Postoperative Patient Satisfaction With Anaesthesia Care
Our study showed that a single postoperative visit by the attending anaesthetist significantly increased the perception of 'Continuity of personal care by the anaesthetist' when compared with no visit at all. However, when compared with a visit by a nurse anaesthetist, there was no significant difference.
Dedicated personal care including postoperative visits has been shown to be one of the most important factors for patient satisfaction with anaesthesia care. In particular continuity of personal care by the anaesthetist, as defined by the presence of a single anaesthetist providing preoperative evaluation and informed consent, performing anaesthesia, and visiting the patient after operation, has been described as a crucial factor for patient satisfaction with anaesthesia care.
In our study, we were interested to know to what extent a postoperative visit by the attending anaesthetist could make up for the deficit resulting from the disruption of personal care between preoperative evaluation and delivery of anaesthesia.
In our study, we could in fact demonstrate a huge improvement in the perception of a postoperative visit when we compared a visit by the attending anaesthetist to a visit by the nurse anaesthetist or no visit at all. However, this positive perception of a visit by the anaesthetist could not be translated into a comparable improvement in the perceived 'Continuity of personal care by the anaesthetist', which was not significantly better when compared with a visit by the nurse anaesthetist. This may be attributed to at least two mechanisms.
First, patients often find it very difficult to recognize the anaesthetist who performs a postoperative visit: only 67% of our patients were able to correctly recall the postoperative visit by their anaesthetist. Similar results were obtained by another study group who reported that only 10% of their patients were able to spontaneously recall the name of the anaesthetist who performed both anaesthesia and the postoperative visit. This percentage could not be improved by increasing the frequency of postoperative visits from one to three. In our study and also in our clinical routine, patients are assigned to anaesthetists and therefore do not know before operation who will perform anaesthesia. Patients first make contact with their anaesthetist directly before the operation, during a stressful period, often at a time when preoperative anxiolytic medications have already been administered. Thus, in sharp contrast to repeated patient contact with the surgeon at various stages of the procedure, the postoperative visit may be the first time that patients clearly visualize 'their' anaesthetist. Another study group showed that only two or more postoperative visits by an anaesthetist improved patient satisfaction. This is in line with other findings, which showed that prolonged patient contact is a significant predictor of patient satisfaction. Yet, another study group came up with contrasting results. This, however, may simply reflect differing types of study design and definitions of patient satisfaction.
Secondly, even if a postoperative visit by the anaesthetist takes place and is actually perceived as such by the patients, they may still judge such a visit as more or less important for their satisfaction. In the present updated questionnaire, we specifically addressed the importance of the postoperative visit for the patients. In Group 1, 22.5% of the patients felt that the postoperative visit of their anaesthetist was of little importance. Taking into consideration the importance, a patient attached to a postoperative visit by the attending anaesthetist even reduced the problem score for the perception of not being visited after operation when compared with not considering the perceived importance of such a visit. Still, Group 1 patients visited by the attending anaesthetist had significantly lower problem scores when compared with those visited by a nurse anaesthetist or those not visited at all. Thus, in general, patients appreciate a postoperative visit by their attending anaesthetist.
The importance of a postoperative visit may vary with the patient's expectations. In our study, the group that rated importance of the postoperative visit by the attending anaesthetist highest was the one that actually received such a visit. Hence, fulfilled expectation is likely to have played a role in judging the importance of such a visit, which would explain the lower rates in Groups 2 and 3. Another study group who researched 'continued' (the anaesthetist who conducts the preoperative visit will also administer the anaesthetic) vs 'divided' (the anaesthetist who conducts the preoperative visit will not administer the anaesthetic) anaesthetic care observed a similar effect: when patients were informed during the preoperative visit that the anaesthetic would be administered by another anaesthetist, they attached significantly less importance to having the same anaesthetist conduct the preoperative visit and administer anaesthesia than another group of patients who were informed that the anaesthetic would be administered by the same anaesthetist. Patient satisfaction with anaesthetic care did not differ between the two groups. Thus, clear information about whether a postoperative visit will occur and by whom it will be performed may influence the importance of such a visit for the patient and, as a consequence, patient satisfaction.
