Patient Dissatisfaction Research Articles

Efficacy of levothyroxine monotherapy in achieving clinical euthyroidism and its impact on weight loss in women with hypothyroidism and obesity.

In light of research indicating that normal TSH levels do not necessarily reflect clinical euthyroidism in hypothyroid patients, and given the patient dissatisfaction with levothyroxine (LT4) monotherapy, we evaluate the response to weight loss treatment in patients with obesity and primary hypothyroidism who are euthyroid under LT4 therapy, with a focus on weight and metabolic parameters. The retrospective study included 138 subjects with obesity (BMI ≥ 30kg/m2), 69 women with hypothyroidism on levothyroxine, and 69 age- and BMI-matched women without thyroid disease. Secondary causes of obesity, medications that may affect thyroid functions and metabolic parameters, chronic and oncological disease, pregnancy, TSH outside the reference range, follow-up periods of less than one year, and bariatric surgery were the exclusion criteria. Patients' characteristics and metabolic responses to weight reduction treatment consisting of calorie restriction, moderate exercise, and metformin if needed were evaluated. TSH and fT4 levels were higher, and fT3 and T3/T4 ratios were lower all within the reference ranges in hypothyroid women. They were less insulin resistant. Both patient' groups experienced a significant decrease in body weight, BMI, and atherogenic index of plasma (AIP) during the follow-up (p = 0.001). Insulin resistance was not changed. The groups' body weight, BMI, HOMA-IR, and AIP changes were similar at the end of the study (p = 0.876, p = 0.850, p = 0.555, p = 0.293). The results suggest that achieving euthyroid status via levothyroxine monotherapy in hypothyroid women leads to weight loss responses comparable to those in women with normal thyroid. This supports the effectiveness of current hypothyroidism treatment strategies, emphasizing TSH level normalization, in achieving clinical euthyroidism concerning weight loss outcomes.

From Detached Concern to Love: Reconsidering Physician-Patient Boundaries

Abstract Developing appropriate professional boundaries is part of becoming a mature clinician. Boundaries help physicians fulfill their duties in relationally complex and emotionally fraught situations. The concept of “detached concern” has been used to characterize physician-patient relationships in which physicians show empathy and concern while maintaining due emotional distance. However, if the default tendency of trainees and clinicians is toward detachment, then emphasis on professional boundaries may do less to promote proper detachment than to diminish human connections with patients, thereby leading to clinician disenchantment and patient dissatisfaction. The authors propose that the physician-patient relationship is better characterized by love—specifically the kind of ordered love described by the fourth- and fifth-century bishop and philosopher Augustine of Hippo. Augustine’s vision of love has influenced many social reformers through the centuries, including, notably, Martin Luther King Jr. Importantly, such love is consistent with safeguards for which professional boundaries in the clinical context are corollaries, including guarding against forms of compassion that interfere with reasonable judgment, acknowledging humans' finite capacity to love, and recognizing potential harms of disordered love. Against a horizon of love, however, such boundaries are transformed from walls that prevent human connection and concern to walls that create spaces for and encourage any human connection that does not hinder healing and the patient’s good. By shifting their emphasis from detached concern to love, medical educators can re-enchant medicine for trainees by encouraging the human connections that make the practice of medicine its own reward.

Pericapsular nerve group block reduces opioid use and pain after hip surgery: A systematic review and meta-analysis of randomized controlled trials.

While the pericapsular nerve group (PENG) block has become increasingly popular for managing pain after hip surgery, its efficacy remains controversial. We systematically searched Pubmed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials to assess current evidence about the efficacy of the PENG block. Patients who received PENG block were compared to those who received sham/no block in terms of opioid consumption and pain within 24h after surgery, time to first opioid requirement, functional recovery, risk of nausea and vomiting, and patient dissatisfaction. The quality of evidence was assessed using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) system. We meta-analyzed six trials involving 416 patients who received preoperative PENG block and 415 who received sham/no block. Patients did not receive any other type of multimodal analgesia. Within 24 h after hip surgery, PENG block significantly reduced postoperative opioid consumption (MD = -12.03, 95% CI: -21.47 to -2.59, P < 0.01, I2 = 97%), particularly in subpopulations undergoing hip replacement, hip fracture, or who had spinal anesthesia, and it significantly decreased dynamic pain scores, but not static scores, without increasing risk of nausea or vomiting or patient dissatisfaction. Individual studies suggested that the PENG block can prolong the time to the first opioid requirement and can improve functional recovery. Most meta-analyses provided evidence of moderate quality according to the GRADE system. The available evidence indicates that preoperative PENG block can significantly decrease opioid consumption and pain early after hip surgery, and it may also promote early functional rehabilitation. However, the limited number of included studies and sample size make it difficult to draw firm conclusions. The decision on whether to apply the PENG block should take into account the patient's age and the type of surgery and anesthesia.

