Mean Patient Satisfaction Score Research Articles

Patient satisfaction with the use of an enhanced recovery programme for primary arthroplasty

Enhanced recovery programmes (ErPs) are increasingly being used for arthroplasty. One of the core aims of an ErP is to improve the quality of patient experience. However, there is currently no published evaluation of patient satisfaction in relation to this new programme of care within orthopaedic surgery. The aim of this study was to compare the ErP against the standard care programme (SCP) at one centre. A satisfaction survey addressing patient opinions on the key objectives of the ErP was conducted by telephone, using a set script. Of the 226 patients contacted, 143 (63.3%) responded (69 from the ErP and 74 from the SCP). Of the respondents, 71 received a total hip arthroplasty and 72 a total knee arthroplasty. Patients were contacted at a mean time from operation to survey of 27.2 weeks. They were asked to rate satisfaction on a five-point scale and complete the EQ-5D™ health questionnaire (EuroQol, rotterdam, Netherlands) to measure healthcare outcomes. The mean patient satisfaction score of 4.07 for speed of recovery in the ErP group was significantly higher than the SCP group's score of 3.68 (p=0.037). Adjusting for the preoperative health score, the postoperative health score was higher for ErP patients at 74.1 compared with 64.7 for SCP patients (p=0.0029). Furthermore, the percentage of patients who had a better than expected recovery was significantly greater in the ErP group at 85.5% compared with 58.1% (p=0.0004) in the SCP group. We believe that the previously established reduction in length of hospital stay delivered by ErPs is not achieved at the expense of the patient's experience.

Surgery First in Orthognathic Surgery: What Have We Learned? A Comprehensive Workflow Based on 45 Consecutive Cases

In some patients, "surgery first" (SF) may represent a reasonable approach for the expedited correction of a maxillofacial deformity. Based on the prospective evaluation of a large sample, this article provides a specific orthodontic and surgical protocol, discusses the benefits and limitations of this approach, and updates its indications. Forty-five patients were managed with an SF approach. Selected cases presented symmetrical skeletal malocclusions with no need for extractions or surgically assisted rapid palatal expansion. Periodontal or temporomandibular joint problems and management by an orthodontist without experience in orthognathic surgery were considered exclusion criteria. Virtual treatment planning included a 3-dimensional orthodontic setup. Standard orthognathic osteotomies were followed by buccal interdental corticotomies to amplify the regional acceleratory phenomenon. Miniscrews were placed for postoperative skeletal stabilization. Orthodontic treatment began 2 weeks after surgery. Archwires were changed every 2 to 3 weeks. At 12-month follow-up, patient satisfaction and orthodontist satisfaction were evaluated on a visual analog scale of 1 to 10. Descriptive statistics were computed for all study variables. The studied sample consisted of 27 women and 18 men (mean age, 23.5 yr). The main motivation for treatment was the wish to improve facial esthetics. Bimaxillary surgery was the most common procedure. Mean duration of orthodontic treatment was 37.8 weeks, with an average of 22 orthodontic appointments. Mean patient and orthodontist satisfaction scores were 9.4 (range, 8 to 10) and 9.7 (range, 8 to 10), respectively. The SF approach significantly shortens total treatment time and is very favorably valued by patients and orthodontists. Nevertheless, careful patient selection, precise treatment planning, and fluent bidirectional feedback between the surgeon and the orthodontist are mandatory.

