles, 6.67-8.74) in 2010 (p for trend < 0.001). A decreasing trend was observed for the living arrangement subscale score (from 7.78 in 1999 to 7.50 in 2010, p for trend < 0.001). Food service and room comfort perceptions deteriorated over the study period while patients increasingly reported better explanations before being examined. PRACTICAL IMPLICATIONS: Patient perception scores may disguise divergent judgments on different care aspect while individual items highlight specific areas with room for improvement. ORIGINALITY/VALUE: Despite growing pressure on healthcare expenditure, this single-center study showed only modest reduction in patients' hospital-care perceptions in the 2000s.

Medical record-keeping and patient perception of hospital care quality.

PURPOSE: Medical record represents the main information support used by healthcare providers. The purpose of this paper is to examine whether patient perception of hospital care quality related to compliance with medical-record keeping. DESIGN/METHODOLOGY/APPROACH: The authors merged the original data collected as part of a nationwide audit of medical records with overall and subscale perception scores (range 0-100, with higher scores denoting better rating) computed for 191 respondents to a cross-sectional survey of patients discharged from a university hospital. FINDINGS: The median overall patient perception score was 77 (25th-75th percentiles, 68-87) and differed according to the presence of discharge summary completed within eight days of discharge (81 v. 75, p = 0.03 after adjusting for baseline patient and hospital stay characteristics). No independent associations were found between patient perception scores and the documentation of pain assessment and nutritional disorder screening. Yet, medical record-keeping quality was independently associated with higher patient perception scores for the nurses' interpersonal and technical skills component. RESEARCH LIMITATIONS/IMPLICATIONS: First, this was a single-center study conducted in a large full-teaching hospital and the findings may not apply to other facilities. Second, the analysis might be underpowered to detect small but clinically significant differences in patient perception scores according to compliance with recording standards. Third, the authors could not investigate whether electronic medical record contributed to better compliance with recording standards and eventually higher patient perception scores. PRACTICAL IMPLICATIONS: Because of the potential consequences of poor recording for patient safety, further efforts are warranted to improve the accuracy and completeness of documentation in medical records. ORIGINALITY/VALUE: A modest relationship exists between the quality of medical-record keeping and patient perception of hospital care.

"When did you decide to receive the Covid-19 vaccine?" Survey in a high-volume vaccination center.

Highly efficient and safe Covid-19 vaccines are available in Europe in amounts that theoretically allow for a high immune coverage. However, a notable proportion of the population is reluctant toward immunization. We aimed to determine, among people who chose to be vaccinated, when they made the decision and whether they would have preferred an earlier vaccination. A survey was conducted in a high-volume Covid-19 vaccination center in France from 28 May to 9 July 2021 through an anonymous questionnaire. The 2519 participants (54.1% males; median age 39 years) attributed lower efficacy and safety to Covid-19 vaccines than to vaccines in general. When asked when they decided to receive the vaccine, 15.5% and 16.0% answered "less than one month ago" and "less than one week ago," respectively; age <40 and female sex were independently associated with these responses. When asked whether they would have preferred to have been vaccinated earlier, 57.6% answered "definitely no," "rather no," or "neither yes nor no"; female sex (independently from age) was associated with these answers. When asked whether they would have preferred to receive the vaccine as early as January 2021, 65.2% answered "definitely no," "rather no," or "neither yes nor no"; age <40 and female sex were independently associated with these responses. In conclusion, one-third people had made the decision to be vaccinated only recently, while more than half would not have preferred an earlier vaccination, in particular women and those aged <40 years. Vaccine campaigns should take such short-term decision-making processes into account.

Evaluation of glycopeptide prescription and therapeutic drug monitoring at a university hospital.

The aim of this study was to assess the appropriateness of glycopeptide prescription almost 15 y after the publication of the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines. We also assessed the adequacy of dose regimen and therapeutic drug monitoring (TDM). All glycopeptide prescriptions were collected during a 3-month prospective study and evaluated by 2 independent infectious diseases experts. Appropriateness of prescription was assessed according to local guidelines based on the HICPAC recommendations. A total of 154 prescriptions were evaluated: 77% (69.1-83.0) were appropriate and 36% (28.2-43.8) were adequate with regard to dose regimen and loading dose. Multivariate analysis showed greater appropriateness for vancomycin than for teicoplanin (p=0.01). There was a wide discrepancy among units (p=0.04). TDM was appropriately performed in 40% (32.3-47.7) of glycopeptide treatments. When required, dose regimen adaptations occurred in 58% of cases. In conclusion, we show a satisfactory appropriateness of glycopeptide prescription. However, the adequacy of dose regimens must be improved. Finally, TDM does not comply with recent recommendations in most cases.

