Quality of Anesthesia Care in a University Hospital in Thailand.

BACKGROUND: Service quality is an important factor, which value differs between the patient's satisfaction and expectation. The patient's expectations are important factors for development. This service quality is a key part for improvement of our anesthesia service. In general, an improvement in service design and delivery helps to achieve higher levels of the service quality. OBJECTIVE: To evaluate the level of patient's expectation, patient's satisfaction and the quality of anesthesia care in a university hospital in Thailand MATERIAL AND METHOD: The patient satisfaction questionnaire, developed from service quality criteria and patient satisfaction questionnaire (PSQ-18), was applied to evaluate 467 in patients 24-72 hours after anesthesia care. The patients'expectation was also assessed A proportional stratified randomized allocation was done. The questionnaire consisted of three dimensions; 1) structure: reliability & empathy, 2) process: assurance & tangible and 3) result: responsiveness. Data expectation and satisfaction were analyzed with mean, standard deviation, t-test, ANOVA and normalized gain for the quality of anesthesia care. RESULTS: The patient's satisfaction in our anesthesia care is relatively high. The mean patient's satisfaction score is significantly higher than the mean patient's expectation in all dimensions. This study indicated that an anesthesia service in our hospital was a high quality service in the inpatient aspects. CONCLUSION: Patient's expectation and satisfaction with anesthesia services in our setting was relatively high. Although most patients never had been any expectation regarding anesthesia service, the information and the involvement in decision- making were the most requirements of the adult inpatients.

Cost-effectiveness of thoracic patient-controlled epidural analgesia using bupivacaine with fentanyl vs bupivacaine with morphine after thoracotomy and upper abdominal surgery.

OBJECTIVES: To compare the effectiveness and cost of thoracic patient-controlled epidural analgesia (TPCEA) using bupivacaine with fentanyl (BF) vs bupivacaine with morphine (BM) solution. MATERIAL AND METHOD: In a blinded, randomized controlled trial, 90 adult patients who were scheduled for thoracotomy or upper abdominal surgery were enrolled. All patients were anesthetized by a combined general/epidural technique. Intraoperative and postoperative analgesia was provided by TPCEA using bupivacaine 0.0625% with either fentanyl (group BF) or morphine (group BM) solution. The occurrence and severity of side effects, visual analogue scale (VAS) for pain at rest and during movement, patients' satisfaction score as well as charged cost of pain and side effect management were recorded for 48 hrs. RESULTS: Demographic data of both groups were not significantly different. No statistical differences were noted with respect to efficacy of pain relief between the 2 groups. Only 28.5% of the patients in group BM required supplemental systemic analgesia within 24 hours after epidural catheter removal compared with 51.4% in the group BE Patients' satisfaction and the severity of epidural analgesia related side effects, using itching and nausea/vomiting score, of both groups were not significantly different except the median nausea/ vomiting scores of group BM at 18 and 24 hours were statistically higher than those of group BF (P = 0.047 and 0.02, at 18 and 24 hour respectively) but not clinically different. The mean charged cost of medication used in group BM (470.64 +/- 160.54 baht) was lower than that in group BF (814.15 +/- 217.51 baht). CONCLUSION: TPCEA using BF and BM solution resulted in similar pain relief and side effect profiles but with higher charged cost of medication in group BF Morphine appears to be a more cost-effective choice than fentanyl for TPCEA after thoracotomy or upper abdominal surgery.