Nurse-led epilepsy follow-up clinic in India: Is it feasible and acceptable to patients? A pilot study

PurposeIndia has an epilepsy treatment gap of up to 90%. Shortage of doctors, especially in rural communities makes getting epilepsy treatment almost impossible for the vast majority. Nurses are relatively more in number and available even in smaller cities and villages. This pilot study investigated if a nurse-led epilepsy follow-up clinic is feasible in India and is acceptable to patients. MethodA II year Nursing postgraduate student was given 8h of didactic teaching tailored for epilepsy patient follow-up, followed by supervised observation time in the epilepsy clinic with a neurologist before conducting epilepsy follow-up clinics independently. Epilepsy patients ≥10 years of age and in follow-up for ≥6 months were included. They were independently followed-up both in the nurse-led clinic and in the neurologist's clinic. Outcome was measured in terms of interrater agreement (kappa) between the recommendations of the neurologist and the nurse in five domains. Patient satisfaction for nurse-led clinic was also evaluated. ResultsThe interrater agreement between the trained nurse and neurologist in following-up 175 enrolled patients was 76–94%; most unanimity (κ=94%) seen in identifying AED adverse effects while least agreement (κ=76%) was present regarding decisions to modify AED. The mean patient satisfaction score was 37.63±3.26 (maximum possible score 40). ConclusionIt is feasible for trained nurses to run epilepsy follow-up clinics in India and patients are likely to be satisfied with this approach.

Mydriasert pupillary dilation for cataract surgery: A clinical and economic study

AbstractPurpose Mydriasert® is an ophthalmic insert containing phenylephrine and tropicamide. A prospective clinical evaluation of Mydriasert for pupillary dilatation prior to cataract surgery was conducted. The impact on nurse time of using Mydriasert compared to eye drops was also evaluated.Methods The following data were collected prospectively: amount of time spent inserting Mydriasert, patient satisfaction score (on a scale of 1‐10), pupil size (on a pre‐defined categorical scale of 1 (small pupil) to 4 (very large pupil) and any adverse events related to the insert. An economic model of mydriasis was also developed.Results Mean nursing time spent inserting Mydriasert was 1.52 minutes(SD=0.6,n=85), mean patient satisfaction score was 8.97(SD=2.32,n=97) and mean pupil size was 3.32(SD=0.66,n=114) corresponding to a large to very large pupil size. The insert had extruded unnoticed in 3 cases. For a national population (England), the estimated nurse time saved was 1,159 hours per week when using the single application Mydriasert compared to repeated instillation of eye drops to achieve mydriasis.Conclusion Mydriasert is a safe and efficacious alternative to topical drops for pupillary dilatation. The rate of insert extrusion was low compared to that published in a smaller study reporting on a much smaller sample. This may reflect a learning curve for Mydriasert insertion. The economic analysis demonstrated that using Mydriasert could potentially free up nursing time to spend on other responsibilities. Commercial interest

Pharmacist–patient counselling in Dubai: assessment and reflection on patient satisfaction

ObjectivesThe aim of the present study was to evaluate the counselling services provided by outpatient pharmacists using the criteria specified by Medication Counseling Behaviour Guideline (US Pharmacopoeia (USP) 1997). The...

Gabapentin does not improve multimodal analgesia outcomes for total knee arthroplasty: a randomized controlled trial

This study assessed whether gabapentin given preoperatively and for two days postoperatively (in addition to patient-controlled analgesia [PCA] morphine, acetaminophen, and ketorolac) is effective in reducing morphine requirements and moderating pain scores when compared with placebo for primary total knee arthroplasty. This single-centre double-blind randomized controlled trial was undertaken in patients who underwent primary total knee arthroplasty. All subjects received acetaminophen 1,000 mg and ketorolac 15 mg po preoperatively. Postoperatively, subjects received PCA morphine, acetaminophen 1,000 mg every six hours, and ketorolac 15 mg po every six hours. Subjects received either gabapentin 600 mg po preoperatively followed by 200 mg po every eight hours for two days or matching placebo. The primary outcome was cumulative morphine consumption at 72 hr following surgery. Secondary outcome measures included pain scores and patient satisfaction. There were 52 subjects in the gabapentin group and 49 subjects in the placebo group. The average cumulative morphine consumption at 72 hr postoperatively was 66.3 mg in the gabapentin group and 72.5 mg in the placebo group (difference -6.2 mg; 95% confidence interval -29.1 to 16.8 mg; P = 0.59). Mean pain scores at rest, with passive movement, or with weight bearing were similar in both groups at corresponding time periods for the first three days following surgery. In addition, mean patient satisfaction scores and hospital length of stay were similar in the two groups. Gabapentin 600 mg po given preoperatively followed by 200 mg po every eight hours for two days has no effect on postoperative morphine consumption, pain scores, patient satisfaction, or length of hospital stay. This trial is registered at ClinicalTrials.gov NCT01307202.

