Patient Experience Journal (PXJ, The Beryl Institute)
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Refining Successful Implementation Strategies for the Surgical Safety Checklist in High-Income Contexts: Results of an International Mixed Methods Study
Get PDFThe WHO Surgical Safety Checklist (SSC) continues to show inconsistent success in reducing surgical complications in high-income settings. Previous implementation research identified potential barriers and facilitators to success, but it primarily consists of qualitative studies with small sample sizes in limited geographic areas. We conducted a multi-country mixed-methods study of barriers and facilitators to SSC implementation to better inform policies and practices for improving SSC buy-in and use to maximize its impact. This convergent parallel mixed-methods study utilized survey and interview data from surgical team members practicing in five countries. Survey data were analyzed using χ2 analysis or Fisher’s exact test for categorical variables and McNemar’s test to analyze differences between related groups for dichotomous variables. Interview data underwent inductive coding followed by thematic analysis for predominant themes common across the study countries. The study resulted in 2,032 survey responses and 51 interviews. Facilitators to success included having influential multi-disciplinary champions from surgery, anesthesiology, and nursing; using a distributed leadership process to promote ownership across all surgical team members; and providing education on the “why” of the checklist. Practitioners found patient safety metrics (e.g., wrong side surgery) more relevant than clinical outcome measures (e.g., surgical mortality) to assess SSC success. Finally, auditing for process engagement was felt to promote more meaningful use than auditing for checklist completion. Our international examination of barriers and facilitators to successful SSC implementation has identified more specific guidance for high-income settings that integrate people, data, and processes
Primary Care Productivity and Patient Satisfaction Community Practice: What is the Relationship?
Get PDFResearch has shown a consistent positive association between patient and provider experience and improved patient outcomes and safety. There is a belief that patient satisfaction and physician productivity are competing interests. The relationship for primary care physicians, in a Midwest Health system was evaluated as part of this project. Data from Press Ganey patient satisfaction surveys on likelihood of recommending the practice and the physician were compared between primary care physicians in the top quartile of average monthly patient visits and those that were in the three lower quartiles. A secondary analysis of patient satisfaction scores related to continuous years of service was also performed. Results of a multi-level logistic regression analysis showed a statistically significant difference between quartiles on average monthly visits and the likelihood of receiving a top box score on recommendation of the practice, but not the provider. The odds ratio was 0.7 for lower quartiles compared to highest quartile of visits. There was not a statistically significant difference for the categories of continuous years of service. On the question of recommending the physician, the odds ratios were not different, although there was a significant difference for the categories of years of service, with those between 0-5 years having a 0.62 odds ratio of a top box score compared to greater than 10 years. The results would tend to refute the belief that patient satisfaction must be sacrificed for physician productivity
Accompanying People Affected by Cancer in Their Return to Life After Treatment: A Report on an Experiment Conducted in Canada
Get PDFThis study aims to assess family doctors\u27 perceived needs for improved patient follow-up post-acute treatment in oncology departments, specifically focusing on the Patient Oriented Discharge Summary (PODS) for individuals living with cancer. A cross-sectional quantitative survey targeted family doctors, and a before/after exploratory study was conducted with patients to measure their needs pre- and post-PODS implementation. Twenty-one out of 42 family doctors participated in the survey (50%). Patient data was collected at three points in time: prior to PODS implementation (T1, n = 20/30; 77%), one month later (T2, n = 20/26; 77%), and six months later (T3, n = 21/28; 75%). Descriptive statistics were used for all inquiries. Results revealed that 52.24% of family doctors lacked information from oncology teams about patient treatments and their progress, while 90.48% received no guidance on monitoring patients for symptoms or necessary tests once treatment was completed, despite everyone expressing the desire to perform such monitoring. Family doctors recommended using standardized sheets with patient information (47%), details of side effects (41%), and post-treatment follow-up plans (12%). At T1, 60% of patients received the necessary information, at T2 95% and 81% at T3. Regarding instructions provided to family caregivers, satisfaction levels were 40% at T1, 90% at T2, and 62% at T3. The study underscores the imperative of enhancing communication between oncology specialists and family physicians, facilitating the latter\u27s follow-up of patients completing acute treatment. It also highlights the need for patients to be adequately prepared for the transition through effective use and sustained use of PODS
Trust Remains the Foundation of my Practice
