A Call on Home Call Comment on “The Influence of Intern Home Call on Objectively Measured Perioperative Outcomes” A Call on Home Call

Horvath K. — Mon, 01 Apr 2013 00:00:00 GMT

This landmark study provides the first comprehensive assessment of surgical intern home call as it relates to patient outcomes. This study included objective, prospectively gathered surgical in-patient perioperative morbidity and mortality using the Veterans Affairs National Surgical Quality Improvement Program data set. During the first era (1999-2003), interns took in-hospital call and during the second (2004-2010), interns took home call. The question raised was whether intern home call correlated with increased rates for postoperative morbidity and mortality compared with intern in-hospital call. The findings did not show an association between intern home call and detrimental postoperative outcomes.

Patient Satisfaction as a Possible Indicator of Quality Surgical Care Patient Satisfaction and Quality of Surgical Care

Lyu H, Wick EC, Housman M, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

In 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care.

Objective

To determine whether patient satisfaction is independent from surgical process measures and hospital safety.

Design

We compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare & Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire.

Setting

Thirty-one US hospitals.

Participants

Patients and hospital employees.

Interventions

There were no interventions for this study.

Main Outcomes and Measures

Hospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey.

Results

Patient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R = −0.216 [P = .24]; appropriate hair removal, R = −0.012 [P = .95]; Foley catheter removal, R = −0.089 [P = .63]; deep vein thrombosis prophylaxis, R = 0.101 [P = .59]). In addition, patient satisfaction was not associated with a hospital's overall safety culture score (R = 0.295 [P = .11]). We found no association between patient satisfaction and the individual culture domains of job satisfaction (R = 0.327 [P = .07]), working conditions (R = 0.191 [P = .30]), or perceptions of management (R = 0.223 [P = .23]); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R = 0.439 [P = .01]), safety climate (R = 0.395 [P = .03]), and stress recognition (R = −0.462 [P = .008]).

Conclusions and Relevance

Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital's ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.

JAMA Surgery: Health Care Delivery Topic Collection

A Call on Home Call Comment on “The Influence of Intern Home Call on Objectively Measured Perioperative Outcomes” A Call on Home Call

Patient Satisfaction as a Possible Indicator of Quality Surgical Care Patient Satisfaction and Quality of Surgical Care