Clinical effects of non-ablative and ablative fractional lasers on various hair disorders: a case series of 17 patients

Background and objectives: Both ablative and non-ablative fractional lasers have been applied to various uncommon hair disorders. The purpose of this study was to demonstrate the clinical effects of fractional laser therapy on the course of primary follicular and perifollicular pathologies and subsequent hair regrowth. Materials and methods: A retrospective review of 17 patients with uncommon hair disorders – including ophiasis, autosomal recessive woolly hair/hypotrichosis, various secondary cicatricial alopecias, pubic hypotrichosis, frontal fibrosing alopecia, and perifolliculitis abscedens et suffodiens – was conducted. All patients had been treated with non-ablative and/or ablative fractional laser therapies. Results: The mean clinical improvement score in these 17 patients was 2.2, while the mean patient satisfaction score was 2.5. Of the 17 subjects, 12 (70.6%) demonstrated a clinical response to non-ablative and/or ablative fractional laser treatments, including individuals with ophiasis, autosomal recessive woolly hair/hypotrichosis, secondary cicatricial alopecia (scleroderma and pressure-induced alopecia), frontal fibrosing alopecia, and perifolliculitis abscedens et suffodiens. Conversely, patients with long-standing ophiasis, surgical scar-induced secondary cicatricial alopecia, and pubic hypotrichosis did not respond to fractional laser therapy. Conclusion: Our findings demonstrate that the use of non-ablative and/or ablative fractional lasers promoted hair growth in certain cases of uncommon hair disorders without any remarkable side effects.

Endoscopic Iliotibial Band Release in Snapping Hip

Several open surgical techniques have been used to treat recalcitrant cases of snapping iliotibial band with varying results. Recently, endoscopic techniques have become available. The purpose of this study was to investigate the results of a modified endoscopic iliotibial band release using a longitudinal retrospective case series. Fifteen patients (three men and 12 women) with symptomatic external snapping hip were treated with an endoscopic release of the iliotibial band. The average age was 25 years (range 16-37 years). The procedure was performed in the lateral decubitus position using two portals; the iliotibial band was transversally released using a radiofrequency hook probe. The mean follow-up period was 33.8 months (range 12-84 months). The snapping phenomenon was overcome in all the patients. The mean pre-op pain VAS score was 5.5 mm (range 5-7 mm) and the mean post-op pain VAS score was 0.53 mm (range 0-2 mm) with a statistically significant reduction with respect to the preoperative value (p<0.0001); sixty percent of the patients were pain-free. The mean postoperative Harris Hip Score was 97.5 (range 94-100). No revision procedures were indicated and all the patients returned to their previous level of activity. The mean patient satisfaction score was, on average, 9.3 mm (range 8-10 mm) on the VAS scale. No complications occurred. Endoscopic iliotibial band release is a safe and reproducible technique with excellent results in terms of snapping phenomenon resolution, patient satisfaction, and return to previous level of activity. After strenuous sporting activities 40% of patients complained of very slight pain.