Our study clearly shows that as long as the patient expects a physician, he or she will be dissatisfied with a nurse performing the postoperative visit.
A limitation of our study set-up is the fact that we relied on a mailed-back questionnaire and a relatively high number of patients (39%) failed to return the questionnaires. Still, using the current questionnaire, we were able to reproduce a very similar pattern of problem scores compared with our previous studies in different hospitals. Other forms of questioning such as personal interviews or in-hospital questionnaires result in higher response rates, but are subject to social desirability and interviewer bias. Another limitation is that we did not measure how often the anaesthetist who consented the patient actually conducted anaesthesia in each group. However, we assumed the rate to be quite low, because the average chance to meet a patient twice in the process of anaesthetic care is only around 3% at our department.
Our study setting excluded patients with adverse events, as those were all followed-up closely. In these patients, true randomization with the option 'no postoperative visit' would not have been feasible.
In conclusion, a single postoperative visit by the anaesthetist is able to increase perceived 'Continuity of personal care by the anaesthetist' and hence satisfaction. However, there is no significant difference compared with a visit by a nurse anaesthetist.
Both moderate recognition rates of the anaesthetist and unclear patient expectations concerning the postoperative visit may limit the effect of such a visit on perceived continuity of care and patient satisfaction.
Future studies should address the issue whether perceived continuity of personal care for the patient, ideally represented by a single anaesthetist providing the entire anaesthetic care, could be replaced by anaesthetic team continuity. Both clear preoperative information of the patient about 'divided' anaesthetic care and strict attention to the patient's needs, as expressed before operation, throughout the process of anaesthetic care may help to reach this goal.
It is our clear understanding that in the case of adverse events occurring during anaesthesia care, intense personal attention is crucial for a satisfactory and trustful relationship between the patient and the physician. Future studies should also address the question whether patients who experienced an adverse event do specifically benefit and appreciate one or repeated postoperative visits by the attending anaesthetist.
Discussion
Our study showed that a single postoperative visit by the attending anaesthetist significantly increased the perception of 'Continuity of personal care by the anaesthetist' when compared with no visit at all. However, when compared with a visit by a nurse anaesthetist, there was no significant difference.
Dedicated personal care including postoperative visits has been shown to be one of the most important factors for patient satisfaction with anaesthesia care. In particular continuity of personal care by the anaesthetist, as defined by the presence of a single anaesthetist providing preoperative evaluation and informed consent, performing anaesthesia, and visiting the patient after operation, has been described as a crucial factor for patient satisfaction with anaesthesia care.
In our study, we were interested to know to what extent a postoperative visit by the attending anaesthetist could make up for the deficit resulting from the disruption of personal care between preoperative evaluation and delivery of anaesthesia.
In our study, we could in fact demonstrate a huge improvement in the perception of a postoperative visit when we compared a visit by the attending anaesthetist to a visit by the nurse anaesthetist or no visit at all. However, this positive perception of a visit by the anaesthetist could not be translated into a comparable improvement in the perceived 'Continuity of personal care by the anaesthetist', which was not significantly better when compared with a visit by the nurse anaesthetist. This may be attributed to at least two mechanisms.
First, patients often find it very difficult to recognize the anaesthetist who performs a postoperative visit: only 67% of our patients were able to correctly recall the postoperative visit by their anaesthetist. Similar results were obtained by another study group who reported that only 10% of their patients were able to spontaneously recall the name of the anaesthetist who performed both anaesthesia and the postoperative visit. This percentage could not be improved by increasing the frequency of postoperative visits from one to three. In our study and also in our clinical routine, patients are assigned to anaesthetists and therefore do not know before operation who will perform anaesthesia. Patients first make contact with their anaesthetist directly before the operation, during a stressful period, often at a time when preoperative anxiolytic medications have already been administered. Thus, in sharp contrast to repeated patient contact with the surgeon at various stages of the procedure, the postoperative visit may be the first time that patients clearly visualize 'their' anaesthetist. Another study group showed that only two or more postoperative visits by an anaesthetist improved patient satisfaction. This is in line with other findings, which showed that prolonged patient contact is a significant predictor of patient satisfaction. Yet, another study group came up with contrasting results. This, however, may simply reflect differing types of study design and definitions of patient satisfaction.
