The changing landscape
Over the years, there has been a paradigm shift in the focus of health care. Not only do patients seek excellent care, but they demand involvement and direct input into establishing directions.1 As partners in health care, patients are best positioned to evaluate service provision and interpersonal relations.
Measuring patient satisfaction with endoscopic procedures
Endoscopic procedures are low risk but have a high volume. According to a recent estimate, there are 75 million endoscopies performed in the US every year. This number will grow in the future due to increased aging demographics and the growing prevalence of GI-related conditions. So patient satisfaction with endoscopic procedures is linked to success and outcome measures of gastrointestinal endoscopies. It directly reflects patient acceptance of the procedures and will possibly reflect their compliance with future screening and monitoring.
Multiple questionnaires/surveys have been proposed to measure patient satisfaction and endoscopic experiences. The American Society for Gastrointestinal Endoscopy modified the original Group Health Association of America patient satisfaction survey into a 9-item instrument (mGHAA-9) patient satisfaction survey tool. Patients rate their satisfaction with (1) waiting time for an appointment, (2) waiting time before the procedure, (3) personal manner (courtesy, respect, sensitivity, and friendliness) of the physician performing the procedure, (4) personal manner of the nurses and support staff, (5) technical skills (thoroughness, carefulness, and competence) of the physician performing the procedure, and (6) adequacy of explanation of the procedure. The remaining three questions included the overall rating of the visit and inquiries into whether the patient would have the procedure done again by the same physician or at the same facility2.
Factors affecting patient satisfaction
Some of the common reviews that endoscopy units have encountered include:
- “Physician was skillful but seemed rushed”
- “Bowel prep was difficult, but no pain during the procedure”
- “Much better experience than anticipated”
- “Facility was clean but crowded”
A study suggested that patient’s perception of the endoscopist’s technical skill was the most important factor in determining patient’s satisfaction, followed by the adequacy of analgesia3. The most important factors also differed by geographic location. For example, in the Midwest American population, the greatest value determining patient satisfaction was the absence of pain whereas for New York patients, pain ranked after ‘‘finding what is wrong.” In a study by Denis et.al., one-fifth of the patients were unsatisfied due to long wait times to schedule a procedure4. As far as patient-related factors, anxiety before the procedure and chronic use of psychotropic medications were the most reliable predictors of a poor experience.
Measures on improving patient satisfaction and endoscopy experience
The European Society of Gastrointestinal Endoscopy suggests using patient satisfaction as a quality indicator for gastrointestinal endoscopy5. Endoscopy units should use mGHAA-9 and improve the key measures in which their scores are lacking. Printed written material, in user-friendly language, explaining the procedures, potential adverse events, and various diagnoses should be available in various languages. It can reduce fear and anxiety. Bowel prep instructions can be tough to follow for some patients, especially if there is a long wait time. Programs such as counseling sessions, educational videos, and Short Messenger Service (SMS) and a short telephone call6,7 can improve patient comprehension as well as serve as reminders to patients about the details of bowel prep instructions.
For a population-based endoscopy screening program to succeed, there is a need for better patient compliance and acceptance. Patient satisfaction not only establishes performance standards, but also increases the accountability of physicians and staff, and most importantly, can lead to improvement in the quality of care.
Dr. Rai is a gastroenterologist at Borland-Groover clinic in Fleming, Florida. He currently serves on the ASGE Practice Operations Committee.
References
1. Brown S, Bevan R, Rubin G, et al. Patient-derived measures of GI endoscopy: a meta-narrative review of the literature. Gastrointest Endosc 2015;81: 1130-1140.e1-9.
2. American Society for Gastrointestinal Endoscopy. Quality and outcomes assessment in gastrointestinal endoscopy. Gastrointest Endosc 2000;52:827-30.
3. Yacavone RF, Locke GR 3rd, Gostout CJ, et al. Factors influencing patient satisfaction with GI endoscopy. Gastrointest Endosc 2001;53:703-10.
4. Denis B, Weiss AM, Peter A, et al. Quality assurance and gastrointestinal endoscopy: an audit of 500 colonoscopy procedures. Gastroenterol Clin Biol 2004;28:1245-55.
5. Bretthauer M, Aabakken L, Dekker E et al. Reporting systems in gastrointestinal endoscopy: Requirements and standards facilitating quality improvement: European Society of Gastrointestinal Endoscopy position statement. United European Gastroenterol J 2016; 4: 172 – 176.
6. Liu X, Luo H, Zhang L et al. Telephone-based re-education on the day before colonoscopy improves the quality of bowel preparation and the polyp detection rate: a prospective, colonoscopist-blinded, randomised, controlled study. Gut 2014; 63: 125 – 130.
7. Liu Z, Zhang MM, Li YY et al. Enhanced education for bowel preparation before colonoscopy: A state-of-the-art review. J Dig Dis 2017; 18: 84 – 91.