Physician E-mail and Telephone Contact After Emergency Department Visit Improves Patient Satisfaction: A Crossover Trial

Enhancing emergency department (ED) patient satisfaction has wide-ranging benefits. We seek to determine how postvisit patient-physician contact by e-mail or telephone affects patients' satisfaction with their emergency physician. We undertook this crossover study from May 1, 2010, to June 30, 2010, at 2 community EDs. Forty-two physicians either e-mailed or telephoned their patients within 72 hours of the ED visit for 1 month; in the alternate month, they provided no contact, serving as their own controls. Patients received satisfaction surveys after their ED visit. Patient satisfaction is reported as a percentage of those responding very good or excellent on a 5-point Likert scale for 3 questions about their emergency physician's skills, care, and communication. We calculated differences between patient groups (noncontact versus contact) using an intention-to-treat analysis. The mean patient satisfaction score was 79.4% for the 1,002 patients in the noncontact group and 87.7% for the 348 patients in the contact group (difference 8.3%; 95% confidence interval 4.0% to 12.6%). Patient satisfaction scores were similar for e-mail and telephone contact: 89.3% for the e-mail group and 85.2% for the telephone group (difference 4.1%; 95% confidence interval -2.3% to 10.5%). Patient satisfaction was higher when emergency physicians contacted patients briefly after their visit, either by e-mail or by telephone. Higher patient satisfaction was observed equally among patients contacted by e-mail and those contacted by telephone. Postvisit patient-physician contact could be a valuable practice to improve ED patient satisfaction.

Total hip arthroplasty in steroid-induced osteonecrosis: early functional and radiological outcomes

The proportion of total hip arhtoplasties (THAs) associated with corticosteroid use is uncertain, and the mechanisms of corticosteroid-induced osteonecrosis remain unknown. We sought to evaluate the clinical and radiographic outcomes, complications and satisfaction with THA among patients with corticosteroid-induced osteonecrosis. We retrospectively assessed functional outcome at a minimum 1-year follow-up using the Western Ontario and MacMaster Universities Arthritis Index (WOMAC); Oxford Hip Score; Short Form (SF)-12; University of California, Los Angeles (UCLA) Activity; and patient satisfaction scores. We included 31 patients (35 hips). The average follow-up was 20 (range 12- 55) months, and the average age at surgery was 47 (range 19-78) years. At follow-up, patients showed significant improvement in all 4 components of the WOMAC (means: function 84, stiffness 75, pain 86, global 84), Oxford-12 (mean 83) and SF-12 (means: mental 40 and physical 48) scores. However, there was no significant improvement in the UCLA Activity scores. Mean patient satisfaction scores were good for pain relief (86), function (80), recreation (77.5) and overall results of surgery (86). Radiographic review at follow-up showed that all components were well fixed with no evidence of loosening. The complication rate was high (17%), with 6 complications in 5 patients (6 of 35 hips). Four patients (4 of 35 hips; 11%) required reoperations. Total hip arthroplasty in patients with corticosteroid-induced osteonecrosis of the femoral head is successful in reducing pain and improving function; however, the rate of complications and reoperation is high.

Single Port Versus Multiple Port Laparoscopic Cholecystectomy—A Comparative Study

Single port laparoscopic cholecystectomy (SPLC) was introduced to minimize postoperative morbidity and improve cosmesis. We performed a comparative study to assess feasibility, safety and perceived benefits of SPLC. Two groups of patients (104 each) with comparable demographic characteristics were selected for SPLC and multiport laparoscopic cholecystectomy (MPLC) between May 2010 to March 2011. SPLC was performed using X cone® with 5mm extra long telescope and 3 ports for hand instruments. MPLC was performed with traditional 4 port technique. A large window was always created during dissection to obtain the critical view of safety. Data collection was prospective. The primary end points were post-operative pain and surgical complications. Secondary end points were patient assessed cosmesis and satisfaction scores and operating time. The mean VAS scores for pain in SPLC group were higher on day 0 (SPLC 3.37 versus MPLC 2.72, p = 0.03) and equivalent to MPLC group on day 1(SPLC 1.90 versus MPLC 1.79, p = 0.06). Number of patients requiring analgesia for breakthrough pain (SPLC 21.1% versus MPLC 26.9%, p = 0.31) was similar. Number and nature of surgical complications was similar (SPLC 17.3% versus MPLC 21.2%, p =0.59). Mean patient assessed cosmesis scores (SPLC 7.96 versus MPLC 7.16, p = 0.003) and mean patient satisfaction scores (SPLC 8.66 versus MPLC 8.16, p = 0.004) were higher in SPLC group indicating better cosmesis and greater patient satisfaction. SPLC took longer to perform (61min versus 26min, p = 0.00). Conversion was required in 5 patients in SPLC group. SPLC appears to be feasible and safe with cosmetic benefits in selected patients. However, challenges remain to improve operative ergonomics. SPLC needs to be proven efficacious with a high safety profile to be accepted as standard laparoscopic technique.