Get PDFNavigating healthcare while managing the complexities of disease, especially in elderly individuals, is challenging for both patients and their families. Physicians play a crucial role as pathfinders in this journey. However, physicians often experience burnout when dealing with patients and families facing complex illnesses. This narrative highlights the characteristics that enable physicians to effectively negotiate with such patients. It describes the experience of an elderly patient during the pandemic, suffering from severe disease complications, and illustrates the uncertainties and fears that families face, feeling as though they are lost in a maze. The physician\u27s role in guiding the patient and family through trust-building is key, achieved through active listening, patience, compassion, availability, and competence. The narrative also emphasizes the importance of a thorough physical examination, which reassures patients that decisions are made after careful evaluation. The first visit of the patient allows the best moment to initially build the trust as patients initially come with recommendation and taking advantage of that initial trust helps to build the trust eventually. Once trust is established, it strengthens the physician-patient relationship, facilitating more straightforward decision-making with families when necessary. This not only reassures patients’ families that the health of their loved ones is valued, but also reduces physician burnout by simplifying the negotiation process
Covid-19 Vaccine Perception and Hesitancy Among Uninsured Free Clinic Patients
Get PDFThere are many complexities regarding the acceptance of COVID-19 vaccines, mainly because the COVID-19 vaccine had a fast track of development compared to vaccines developed in the past years. The purpose of this study is to understand COVID-19 vaccine perception and hesitancy among uninsured free clinic patients using the theory of planned behavior. This study had seven focus groups with 37 total participants, including 19 Spanish speakers. Free clinic adult patients (over the age of 18) participated in four focus groups during Summer of 2021. The average age of the participants was 44.7, and the majority of the participants self-identified as female and Hispanic. Social networks are found to be important factors in reducing vaccine hesitancy. Hesitant patients had concerns related to vaccines’ safety, effectiveness, and side effects. The lack of valid and reliable COVID-19 vaccination information was a challenge among this study’s participants. This exploratory study highlights some of the factors contributing to vaccine behavior among free clinic patients. This study concluded that the influence of family and friends are important motivational factors in vaccine behavior. A future study could focus on the multifaceted influences on vaccine hesitancy among free clinic patients, emphasizing the strong motivational role of family and friends while also addressing concerns about vaccine safety, efficacy, and the dissemination of reliable information
Investigating the Perceived Impact of Surgeons\u27 Burnout on Surgical Physician Associates\u27 Wellness in United States Ambulatory Surgery Centers
Get PDFSurgeons are the de facto leaders of surgical teams with surgical physician associates (SPAs) as integral members who function in all areas of the peri-operative environment. Surgeons often supervise SPAs. Ambulatory surgery centers (ASCs) provide patients with same-day diagnostic and preventive procedures as more convenient alternatives to hospital-based outpatient procedures. This qualitative, national, and cross-sectional study explored the perceived impact of surgeons\u27 burnout on SPAs\u27 wellness in U.S. ASCs during global health crises. Primary demographic and qualitative data were collected using a self-developed, three-section survey instrument: (1) information regarding informed consent; (2) 10 short demographic questions; and (3) two open-ended essay questions regarding surgeons\u27 burnout and SPAs\u27 wellness. To ensure validity and reliability, we individually reviewed the survey instrument to ensure it be formative of the two study constructs, two retired newspaper editors completed the cognitive interviews, and four subject matter experts critically reviewed it. Demographic data were analyzed using Minitab V21, and qualitative data were analyzed using MAXQDA V2022. The final sample (n = 29) represented 29 unique ASCs across all five U.S. geographic regions. Three main findings emerged from the thematic analyses. First, the SPAs experienced poor and decreased work life balance, decreased exercise, stress, burnout, increased job demand, exhaustion, and decreased job satisfaction when their supervising surgeons\u27 burnout affected their wellness negatively. Second, the SPAs experienced work-related frustration when their interaction with supervising surgeons decreased as a result of the surgeons\u27 burnout. Finally, the SPAs reported feeling supported when their supervising surgeons were supportive and affected their wellness positively
Examining the Impact of Telehealth Visits on Patient and Family Experience in a Pediatric Emergency and Urgent Care Center
