Background Patient reported outcomes (PRO) have been increasingly emphasized; however determining clinically valuable PRO has been problematic and investigation limited. This study examines the association of a previously described PRO – readiness for discharge – with patient satisfaction and readmission. Study Design Data from adult patients admitted to our institution from 2009 to 2012 who completed both the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and the Press Ganey (PG) surveys post-discharge were extracted from an existing database of patients (comprised of 220 patients admitted for small bowel obstruction (SBO) and 98 patients with hospital stays ≥21 days). Using the survey question, “Did you feel ready for discharge?” (RFD), 2 groups were constructed, those RFD and those with lesser degrees of readiness (LRFD – less ready for discharge) using topbox methodology. Outcomes, readmission rates, and satisfaction were compared between those RFD and those LRFD. Results Three hundred and eighteen patients met the inclusion criteria; 45% were female and 94% were Caucasian. Median age was 62.3 years (interquartile range [IQR] 52.5-70.8 years). Median length of stay was 10 days (IQR 6.0-24.0 days) and 69.2% were admitted with SBO. The 30-day readmission rate was 14.3%; and 55% indicated they were RFD. Those RFD and LRFD had similar demographics, comorbidity scores, and rates of surgery. Those RFD had higher overall hospital satisfaction (87.3% RFD vs. 62.4% LRFD, p<0.001), higher physician communication scores (median 3.0 RFD vs 2.0 LRFD, p<0.001), and higher nursing communication scores (median 3.0 RFD vs. 2.0 LRFD, p<0.001). Readmission rates were similar between the groups (11.4% RFD vs 18.2% LRFD; p=0.09). Conclusions Readiness for discharge appears to be a clinically useful patient-reported metric, as those RFD have higher satisfaction with the hospital and physicians. Prospective investigation into variables affecting patient satisfaction in those LRFD is needed.

Background Patient satisfaction is often measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. Our aim was to examine the structural and clinical determinants of satisfaction among inpatients with prolonged lengths of stays (LOS). Methods Adult patients who were admitted between 2009 and 2012, had a LOS ≥ 21 days, and completed the HCAHPS survey were included. Univariate analyses assessed the relationship between satisfaction and patient/system variables. Recursive partitioning was used to examine the relative importance of the identified variables. Results 101 patients met inclusion criteria. The average LOS was 35 days and 58% were admitted to a surgical service. Satisfaction with physician communication was significantly associated with fewer consultations (p<0.01), non-operative admission (p<.001), no ICU stay (p<.01), non-surgical service (p<.01), and non-ER admissions (p=.03). Among these, having fewer consultations had the highest relative importance. Conclusions In long stay patients, having fewer inpatient consultations was the strongest predictor of patient satisfaction with physician communication. This suggests that examination of patient-level data in clinically relevant subgroups may be a useful way to identify targets for quality improvement.

Objective Pain is challenging to diagnose and manage in primary care, especially when patients have limited English proficiency (LEP). Little is known about whether LEP patients can provide pain information that is consistent with the process and the content that providers expect in a clinical interaction. We explore how LEP Hmong patients communicate their pain to providers in primary care settings. Methods A qualitative study with 67 Hmong participants (63% female and x̄ age = 53.7 years) were recruited from a Midwestern state. Semistructured interviews on pain communication were conducted, audio-recorded, transcribed, and analyzed using directed content analysis. Results The Hmong participants described pain using stories that generally had the same dimensions of information that providers require for pain assessment. These included references to time, causality, associated symptoms or related experiences, intensity, and consequences of pain. However, the participants expressed some pain dimensions in language that was not shared by providers: visual metaphors that were generally in reference to pain quality and fewer words for pain location, intensity, and some qualities. Participants used two strategies to decide whether they should tell their pain story: assessing the provider and determining whether their story was appreciated. The perception that providers underappreciated their stories resulted in dissatisfaction and undertreatment of pain. Ultimately, this resulted in having less frequent contact with providers or changing providers. Conclusions Findings demonstrate a discordance in the expected process and content of the clinical interaction between LEP Hmong patients and providers, suggesting the need for culturally appropriate pain assessments in this population.

Background For patients with small bowel obstruction (SBO), surgical care has been associated with improved outcomes; however it remains unknown how it impacts satisfaction. Methods Patients admitted for SBO who completed the hospital satisfaction survey were eligible. Only those with adhesions or hernias were included. Chart review extracted structural characteristics and outcomes. Results 47 patients were included; 74% (n=35) were admitted to a surgical service. 26% (n=12) were admitted to medicine, and 50% of those (n=6) had surgical consultation. Patients with surgical involvement as the consulting or primary service (SURG) had higher satisfaction with the hospital than those cared for by the medical service (80% SURG; 33% MED, p=0.015). SURG patients also had higher satisfaction with physicians (74% SURG; 44% MED; p=0.015). Conclusions Surgical involvement during SBO admissions is associated with increased patient satisfaction, and adds further weight to the recommendation that these patients be cared for by surgeons.