Measuring Patient Satisfaction with Anesthesia Care: A Review of Current Methodology

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In clinical settings such as anesthesia, using patient satisfaction as an indicator to monitor the quality of clinical care has potential merit. For patients, satisfaction represents, at least in theory, an evaluation of the healthcare experience based on their own values, perceptions, and interactions with the healthcare environment. For healthcare providers, patient satisfaction can be used to assess the actual impact of healthcare processes on the patients themselves. Patients' ratings of their satisfaction can reflect many facets of care not easily examined in any other manner: compassionate bedside skills, efficient attendance to needs, participation in decision-making, and adequate communication and information [1]. An ideal measure of patient satisfaction could therefore provide unique feedback on the quality of practice for medical specialties such as anesthesia.A renewed focus has been sought for patient satisfaction as a clinical end point and a quality indicator of anesthesia care. Previous studies have demonstrated the limitations of using adverse anesthetic events to monitor anesthesia care [2]. Major outcomes (death and complications such as myocardial infarction, cardiac arrest, and severe brain injury) are too rare to allow useful comparisons among institutions. Assessing minor outcomes (such as pain and nausea) pose significant methodological problems of uncertain case mix, inconsistent reporting compliance, imprecise definitions, and under- and overreporting. Orkin et al. [3] emphasized the still unproven relationships between most intermediate events (for example, transient intra- and postoperative hypoxemia) and clinically significant adverse events (death, myocardial infarction, etc.), as well as the difficulties in establishing those relationships. They also suggested that, in light of the demonstrated safety of anesthesia, the field may have become a victim of its own success and that a redefinition of what constitutes important anesthetic outcomes is necessary.This is echoed in a review on quality models for anesthesia care by Eagle and Davies [4], who cite preliminary evidence of the benefits of examining positive outcomes such as patient satisfaction [5]. In an accompanying editorial, Duncan [6] states that quality in anesthesia should encompass that which satisfies all of its customers, which includes surgeons, administrators, fellow anesthesiologists, and patients. In an editorial, Klock and Roizen [7] hoped to "wake up" the specialty of anesthesia to the potential value of patient satisfaction as a means to assess and improve the quality of modern anesthesia practice. Thus, researchers and authorities on anesthetic outcomes and quality have articulated the need to expand the scope of important anesthetic outcomes and have targeted patient satisfaction as a potentially useful indicator of the quality of anesthesia care.Despite the many attractive features of patient satisfaction, current measures of satisfaction in anesthesia care suffer from lack of refinement and have uncertain reliability and validity. Cross-sectional surveys using single-item questions and yes/no or Likert response formats [2,8-11] have yielded uniformly high scores (>80% satisfied or very satisfied). Unfortunately, it is unclear what these global ratings mean. Are patients truly satisfied with their anesthesia care or merely expressing their satisfaction with their surgical or hospital care? Do patients base these positive ratings on a single factor (such as intact survival) or on several criteria (friendliness, sensitivity, compassion, information, and communication)? Are reports of satisfaction biased by patients' respect, trust, confidence, and gratitude to their doctors, nurses, and healthcare in general (a so-called halo effect)? The inability to answer these types of questions limits the utility of simple measures of patient satisfaction in anesthesia.If patient satisfaction can truly help to monitor the quality of anesthesia care, a better measure of patient satisfaction that has proven reliability and validity is needed.

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