The Importance of Physicians’ Communication Skills and Patients’ Satisfaction

: Background: Doctor-patient interaction plays an important role in patient satisfaction, treatment results, medical expenses, quality of clinical services and even patient’s complaints toward doctors and health care system. Objectives: This study was performed to assess the level of patient satisfaction in the Iranian context. Materials and Methods: This cross-sectional study was conducted in a public clinic in Tehran in 2010. The participants included 392 patients who referred to this center for a period of two months. A patient satisfaction questionnaire was used which had 24 items on patient satisfaction with the communication skills of the physician that included six subscale scores. The total score and subscales scores were calculated on a maximum possible of 100. Results: The mean age of the patients was 38 years and 69% of them were female. The education level of most patients was high school diploma or higher (72%). The mean patient satisfaction score was 44 ± 15. Patients expressed highest satisfaction with patient training (56 ± 24) and response to their questions (49 ± 17) while they were least satisfied with the examination (31 ± 23). No significant relation was found between patient age and overall patient satisfaction (P = 0.392, r = 0-.007). In addition, no significant differences were found between the overall scores of male and female or married and single patients. However, highly educated or salaried employee patients showed a higher satisfaction score than self-employed or unemployed patients (P < 0.001). The results of the regression analysis showed education and employment status of patients to be the effective variables on patients’ satisfaction. Conclusions: The results of the present study revealed that patients are not highly satisfied with the communication skills of physicians and they were least satisfied only with the quality of examination processes by the physicians. In addition, patients with lower education showed lower satisfaction as well. Thus, a higher quality and elaboration of examination, more patience and better communication skills considering the education and social status of the patients may increase patient satisfaction.

Carbon Dioxide Laser Treatment of Cutaneous Neurofibromas

IntroductionNeurofibromatosis type 1 (NF1) is an autosomal dominant disorder, with multisystem involvement, including cutaneous manifestations of hyperpigmentation and neurofibromas. Multiple cutaneous lesions are often disfiguring and lead to emotional distress and social isolation. Treatment of NF1 is predominantly surgical but alternative treatments should be considered for patients with large numbers of lesions as cold steel excision of multiple lesions can be cumbersome and may not be practical. The authors report a series of patients with multiple neurofibromas successfully treated using a CO2 laser.MethodsData on CO2 laser treatments, follow-up, and recurrence following treatment was collected retrospectively. A post-treatment telephone survey was carried out to assess patient satisfaction using a standardized set of questions and a scoring tool.ResultsFive of seven patients who underwent CO2 laser treatment of their multiple neurofibromas responded to the post-treatment survey. All five patients (age range 36–56 years, mean age 45.2 years, three men:two women) had multiple variable-sized neurofibromas. The mean number of lesions per patient was 114 (range 20–200 lesions). The mean number of treatment sessions was 2.2 (range 1–4 sessions) and mean follow-up was 14.4 months (range 6–24 months). Three patients (60%) reported no recurrence up to 2 years post-laser treatment. Two patients (40%) had recurrences of a few lesions (≤10% of treated lesions per patient). The mean patient satisfaction score was 9.2 out of 10 (range 8–10). All patients mentioned that they would recommend CO2 laser treatment to others with multiple neurofibromas. Hypopigmentation or depigmentation at treatment sites were the only reported adverse effects.ConclusionBased on current results, the authors feel that CO2 laser treatment achieves a high level of patient satisfaction with a low recurrence of treated lesions.

