Improving quality in healthcare: What makes a satisfied patient?

OBJECTIVE: To update the metric properties of a perceived quality questionnaire for patients admitted to hospital medical departments, to determine the level of patient satisfaction achieved, and to identify the variables which predict satisfaction. METHODS: Self-administered questionnaire completed at home following patient discharge, using a questionnaire prepared by the authors on a sample of 7207 users of medical departments in 9 public hospitals during the years 2006-2009. A principal component analysis with varimax rotation was performed. Reliability was assessed using internal consistency coefficient. An analysis was made of the compliance with each indicator reported by respondents. A logistic regression analysis was performed to determine the perceived quality dimensions which predicted overall patient satisfaction. RESULTS: The results of the reliability analysis indicated good coefficients for interpersonal manner (0.94) and professional competence (0.85) dimensions, and moderate values for the other dimensions (comfort 0.55, information 0.38, and organisation 0.37). Factor analyses showed single factors in each of the perceived quality dimensions, with a percentage of explained variance greater than 35% for information, interpersonal manner, professional competence, and comfort, and less than 30% for organisation. The dimensions which predicted satisfaction were interpersonal manner of healthcare staff, professional competence, and information. CONCLUSIONS: The metric properties of the questionnaire used have been updated, yielding a valid and reliable questionnaire for assessing patient satisfaction in quality management programmes, both for internal purposes and for conducting external comparisons. A positive relationship was obtained between the level of patient satisfaction and level of professional competence, interpersonal manner of healthcare staff, and information received.

[The acute pseudobstruction of the colon, or Ogilvie's syndrome: a rare cause of acute abdomen, high mortality and associated pathologies in an internal medicine department]. / Síndrome de Ogilvie o pseudobstrucción aguda del colon: una causa rara de abdomen agudo, de elevada mortalidad y asociada a patologías frecuentes en un Servicio de Medicina Interna.

The acute pseudobstruction of the colon or Ogilvie's syndrome is a infrequent pathology of acute or subacute evolution, that is associated to different clinical or surgical pathologies, and whose pathophysiology continues to be unknown. The treatment begins with general measures and if these are not effective, with the surgical decompression of colon to avoid the most serious complication, and frequently that is perforation of the cecum. We present a case of an acute and idiopathic dilatation of colon in an adult man who entered by an episode of acute respiratory insufficiency, and that was solved with preservative medical treatment.