[Assessment of antibiotic prescriptions in the emergency department of a general hospital. Prospective analysis of 211 prescriptions]. / Evaluation de la qualité des prescriptions antibiotiques dans le service d'accueil des urgences d'un centre hospitalier général. Analyse prospective de 211 prescriptions.

AIM: To study the appropriateness and conformity to antibiotic prescription guidelines in an emergency department and to assess the factors likely to influence them. METHODS: This prospective study included all adult patients visiting the emergency department over a period of 100 days and receiving antibiotic treatment. Two independent specialists in infectious disease assessed the appropriateness of the indications and the treatment's conformity with good practice guidelines. We also studied patient's status 7 days after initiation of antibiotic treatment, duration of hospitalization and any treatment changes. RESULTS: The study included 211 patients, 47% of them men. Prescriptions were appropriate in 53% of cases and in accordance with guidelines in 34%. Half of all prescriptions were related to urinary tract or pulmonary infections. Four antibiotic families accounted for 88% of prescriptions. Prescription errors were related to multidrug treatments, intravenous drugs, and inappropriate antibiotic families. More than half (56%) of the patients were admitted, and 70% of these remained in the hospital more than one week. Duration of treatment was inappropriate for 31% of the patients not admitted. In all, 44% of the antibiotic prescriptions ordered in the emergency department were later modified. CONCLUSION: Multidisciplinary work is essential in improving the quality of antibiotic prescriptions in an emergency department.

Cerebral imaging in infectious endocarditis: A clinical study.

BACKGROUND: Because neurological failure is the most frequent extra-cardiac complication in Infectious Endocarditis (IE), a brain computerised tomography (CT) scan is usually performed. The benefits of magnetic resonance imaging (MRI) have not been clearly established. This study aims to clarify the prevalence and type of cerebral lesions in IE detected using MRI and to compare them with those detected using CT scans. METHODS: In the Grenoble University Hospital, patients diagnosed with definite or possible endocarditis according to Duke's criteria were screened from 2010-2012. Brain CT and MRI were performed as soon as possible after diagnosis. RESULTS: Of the 62 patients with IE who underwent at least one cerebral imaging within 3 weeks of diagnosis, Streptococcus (29) and Staphylococcus (14) were the main micro-organisms present. Twenty-eight (45%) patients underwent cardiac surgery. Eight (13%) died before discharge. Twenty (32%) had neurological symptoms. A brain CT-scan was performed on 53 (85%) patients and a MRI was performed on 43 (69%) patients. CT was pathological in 26 (49%) patients, whereas 32 (74%) MRI demonstrated abnormalities. The MRI lesions were classified as follows: ischaemia (48%), microbleeds (34%), haemorrhages (16%), abscesses (9%) and microbial aneurysms (4%). Of the 37 patients who underwent both MRI and CT examinations, ischaemia (48% vs 35%) and microbleeds (34%) demonstrated the difference between the two imaging methods. CONCLUSION: Through the early diagnosis of cerebral damage, even in asymptomatic cases, MRI may have a role in the IE management, influence any surgical decision and assist in prognosis assessment.

Does an educational session with an infectious diseases physician reduce the use of inappropriate antibiotic therapy for inpatients with positive urine culture results? A controlled before-and-after study.

In this controlled before-and-after study involving 19 departments in a university-affiliated hospital, a single 1-hour educational session delivered by an infectious diseases physician reduced the use of inappropriate antibiotic therapy for inpatients with positive urine culture results. Further study is warranted to assess the long-term effect of this intervention.

Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs.