NURSES’ EXPERIENCE OF BURNOUT SYNDROME WHILE WORKING IN ONCOLOGY DEPARTMENTS

When experiencing burnout, the emotional and physical health of nurses deteriorates, the quality of work decrea­ses, and patient dissatisfaction increases. Nurses working in oncology units, due to the nature of their specialty, face those with a cancer diagnosis, which causes a lot of fear and uncertainty. The aim of the study is to reveal the burnout experienced by nurses working in oncology departments. The Copenhagen Burnout Questionnaire was used to implement the quantitative study. The results of the study revealed that nurses working in oncology departments had the strongest personal and work-rela­ted burnout. The most common factors leading to bur­nout were lack of feedback from patients and decreased energy. The relationships between demographic indica­tors and burnout components were used to analyze the research results. Methodology. Analysis of scientific literature; question­naire; descriptive analysis of research data using IBM SPSS 22.0 computer program statistics package and MS Excel 2021 computer program. After analyzing the scien­tific literature, a descriptive quantitative research met­hod was chosen for the research. A questionnaire survey aimed at analyzing the burnout experienced by nurses working in oncology departments. The research was con­ducted in October-November 2023, the respondents were nurses working in the city of Klaipeda (Lithuania). Re­search object: burnout experienced by nurses working in oncology departments. The questionnaire survey was created on the website online. The survey instrument consists of demographic indicators and the “Copenhagen Burnout Questionnaire”. The sample consisted of 143 respondents. Selection criteria: age, seniority, education, marital status, distribution of working time, workload and workplace. Respondents were selected by convenient non-probability sampling, respondents could choose the right place and time when answering questionnaire qu­estions, because the survey was conducted online, and the duration of the survey was not limited. Conclusions. after examining the manifestation of bur­nout syndrome, it became clear that nurses with personal burnout usually experience frequent fatigue and emotio­nal exhaustion. Burnout caused by work was most stron­gly related to emotionally exhausting work and fatigue at the end of the working day, and burnout caused by work with patients was most strongly determined by decrea­sed energy due to work with patients, lack of feedback from patients. The least burnout caused by working with patients was caused by irritation while working with pa­tients and difficult work with patients.

Enhancing patient understanding in obstetrics: The role of generative AI in simplifying informed consent for labor induction with oxytocin.

Informed consent is a cornerstone of ethical medical practice, particularly in obstetrics where procedures like labor induction carry significant risks and require clear patient understanding. Despite legal mandates for patient materials to be accessible, many consent forms remain too complex, resulting in patient confusion and dissatisfaction. This study explores the use of Generative Artificial Intelligence (GAI) to simplify informed consent for labor induction with oxytocin, ensuring content is both medically accurate and comprehensible at an 8th-grade readability level. GAI-generated consent forms streamline the process, automatically tailoring content to meet readability standards while retaining essential details such as the procedure's nature, risks, benefits, and alternatives. Through iterative prompts and expert refinement, the AI produces clear, patient-friendly language that bridges the gap between medical jargon and patient comprehension. Flesch Reading Ease scores show improved readability, meeting recommended levels for health literacy. GAI has the potential to revolutionize healthcare communication by enhancing patient understanding, promoting shared decision-making, and improving satisfaction with the consent process. However, human oversight remains critical to ensure that AI-generated content adheres to legal and ethical standards. This case study demonstrates that GAI can be an effective tool in creating accessible, standardized, yet personalized consent documents, contributing to better-informed patients and potentially reducing malpractice claims.

Addressing Patient Concerns at the University of Michigan Dental School

Effective communication between patients and dental providers is crucial for successful dental appointments, fostering trust and comfort. However, patients often carry unspoken concerns into dental clinics that significantly influence their experiences. The dental profession needs a standardized approach to record and address these concerns, leading to inconsistencies in how patient feedback is collected and acted upon. This can result in unresolved issues and patient dissatisfaction. Recognizing this problem, the University of Michigan School of Dentistry thought to improve how patient concerns are documented and addressed.