Secondly, even if a postoperative visit by the anaesthetist takes place and is actually perceived as such by the patients, they may still judge such a visit as more or less important for their satisfaction. In the present updated questionnaire, we specifically addressed the importance of the postoperative visit for the patients. In Group 1, 22.5% of the patients felt that the postoperative visit of their anaesthetist was of little importance. Taking into consideration the importance, a patient attached to a postoperative visit by the attending anaesthetist even reduced the problem score for the perception of not being visited after operation when compared with not considering the perceived importance of such a visit. Still, Group 1 patients visited by the attending anaesthetist had significantly lower problem scores when compared with those visited by a nurse anaesthetist or those not visited at all. Thus, in general, patients appreciate a postoperative visit by their attending anaesthetist.
The importance of a postoperative visit may vary with the patient's expectations. In our study, the group that rated importance of the postoperative visit by the attending anaesthetist highest was the one that actually received such a visit. Hence, fulfilled expectation is likely to have played a role in judging the importance of such a visit, which would explain the lower rates in Groups 2 and 3. Another study group who researched 'continued' (the anaesthetist who conducts the preoperative visit will also administer the anaesthetic) vs 'divided' (the anaesthetist who conducts the preoperative visit will not administer the anaesthetic) anaesthetic care observed a similar effect: when patients were informed during the preoperative visit that the anaesthetic would be administered by another anaesthetist, they attached significantly less importance to having the same anaesthetist conduct the preoperative visit and administer anaesthesia than another group of patients who were informed that the anaesthetic would be administered by the same anaesthetist. Patient satisfaction with anaesthetic care did not differ between the two groups. Thus, clear information about whether a postoperative visit will occur and by whom it will be performed may influence the importance of such a visit for the patient and, as a consequence, patient satisfaction.
Our study clearly shows that as long as the patient expects a physician, he or she will be dissatisfied with a nurse performing the postoperative visit.
A limitation of our study set-up is the fact that we relied on a mailed-back questionnaire and a relatively high number of patients (39%) failed to return the questionnaires. Still, using the current questionnaire, we were able to reproduce a very similar pattern of problem scores compared with our previous studies in different hospitals. Other forms of questioning such as personal interviews or in-hospital questionnaires result in higher response rates, but are subject to social desirability and interviewer bias. Another limitation is that we did not measure how often the anaesthetist who consented the patient actually conducted anaesthesia in each group. However, we assumed the rate to be quite low, because the average chance to meet a patient twice in the process of anaesthetic care is only around 3% at our department.
Our study setting excluded patients with adverse events, as those were all followed-up closely. In these patients, true randomization with the option 'no postoperative visit' would not have been feasible.
In conclusion, a single postoperative visit by the anaesthetist is able to increase perceived 'Continuity of personal care by the anaesthetist' and hence satisfaction. However, there is no significant difference compared with a visit by a nurse anaesthetist.
Both moderate recognition rates of the anaesthetist and unclear patient expectations concerning the postoperative visit may limit the effect of such a visit on perceived continuity of care and patient satisfaction.
Future studies should address the issue whether perceived continuity of personal care for the patient, ideally represented by a single anaesthetist providing the entire anaesthetic care, could be replaced by anaesthetic team continuity. Both clear preoperative information of the patient about 'divided' anaesthetic care and strict attention to the patient's needs, as expressed before operation, throughout the process of anaesthetic care may help to reach this goal.
It is our clear understanding that in the case of adverse events occurring during anaesthesia care, intense personal attention is crucial for a satisfactory and trustful relationship between the patient and the physician. Future studies should also address the question whether patients who experienced an adverse event do specifically benefit and appreciate one or repeated postoperative visits by the attending anaesthetist.
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