Contributions of Surgical Residents to Patient Satisfaction: Impact of Residents Beyond Clinical Car

1
Contributions of Surgical Residents to Patient
Satisfaction Impact of Residents Beyond Clinical
Care
Andrew S. Resnick MD MBA, Maureen Disbot MS,
Angela Wurster CRNP, James L. Mullen MD, Larry R.
Kaiser MD, Jon B. Morris MD University of
Pennsylvania Department of Surgery Division of
Surgery Education
2
Introduction

• ACGME Core Competencies
• Interpersonal and communication skills
• Professionalism
• Patients are most satisfied when they feel their
  doctors understand them and can communicate with
  them1
• Hospitals increasingly concerned about patient
  satisfaction
• What influence do residents have on patient
  satisfaction?
• 1 Greco et al. Health Comm. 2000 12 173-193.

3
Introduction

• In other fields, patients view residents as
  either neutral1 or as beneficial2 to their care
• Attending physicians rated better than residents
  on personal manner and treats me with the
  highest respect3 ? evidence that residents could
  use some improvement
• 1 Jackson et al. Am J Gastroent. 2000 95
  1563-1566.
• 2 OMalley et al. Acad. Med. 1997 72 1015-1017.
• 2 Sheets et al. Fam Prac Res J. 1991 11
  421-428.
• 3 Yancy et al. J. Gen Intern Med. 2001 16
  755-762.

4
Introduction

• Univ. Michigan study patients believed they
  received extra attention and benefited from
  having many physicians participate in their care1
• Goldstein et al. increase in Press-Ganey scores
  after switch from Q3 to night float2
• What is the role of surgery residents in patient
  satisfaction?
• 1 Cowles et al. JACS 2001 193 73-80
• 2 Goldstein et al. Curr Surg 2004 61 445-451

5
Hypothesis

• Residents contribute to overall patient
  satisfaction
• Chief residents most significant out of resident
  team
• Specific resident questions added to Press-Ganey
  surveys in April 2005

6
Methods

• Press-Ganey surveys routinely mailed to half of
  all discharged patients
• 1-6 questions per category in survey ? normalized
  and calculated mean category scores
• Categories
• Admissions -- Discharge
• Room -- Nurse practitioners
• Food -- Safety
• Nursing -- General
• Testing / Treatment -- Chaplain
• Attending physician -- ICU
• House Staff -- Emergency Room
• Emotional needs
• Overall rating of care given

7
Methods

• 5,828 surveys overall
• Chief Resident Evaluation Scores
• Limited to Dept. of Surgery services led by PGY-4
  or PGY-5 chief residents
• 903 surveys with corresponding chief resident
  names
• 701 surveys with corresponding chief resident
  evaluation scores by faculty (mean score by
  month)
• Simple, multiple regression, anova
• Microsoft Excel, JMP

8
Results

• April 2005-June 2006
• 49,081 discharges
• 24,540 surveys mailed
• 5,828 surveys returned and analyzed (24)
• For the 5,828 surveys
• Average age 55.3
• 52.5 female
• Mean LOS 4.9 days
• 2,386 admitted to Dept. of Surgery
• 3,731 admitted to surgical departments
• 2,097 admitted to non-surgical departments

9
Results
10
Results Simple Regression Model
11
Results Multiple Regression Model
12
P lt 0.05
13
Results
P 0.07

• June Data Excludes June 20-30th

P lt 0.05
14
Results

• Chief resident data
• No statistical significance between chief
  residents for either housestaff score or overall
  rating of care given
• Faculty data
• Overall rating R2 0.09, P lt 0.001
• Physician rating R2 0.12, P lt 0.001

15
Ratings by chief resident
16
Results

• Chief resident evaluation scores by FACULTY
  completely uncorrelated with patient ratings of
  house staff

17
Conclusions

• Nurses most important for patient satisfaction
• Emotional needs multifactorial and thus important
• All practitioners received high scores by
  patients, housestaff slightly lower than nurses
  and faculty
• Residents are important to patient satisfaction
  in general
• Individual residents can be positive outliers and
  need to be studied
• Need more data to sort out seasonal effect versus
  service effect but these data point to both
  expected and unanticipated nadirs in housestaff
  ratings

18
Conclusions

• ACGME emphasizing communication and
  professionalism
• Patients want more communication and
  understanding
• Failure of practitioners to communicate causes
  decreased satisfaction, poor understanding, and
  reduced compliance1
• Residents satisfied when patients are happy and
  can change behavior when given feedback2
• Need to provide residents with feedback and
  continue analysis of this data
• 1 Evans et al. Health Comm. 1992 4 155-170.
• 2 Falvo et al. J Fam Prac 1980 17 479-483.

19
Acknowledgments

• Craig Kean and Maureen Disbot
• DSE Office, Lori Pray
• Dr. Larry Kaiser
• Dr. Jim Mullen
• Dr. Jon Morris