Beyond Empathy: Examining the Complexities of Outpatient Satisfaction in a Resource-Constrained Setting

Patient satisfaction is a critical indicator of healthcare quality, particularly in resource-constrained settings where efficient and effective care is paramount. This study aimed to explore the multifaceted nature of outpatient satisfaction at a private Indonesian hospital, moving beyond the traditional focus on empathy to understand the interplay of various service quality dimensions. A mixed-methods sequential explanatory design was employed. The quantitative phase involved a survey of 400 outpatients, measuring their satisfaction with five service quality dimensions: tangibles, reliability, responsiveness, empathy, and assurance. Data were analyzed using descriptive statistics, Importance-Performance Analysis (IPA), and gap analysis (suitability index). The qualitative phase utilized in-depth interviews and focus group discussions with patients, staff, and management to provide context and depth to the quantitative findings. While overall patient satisfaction was 82.9%, a gap analysis revealed substantial discrepancies between patient expectations and perceptions across several service quality dimensions. Tangibles, reliability, and responsiveness emerged as key areas requiring improvement. Qualitative findings highlighted extended wait times, inconsistent staff communication, and concerns about the physical environment as significant contributors to patient dissatisfaction. Achieving high levels of patient satisfaction in resource-constrained environments necessitates a comprehensive approach that addresses systemic inefficiencies and communication gaps alongside interpersonal factors like empathy. These findings underscore the need for targeted interventions to optimize resource allocation, streamline processes, and enhance staff communication skills to improve the patient experience.

Evaluation of a novel robotic testing method for stability and kinematics of total knee arthroplasty.

This work developed a novel preclinical test of total knee replacements (TKRs) in order to explain TKR instability linked to patient dissatisfaction. It was hypothesized that stability tests on the isolated moving prostheses would provide novel comparative data on the stability and kinematics among TKR designs. Three TKR designs, DePuy Synthes Attune MS, Stryker Triathlon and Zimmer Biomet Persona MC, were assessed using a robotic arm while flexing-extending 0-140°. Tests imposed 710 N body weight combined with three tibial loads: no anterior-posterior (AP) force, 90 N anterior or 90 N posterior force. Other load effects were minimized and the kinematics was recorded. Each implant was tested six times to investigate the repeatability of the method. Data were analysed using statistical parametric mapping with one-way analysis of variance (ANOVA). If significance was found (p < 0.05), post hoc t tests with Bonferroni correction were used to contrast groups. Significant differences were found throughout flexion-extension. Femoral rollback, AP stability, coupled internal-external rotation and AP position (roll-back) were all influenced by implant design. AP stability of the TKRs reduced with flexion reaching Attune 15 mm, Persona 13 mm and Triathlon 21 mm at 140° flexion. Tractive rolling significantly affected kinematics in the less congruent Triathlon design, with 6 mm different paths between flexion and extension motion (p < 0.05 across 5-100°). Paradoxical anterior femoral sliding in early flexion (0-40°) occurred in Persona and Triathlon designs. The novel testing technique provides, for the first time, comparative data on the inherent stability and kinematics of the TKR implants themselves across the arc of flexion-extension, independent of variables including soft tissue behaviour and surgical technique. The data show how much each prosthesis can contribute to the stability and motion of the implanted knee. Similar data from a wider range of designs will enable more informed decisions regarding implant design choice, aiming to reduce the prevalence of TKR instability in patients. Controlled laboratory study.

Implant outcomes following breast conservation therapy in patients with history of augmentation mammoplasty

BackgroundIn women who are eligible, breast conservation therapy (BCT) is often the preferred local treatment for early-stage BC. Concern for implant contracture in patients undergoing BCT including radiation therapy (RT) with prior augmentation mammoplasty has been expressed in several prior studies. The exact incidence of patient dissatisfaction remains unknown. MethodsA single institution retrospective review was performed for patients with prior augmentation mammoplasty who received BCT for BC between 2010 and 2020. 77 patients met inclusion criteria. Of these, 34 were consented and completed study survey which included validated BREAST-Q modules. Data was reviewed with primarily descriptive analyses. P-values were calculated from Fisher’s exact test and Kruskal-Wallis rank sum test. Results34 patients completed study survey, with 55.9 % of patients (n=19) having silicone implants and 44.1 % (n=15) having saline. Most implants (91.1 %, n=31) were retropectoral. Median total dose of RT was 4005 cGy and median age of implants at BC diagnosis was 16 years (range 2, 40). 41 % (n=14) of patients reported dissatisfaction with breast appearance, with median BREAST-Q RASCH score for satisfaction with breasts 48 (range 20–82). No differences in breast satisfaction were seen in patients with silicone implants compared to saline (p= 0.171) although there were improved reported physical well-being chest scores in patients with saline implants (median 100 vs 89; p = 0.039). ConclusionsA large proportion of women are dissatisfied with implant appearance following BCT with RT. Future larger studies are needed to explore contributing factors for dissatisfaction including implant type, location, RT dosing and fractionation.