Teledermatology Patient Satisfaction in the Pacific Northwest

The aim of this quality improvement project is to assess patient satisfaction with a store-and-forward teledermatology project and to identify factors associated with patient satisfaction and dissatisfaction. Veterans receiving care in rural clinics in the Pacific Northwest were surveyed using a 5-point Likert scale about satisfaction with face-to-face care for a skin complaint prior to any teledermatology exposure. One year later, veterans in the same rural clinics were surveyed about satisfaction with teledermatology care using a more comprehensive survey. Ninety-six patients completed the face-to-face satisfaction survey questions, and 501 completed the teledermatology satisfaction survey. Most (78%) of surveyed patients were highly satisfied or satisfied with face-to-face dermatology care. After 1 year of teledermatology, 77% of patients were highly satisfied or satisfied with teledermatology care. The mean patient satisfaction score for teledermatology was equivalent to face-to-face care (4.1±1.2 and 4.3±1.0, p=0.4). Factors associated with teledermatology patient satisfaction included short wait times for initial consultation, a perception that the initial wait time was not too long, a perception that the skin condition was properly treated, and the belief that adequate follow-up was received. Factors associated with teledermatology patient dissatisfaction included perceptions that the skin condition was not properly treated and that inadequate follow-up was received. Teledermatology was widely accepted by the majority of patients receiving care at rural clinics. Patient satisfaction with care received through teledermatology was equivalent to that with face-to-face dermatology.

NovaSure® Endometrial Ablation: Effectiveness and Patient Satisfaction

Objective: The purpose of this study was to describe effectiveness of and patient satisfaction with NovaSure® endometrial ablation in patients with dysfunctional uterine bleeding. NovaSure procedures performed in the outpatient clinic (OPC) and the operating theater (OT) were compared. Design: This was a retrospective cohort study. Materials and Methods: The study was conducted on all NovaSure endometrial ablation procedures (n=112) performed between April 2007 and October 2008 on patients diagnosed with dysfunctional uterine bleeding in the Meander Medical Centre, Amersfoort, The Netherlands. Data were collected from medical records and a retrospective questionnaire. Main outcome measures were effectiveness: the presence of amenorrhea, dysmenorrhea and blood clots, and menstruation duration. Pain experience and patient satisfaction scores ranged from 0 to 10. Results: After NovaSure treatment an amenorrhea rate of 51.4% was found. The mean menstruation duration significantly decreased, as well as the presence of blood clots and dysmenorrhea (p<0.001). Mean patient satisfaction score was 8.5 and patient satisfaction was significantly higher in the OT group (p=0.027). A hysterectomy rate of 1.9% was noted after a follow-up period of 6 months up to 2 years. Conclusions: NovaSure endometrial ablation is an effective treatment option for patients with dysfunctional uterine bleeding, when performed in both the OPC and OT. NovaSure treatment in the OPC is good option for a selected patient population. Significantly lower patient satisfaction was found in the OPC, probably resulting from the pain experienced by these patients. High pain experience during menstruation prior to the NovaSure predicts for high pain experience of the NovaSure treatment. Therefore, treatment in the OPC is recommended only for patients without dysmenorrhea. (J GYNECOL SURG 28:1)

A Randomized Controlled Trial to Assess the Efficacy of Arthroscopic Subacromial Decompression with and without Rotator Cuff Repair Using a Mini-open Technique