Get PDFProviders and healthcare organizations have created novel ways of evaluating patients using telehealth. Patient volumes in urgent cares (UCs) and emergency departments (EDs) continue to climb, contributing to longer wait times and suboptimal patient and family experiences (PFEs). Optimizing use of telehealth may not only impact PFE of those evaluated virtually, but also reduce crowding in EDs and UCs, indirectly impacting PFE in those spaces as well. The purpose of this study is to identify any association between telehealth encounters and PFE scores. This is a retrospective review of patients seen via telehealth in virtual urgent care, UC, or the ED who completed a post-visit PFE survey. Data were extracted from our electronic health record and our experience survey platform. We generated descriptive statistics of our patient populations seeking care at all three site categories who were treated for specific diagnoses. We performed univariate and multivariate analysis to identify independent associations between encounter characteristics and PFE scores. While encounter location was not independently associated with PFE scores, the interaction between wait time and location of service favors use of telehealth services for low-acuity patients by improving the healthcare experience for these patients and families
Improving Patient Care: Expansion of Access to Free Clinics
Get PDFFree clinics provide free or reduced-fee healthcare services for uninsured, underserved, and marginalized populations. Free clinics may be the only source of primary care for socioeconomically disadvantaged individuals lacking health insurance. However, consistently understaffed and underfunded free clinics are struggling to meet growing needs. The demand for services results in long waitlists with long wait times. Most free clinics rely on volunteer providers and staff due to limited financial resources. This case study proposes recommendations that can address the challenges of funding limitations while improving free clinics\u27 ability to offer more accessible and equitable care to serve a greater proportion of people seeking health care. Suggested solutions include improving clinical workflow efficiency, coordinating patient referral networks, and allocating greater safety net funding from federal and local governments. In addition, incentivizing healthcare profession students to engage with free clinics within their communities would increase the number of available providers for assisting with the work of free clinics
Patient, Family, and Health Professional Perspectives of How Families are Involved in Adult Inpatient Traumatic Brain Injury Rehabilitation
Get PDFObjective: We aimed to answer the following research question: From the perspectives of patients, family members, and health professionals, how are families involved in the rehabilitation of adult patients with Traumatic Brain Injury at an inpatient Acquired Brain Injury service within an adult rehabilitation centre? Methods: We used an interpretive qualitative approach, from a constructivist view. This approach allowed us to understand and describe family involvement from the perspectives of patients with Traumatic Brain Injury, family members, and health professionals. We conducted one-on-one interviews with patients, family members, and health professionals. We used a three-step analysis method: data reduction, data display, and conclusions/verifications. Results: Six patients, four family members, and ten health professionals participated. Participants described how families are involved in supporting and encouraging the patient, seeking and exchanging information, making decisions, and care and therapy. Conclusion: Overall, patients and family members perceived family involvement as critical, while health professionals viewed it as not always necessary. This study also revealed that patients and family members shared similar understandings of family involvement but had different understandings than health professionals. Recognizing that the adult population and rehabilitation processes are unique and complex, we need to understand how to support family involvement, through patient- and family-centered care, in this type of setting. We also need to understand how to better facilitate patient-family-health professional collaboration
Laboratory Literacy: Surveying Lab Result Interpretations of a Local Patient Population
Get PDFA patient\u27s independent interpretation of their medical laboratory data has become an unspoken prerequisite in the current age of medicine. In the outpatient setting, it is anecdotally commonplace for patients to receive their lab results before their physicians, resulting in patients often relying on self-interpretations of their results. This study analyzed the degree to which patients are comfortable interpreting lab results and sought to shed light on the question: How are patients interpreting their laboratory reports? A survey was constructed to include the items from a validated health literacy screening tool, followed by items inquiring about the respondent\u27s experience and comfort interpreting medical lab reports. The survey then contained five sets of two questions, each asking the respondent to interpret a mock-up laboratory report associated with a disease state and to report their level of confidence in their answer. The survey was distributed to 173 patient advisors, of which 61 completed the survey. There was a statistically significant association between one\u27s health literacy and one\u27s confidence in interpreting lab results (p \u3c 0.001). Additionally, respondents with a chronic disease were more confident in interpreting a within-range HbA1c compared to respondents without chronic disease (p \u3c 0.05), although similar comparisons for other lab result types failed to yield statistically significant differences. This study detailed the lessons learned in conducting a health and laboratory literacy survey, a preliminary step towards developing a working knowledge of how patients relate to their lab results