Healthcare leadership practice and associated factors among primary healthcare managers in East Gojam Zone, Northwest Ethiopia: a mixed method study

BackgroundLeadership plays a critical role in the delivery of person centered, safe, efficient, and effective healthcare services globally. Poor healthcare leadership contributes to low staff motivation, patient dissatisfaction, and reduced healthcare-seeking behavior. However, there is limited evidence on healthcare leadership practice and associated factors among primary healthcare managers in the study area and at large in Ethiopia. Therefore, the findings of this study will contribute to improved healthcare leadership practices among primary healthcare managers.MethodFacility-based cross-sectional study supplemented with qualitative inquiry was conducted in the East Gojam zone among 532 primary healthcare managers selected by a two-stage stratified random sampling technique. A pre-tested and structured self-administered questionnaire was used to collect the quantitative data. Data were entered into Epi-Data version 4.6 and exported into Stata version 14.0 for analysis. Multiple linear regression analysis was used to identify factors associated with healthcare leadership practice, and statistical significance was declared at a p-value < 0.05 with a 95% CI. Six key informant interviews were conducted, and thematic analysis was used for the qualitative study.ResultThe magnitude of healthcare leadership practice among primary healthcare managers in the East Gojam zone was 45.7% (95% CI: (41.4, 50.0)). Factors associated with healthcare leadership practice were age [β = 0.44, 95% CI: (0.16, 0.71)], training in healthcare leadership practice [β = 1.19, 95% CI: (0.19, 2.20)], experience sharing [β = 1.68, 95% CI: (0.59, 2.76)], organizational communication [β = 0.19, 95% CI: (0.05, 0.33)], managerial working experience [β = 0.94, 95% CI: (0.18, 1.69)] and emotional intelligence [β = 0.35, 95% CI: (0.31, 0.38)].Conclusion and recommendationThe magnitude of healthcare leadership practice among primary healthcare managers in the East Gojam zone was low as compared with a previous study in Ethiopia. It was significantly associated with age, training in leadership, experience sharing, organizational communication, managerial working experience, and emotional intelligence. Thus, human resource managers at primary healthcare level should consider older and more experienced candidates during assigning managers, organize training on healthcare leadership and experience sharing with model managers to improve the leadership practice of primary healthcare managers in the East Gojam zone.

Counselling sessions for patients in contact isolation due to multi-drug-resistant organisms improve informedness and reduce dissatisfaction

The spread of multidrug-resistant organisms (MDROs) is a critical health issue. Isolation measures imposed to prevent transmission may result in adverse psychological effects among affected patients. This emphasises the need for better communication and information to improve their hospital experience and mental well-being as well as to prevent inadequate treatment. The present study examines whether tailored counselling sessions during contact isolation can enhance patients' understanding of their situation concerning the significance of their MDRO status and enhance their well-being. A pre-post-intervention study was conducted in a German tertiary care hospital in which N = 64 patients who were isolated due to MDROs received tailored counselling. The counselling included information about MDROs, the reason for hospital isolation measures, and appropriate behaviour during and after hospitalisation. Participants completed questionnaires before and after the counselling sessions to assess its impact on their informedness, patient (dis)satisfaction and well-being measures. Prior to the counselling session, patient dissatisfaction was associated with anxiety and inadequate informedness about MDROs. After the counselling, patients reported a significantly improved comprehension of their MDROs-related situation and a notable decrease in dissatisfaction with their hospital situation, primarily attributed to the acquired information. This is the first German study to show how improved information about MDROs impacts patient satisfaction in hospitals. The findings stress the crucial need for improving healthcare workers' interaction and communication with patients affected by MDROs.

