Anesthesia Patient Satisfaction Surveys
Are there any anesthesia or pain medicine practices that have not yet implemented a patient satisfaction survey?
The answer is of course “yes.” Quite a few anesthesiologists question the relevance and usefulness of patients’ opinions regarding their care, asking, for example, whether patients are evaluating “pain-free surgery or pain-free parking.” Others are leery because there are no standards for patient surveys and because so few instruments have been validated. The subjective patient experience is, however, an outcome measure that is here to stay. Current and projected uses include quality assessment, for anesthesiologists as well as for hospitals and ambulatory surgery centers; quality improvement; provider comparisons; competency assessment; pay-for-performance programs; marketing, and education and coaching.
The vast majority of health systems have deployed patient experience surveys, if for no other reason than under CMS’ Hospital Value-Based Purchasing program, hospitals can either lose or gain up to 1.25 percent of their Medicare payments in fiscal year 2014 based in part on their Consumer Assessment of Health Care Provider (CAHPS) scores; the penalty/reward will increase to 2.0 percent by 2017. Questions about the appropriateness of obtaining patients’ views are, in effect, settled.
Although patient survey instruments are ubiquitous, recent reviews of the literature have found few that have been appropriately developed or validated. (Barnett, SF, Alagar RK, Grocott, MPW, Giannaris, S, Dick JR, Moonesinghe, SR. Patient-Satisfaction Measures in Anesthesia: Qualitative Systematic Review. Anesthesiology 2013 Aug;119(2):452-78.) The American Society of Anesthesiologists and the Anesthesia Quality Institute are well aware of both the widespread implementation of surveys and the lack of a standardized and validated set of survey questions. Notably, ASA’s Committee on Performance and Outcome Measurement (CPOM) has significant reservations about the eight questions relating to anesthesia services in the Surgical CAHPS. The S-CAHPS was developed by the American College of Surgeons with the federal Agency for Healthcare Research and Quality and endorsed by the powerful National Quality Forum. CPOM is concerned that the S-CAHPS could be adopted widely by surgeons or facilities, or mandated as a part of value-based purchasing. Accordingly, CPOM “developed a set of survey questions for use by anesthesia practices to report to the Anesthesia Quality Institute.” (Patient Satisfaction and Experience with Anesthesia, ASA White Paper, May 2013.)
The ASA CPOM looked at studies that evaluated multiple items, were validated with at least 100 patients, provided the questionnaire and followed a rigorous methodology using principles of accepted psychometric questionnaire construction. From two rounds of reviews, the committee selected and revised questions to improve the accuracy of the translation to English or to reflect the anesthesia care team model of service delivery.
The recommendations are divided into four data collection categories: (1) general information about the survey type and mechanism, elapsed time between procedure and response date, type of anesthesia and surgical procedure; (2) patient demographic information, including educational attainment and self-assessment of health status; (3) questions for a short form survey intended to supplement another patient satisfaction that does not assess the anesthesia experience and (4) questions for a long form anesthesia satisfaction survey intended to be used as a stand-alone instrument. The third and fourth categories use a five-point Likert scale “as this has been shown to be optimal for surveys of patient satisfaction. [Citations omitted.]”
The long form anesthesia satisfaction survey developed by the ASA CPOM contains 15 questions: 11 questions from the domains of Information, Involvement in Decision Making, Pain Management, Attention, Provider-Patient Relationship and Anesthesia Related Sequelae; three questions reflecting global satisfaction with anesthesia and one question determining global satisfaction with the facility. The five responses from which patients must choose one per question are either “disagree very much, disagree moderately, disagree slightly, agree slightly, agree moderately, agree very much” or “very dissatisfied, dissatisfied, slightly dissatisfied, slightly satisfied, satisfied, very satisfied.”
These are the 15 questions:
Q1. During the visit with the anesthesia team before the surgery I was able to ask the questions I wanted.
To what degree were you satisfied with the amount of information given from the anesthesia practitioners?
The Anesthesia practitioners explained to me how I would feel after anesthesia.
Q5. How satisfied were you with pain therapy after surgery?
Q6. How satisfied were you with treatment of nausea and vomiting after the operation?
Q7. To what degree did the staff of the surgery center or operating room and recovery area take into account your privacy?
Q8. To what degree did you find the staff of the surgery center or operating room and recovery area professional?
Q9. To what degree did you find your anesthesia practitioners professional?
Q10. To what degree did your anesthesia practitioners pay attention to your complaints like pain and nausea?
Q11. I would want to have the same anesthetic again?
Q12. How satisfied were you with the care provided by the department of anesthesia?
Q13. Based on this experience, I have a good understanding of the role the anesthesiologist played in my surgery.
Q14. I would recommend the anesthesia team to others in my family.
Q15. How would you rate the quality of your overall care at the facility?
Anesthesia practices that are developing or updating patient satisfaction surveys should consider the above questions, along with the general survey- and procedure-related questions and the demographic questions for which readers are referred to the ASA white paper. Those practices whose hospitals or surgery centers already have a survey instrument in place may want to have the six questions from the short form added to the facility instrument. Others that prefer a survey that is ready to deploy—or pain medicine practices—have various options, including the system offered by SurveyVitals™, which is available on its own or together with ABC’s partner ePREOP. SurveyVitals™ has been psychometrically validated and approved by the American Board of Anesthesiology for Maintenance of Certification purposes. The system, which includes questionnaires for surgeons, for anesthesiologists, for employees and for the hospital to evaluate the group, is being used by hundreds of practices.
As stated by Richard Dutton, MD, MBA, Executive Director of the Anesthesia Quality Institute, “Measurement of anesthesia patient experience is one of the most important elements of perioperative quality improvement, and is consistent with the emerging federal emphasis on patient-centered outcomes of healthcare.” The benefits of surveying patients outweigh the hassle. We expect that the balance will continue to tip further in favor of patient satisfaction surveys, as long as these are properly developed and implemented.