Background Management of degenerate rotator cuff tears associated with subacromial impingement is debatable. Methods We performed a prospective, randomised controlled trial to assess the efficacy of arthroscopic subacromial decompression (ASD) with or without repair of the rotator cuff using a mini-open technique. Results 42 patients (29 males and 13 females) with a mean age of 64 years (range 54–77 years) were recruited. 25 patients underwent ASD and cuff repair using mini-open technique whereas 17 patients had only ASD alone. All the patients were followed for a minimal of 1 year post-operatively. At final follow-up the mean Constant scores and patient satisfaction scores were not different between the groups (p value 0.06 and 0.44 respectively). The mean DASH scores were marginally significant (p value 0.05) and mean ASES scores were significant (p value 0.03). A 38% cuff rerupture rate was noted in the cuff repair group. Conclusions Our study demonstrates that in short-term the results of ASD with or without rotator cuff repair are not significantly different, however positive trends were noted in the cuff repair group. Although a significant rerupture rate was noted (38%) this had little effect on the outcome.

Comparative Study between Laparoscopic and Open Repair of Paraumbilical Hernia

This randomized prospective study compared the effectiveness of laparoscopic paraumbilical hernioplasty to the conventional open technique. Forty patients with paraumbilical hernia were randomly categorized into 2 equal groups. GL treated by laparoscopic paraumbilical hernioplasty and GO treated by conventional (open) umbilical hernioplasty. The mean length of follow up was 36 months. In GL, mean operative time was 58.1 +/- 15.5 minutes, in GO, it was 42.2 +/- 10.3 minutes (p = 0.0005). Postoperative pain score 6 hours after surgery was 2.95 +/- 1.19 in GL patients as compared to 6.10 +/- 1.74 in GO ones (p < 0.0001). Mean hospitalization time was 1.05 +/- 0.224 days in GL versus 1.25 +/- 0.550 days in G O (p = 0.14). There was one conversion (5%) to the open repair. Postoperative seroma occurred in 2 patients (10%) in GL and 3 patients (15%) in GO. Three patients (15%) in G O developed surgical site infection. Hernia recurrence was not seen in either 2 Groups. Mean patient satisfaction score for GL patients was 7.85 +/- 1.27 versus 6.00 +/- 1.69 for GO patients (p = 0.0004). Compared to open repair, laparoscopic repair is technically feasible, safe and effective, with good clinical outcome. It is associated with longer time for surgery but reduced postoperative pain, analgesic requirement, complication and infection rates with earlier return to normal activities.

Application of Statistical Process Control to Physician‐specific Emergency Department Patient Satisfaction Scores: A Novel Use of the Funnel Plot

Emergency department (ED) patient satisfaction remains a high priority for many hospitals. Patient surveys are a common tool for measuring patient satisfaction, and process improvement efforts are aimed at improving patient satisfaction scores. In some institutions, patient satisfaction scores can be calculated for each emergency physician (EP). ED leaders are faced with the task of interpreting individual as well as group physician scores to identify opportunities for improvement. Analysis of these data can be challenging because of the relatively small numbers of returned surveys assignable to a single physician, variable numbers of surveys returned for each physician and high standard deviations (SDs) for individual physician scores. The objective was to apply statistical process control methodology to analyze individual as well as group physician patient satisfaction scores. The novel use of funnel plots to interpret individual physician patient satisfaction scores, track individual physician scores over two successive 8-month periods, and monitor physician group performance is demonstrated. Patient satisfaction with physicians was measured using Press Ganey surveys for a 65,000-volume ED over two successive 8-month periods. Using funnel plots, individual physician patient satisfaction scores were plotted against the number of surveys completed for each physician for each 8-month period. Ninety-fifth and 99th percentile control limits were displayed on the funnel plots to illustrate individual physician patient satisfaction scores that are within, versus those that are outside of, expected random variation. Control limits were calculated using mean patient satisfaction scores and SDs for the entire group of physicians. Additional funnel plots were constructed to demonstrate changes in individual physicians' patient satisfaction scores as a function of increasing numbers of returned surveys and to illustrate changes in the group's patient satisfaction scores between the first and second 8-month intervals after the institution of process improvement efforts aimed at improving patient satisfaction. For the first 8-month period, 34,632 patients were evaluated in and discharged from the ED, with 581 surveys returned for 21 physicians. The mean (±SD) overall group physician patient satisfaction score was 81.8 (±24.7). Returned surveys per physician ranged from 2 to 58. For the second period, 34,858 patients were evaluated and discharged from the ED, with 670 patient satisfaction surveys returned for 20 physicians. The mean (±SD) overall physician score for all surveys returned during the second period was 85.0 (±22.2). Returned surveys per physician ranged from 8 to 65. The application of statistical control methodology using funnel plots as a means of analyzing ED group and physician patient satisfaction scores was possible. The authors believe that using funnel plots to analyze scores graphically can rapidly help determine the significance of individual physician patient satisfaction scores. In addition, serial funnel plots may prove to be useful as a means of measuring changes in patient satisfaction, particularly in response to quality improvement interventions.