BACKGROUND: Despite growing evidence of the benefits of prolonged breastfeeding for mother and infant health, the rate of breastfeeding at infant age of 6 months remains below the Healthy People 2010 goal. The greatest decrease in the breastfeeding rate occurs during the first 4 postpartum weeks. Mothers who discontinue breastfeeding early are more likely to report lack of confidence in their ability to breastfeed, problems with the infant latching or suckling, and lack of individualized encouragement from their clinicians in the early postdischarge period. Observational studies suggest that primary care physicians can increase breastfeeding rates through specific advice and practices during routine preventive visits. However, robust scientific evidence based on randomized, controlled trials is currently lacking. OBJECTIVE: The purpose of this study was to determine whether attending an early, routine, preventive, outpatient visit delivered in a primary care physician's office would improve breastfeeding outcomes. DESIGN: The study was a prospective, randomized, parallel-group, open trial. SETTING: Participants were recruited at a level 3 maternity facility, with an average of 2000 births per year, in France. PARTICIPANTS: A total of 231 mothers who had delivered a healthy singleton infant (gestational age: > or =37 completed weeks) and were breastfeeding on the day of discharge were recruited and randomized (116 were assigned to the intervention group and 115 to the control group) between October 1, 2001, and May 31, 2002; 226 mother-infant pairs (112 in the intervention group and 114 in the control group) contributed data on outcomes. INTERVENTION: Support for breastfeeding in the control group included the usual verbal encouragement provided by the maternity ward staff members, a general health assessment and an evaluation for evidence of successful breastfeeding behavior by the pediatrician working in the obstetrics department on the day of discharge, provision of the telephone number of a peer support group, mandatory routine, preventive, outpatient visits at 1, 2, 3, 4, 5, and 6 months of infant age, and 10 weeks of paid maternity leave (extended to 18 weeks after the birth of the third child). In addition to the usual predischarge and postdischarge support, the mothers in the intervention group were invited to attend an individual, routine, preventive, outpatient visit in the office of 1 of the 17 participating primary care physicians (pediatricians or family physicians) within 2 weeks after the birth. The participating physicians received a 5-hour training program on breastfeeding, delivered in 2 parts in 1 month, before the beginning of the study. OUTCOME MEASURES: The primary outcome was the prevalence of exclusive breastfeeding reported at 4 weeks (defined as giving maternal milk as the only food source, with no other foods or liquids, other than vitamins or medications, being given). The secondary outcomes included any breastfeeding reported at 4 weeks, breastfeeding duration, breastfeeding difficulties, and satisfaction with breastfeeding experiences. Classification into breastfeeding categories reported at 4 weeks was based on 24-hour dietary recall. RESULTS: Ninety-two mothers (79.3%) assigned to the intervention group and 8 mothers (7.0%) assigned to the control group reported that they had attended the routine, preventive, outpatient visit in the office of 1 of the 17 primary care physicians participating in the study. Mothers in the intervention group were more likely to report exclusive breastfeeding at 4 weeks (83.9% vs 71.9%; hazard ratio: 1.17; 95% confidence interval [CI]: 1.01-1.34) and longer breastfeeding duration (median: 18 weeks vs 13 weeks; hazard ratio: 1.40; 95% CI: 1.03-1.92). They were less likely to report any breastfeeding difficulties (55.3% vs 72.8%; hazard ratio: 0.76; 95% CI: 0.62-0.93). There was no significant difference between the 2 groups with respect to the rate of any breastfeeding at 4 weeks (89.3% vs 81.6%; hazard ratio: 1.09; 95% CI: 0.98-1.22) and the rate of mothers fairly or very satisfied with their breastfeeding experiences (91.1% vs 87.7%; hazard ratio: 1.04; 95% CI: 0.95-1.14). CONCLUSIONS: Although we cannot exclude the possibility that findings might differ in other health care systems, this study provides preliminary evidence of the efficacy of breastfeeding support through an early, routine, preventive visit in the offices of trained primary care physicians. Our findings also suggest that a short training program for practicing physicians might contribute to improving breastfeeding outcomes. Multifaceted interventions aiming to support breastfeeding should involve primary care physicians.

Effect of a training program for maternity ward professionals on duration of breastfeeding.

BACKGROUND: Training programs are commonly viewed as an effective way to improve breastfeeding-related practices of health professionals. The objective of this study was to determine whether a 3-day training program for maternity ward professionals was followed by an increase in duration of any breastfeeding. METHODS: A before-and-after study was conducted involving two retrospective random samples of 308 mothers who had delivered a healthy singleton infant of 37 weeks' or more gestation and 2,500 g or more birthweight in a level 3 maternity ward in a university hospital in France. Data were gathered from medical records and postal questionnaire. RESULTS: Study participants included 169 mothers (54.9%) in the pre-intervention sample and 178 (57.8%) in the post-intervention sample. The prevalence of any breastfeeding at birth was 77.5 percent (70.5%-83.6%) in the pre-intervention sample and 82.6 percent (76.2%-87.8%) in the post-intervention sample(p=0.24); the median duration of any breastfeeding was 13 weeks and 16 weeks, respectively(chi2 log-rank test=5.8, p=0.02). The decreased risk of weaning in the post-intervention sample persisted after adjustment for baseline characteristics (adjusted hazard ratio=0.70 [0.54-0.91]). It was paralleled by significant improvement in maternity ward practices that are known to affect the duration of breastfeeding. CONCLUSION: An intensive 3-day training program for maternity ward professionals can be followed by a significant but moderate increase in the duration of any breastfeeding. Multifaceted interventions involving prenatal components and community support should be planned in Western countries with low to intermediate prevalence of breastfeeding.