Birmingham hip resurfacing at a mean of ten years

We report the findings of an independent review of 230 consecutive Birmingham hip resurfacings (BHRs) in 213 patients (230 hips) at a mean follow-up of 10.4 years (9.6 to 11.7). A total of 11 hips underwent revision; six patients (six hips) died from unrelated causes; and 13 patients (16 hips) were lost to follow-up. The survival rate for the whole cohort was 94.5% (95% confidence interval (CI) 90.1 to 96.9). The survival rate in women was 89.1% (95% CI 79.2 to 94.4) and in men was 97.5% (95% CI 92.4 to 99.2). Women were 1.4 times more likely to suffer failure than men. For each millimetre increase in component size there was a 19% lower chance of a failure. The mean Oxford hip score was 45.0 (median 47.0, 28 to 48); mean University of California, Los Angeles activity score was 7.4 (median 8.0, 3 to 9); mean patient satisfaction score was 1.4 (median 1.0, 0 to 9). A total of eight hips had lysis in the femoral neck and two hips had acetabular lysis. One hip had progressive radiological changes around the peg of the femoral component. There was no evidence of progressive neck narrowing between five and ten years. Our results confirm that BHR provides good functional outcome and durability for men, at a mean follow-up of ten years. We are now reluctant to undertake hip resurfacing in women with this implant.

Endoscope-assisted versus conventional second branchial cleft cyst resection

This study evaluates the feasibility of endoscope-assisted second branchial cleft cyst resection via retroauricular approach by comparing it with conventional cervical incision for removal of second branchial cleft cyst. From January 2009 to December 2010, 25 patients were randomly assigned to the endoscope-assisted surgery group (13 patients) or the conventional surgery group (12 patients). The clinical characteristics of patients, operation time, operative bleeding volume, postoperative complications, and subjective satisfaction with incision scar checked by visual analog scale were compared between the groups, retrospectively. All 13 second branchial cleft cyst resections were successfully performed endoscopically, and the wounds healed uneventfully. Endoscope-assisted surgery lasted 54.6 ± 6.3 min, and conventional surgery lasted 49.6 ± 6.9 min (P = 0.069). Degree of bleeding volume did not differ between the groups (P = 0.624). Mean patient satisfaction score was 9.2 ± 0.6 in the endoscope-assisted surgery group and 6.2 ± 0.8 in the controls (P < 0.001). All 13 patients in the endoscope-assisted surgery group were satisfied with their cosmetic results. One case showed temporary numbness around the earlobe that recovered within 1 month after surgery. No marginal nerve palsy occurred. No complications such as bleeding, salivary fistula, or paresis of the marginal mandibular branch occurred. All 25 patients were disease free with follow-up of 6-24 months (median 16 months). Endoscope-assisted second branchial cleft cyst resection via retroauricular approach is a feasible technique. This procedure may serve as an alternative approach that allows an invisible incision and better cosmetic results.