Optimizing emergency department efficiency: a comparative analysis of process mining and simulation models to mitigate overcrowding and waiting times

ObjectiveOvercrowding and extended waiting times in emergency departments are a pervasive issue, leading to patient dissatisfaction. This study aims to compare the efficacy of two process mining and simulation models in identifying bottlenecks and optimizing patient flow in the emergency department of Al-Zahra Hospital in Isfahan. The ultimate goal is to reduce patient waiting times and alleviate population density, ultimately enhancing the overall patient experience.MethodsThis study employed a descriptive, applied, cross-sectional, and retrospective design. The study population consisted of 39,264 individuals referred to Al-Zahra Hospital, with a sample size of at least 1,275 participants, selected using systematic random sampling at a confidence level of 99%. Data were collected through a questionnaire and the Hospital Information System (HIS). Statistical analysis was conducted using Excel software, with a focus on time-averaged data. Two methods of simulation and process mining were utilized to analyze the data. First, the model was run 1000 times using ARENA software, with simulation techniques. In the second step, the emergency process model was discovered using process mining techniques through Access software, and statistical analysis was performed on the event log. The relationships between the data were identified, and the discovered model was analyzed using the Fuzzy Miner algorithm and Disco tool. Finally, the results of the two models were compared, and proposed scenarios to reduce patient waiting times were examined using simulation techniques.ResultsThe analysis of the current emergency process at Al-Zahra Hospital revealed that the major bottlenecks in the process are related to waiting times, inefficient implementation of doctor’s orders, delays in recording patient test results, and congestion at the discharge station. Notably, the process mining exercise corroborated the findings from the simulation, providing a comprehensive understanding of the inefficiencies in the emergency process. Next, 34 potential solutions were proposed to reduce waiting times and alleviate these bottlenecks. These solutions were simulated using Arena software, allowing for a comprehensive evaluation of their effectiveness. The results were then compared to identify the most promising strategies for improving the emergency process.ConclusionIn conclusion, the results of this research demonstrate the effectiveness of using simulation techniques and process mining in making informed, data-driven decisions that align with available resources and conditions. By leveraging these tools, unnecessary waste and additional expenses can be significantly reduced. The comparative analysis of the 34 proposed scenarios revealed that two solutions stood out as the most effective in improving the emergency process. Scenario 19, which involves dedicating two personnel to jointly referring patients to the ward, and scenario 34, which creates a dedicated discharge hall, have the potential to create a more favorable situation.

The Cosmetic Readiness Questionnaire (CRQ): Validation of a Pre-Operative Psychological Screening Tool for Aesthetic Procedures.

Several psychological risk factors are associated with patient dissatisfaction with aesthetic procedures, such as body dysmorphic disorder (BDD), unmanaged mental health concerns or unrealistic expectations. Identifying these risks via preoperative screening may protect patients from adverse psychological outcomes and provide reputational or legal protection for practitioners. This study aimed to further develop and validate the Cosmetic Readiness Questionnaire (CRQ), a comprehensive psychological screening tool to assess patient suitability for surgical and non-surgical aesthetic procedures. The CRQ was validated across two studies in clinical contexts, examining structural and construct validity in a sample of 8031 individuals who completed the CRQ as part of routine clinical care. In a further sample (n = 574), criterion validity was explored through the relationship between the CRQ and dissatisfaction with past aesthetic treatments. Risk category cut-off scores were developed. Results supported the reliability and validity of a five-factor CRQ which measures Body Dysmorphia, Psychological Distress, Self-Criticism, Unrealistic Expectations and Lack of Openness. High scorers on the CRQ were 78% more likely to report dissatisfaction with a past cosmetic procedure than low scorers. The CRQ is a comprehensive and valid screening measure to identify patients who may require further psychological assessment or additional support prior to aesthetic treatment. Instructions are provided on how to implement the CRQ in clinical practice.

Management of dermatosis papulosa nigra: a systematic review.

Dermatosis papulosa nigra (DPN) is a variant of seborrheic keratosis that typically presents as hyperpigmented pedunculated papules on the face, trunk, and/or back in those with skin of color. Although benign, the lesions can cause significant discomfort and distress. Management options are limited and often unaffordable, as treatment is elective in most cases. This study was undertaken to provide an updated summary of safe and efficacious treatments for DPN. Five databases were searched to identify full-text publications reporting on treatments and outcomes in adults with DPN. Seventeen publications met inclusion criteria and were included: six cohort studies, one randomized controlled trial, five case report studies, one case series, and four pilot studies. Treatment options included simple excision, curettage, electrodesiccation, cryotherapy, topicals, and laser therapies. These modalities varied in their documented outcomes and associated potential adverse effect profiles. Postinflammatory hyperpigmentation is a common adverse effect that often leads to patient dissatisfaction. It can be mitigated with topical treatments aimed at reducing local inflammation. Study limitations included small sample size in individual studies, lack of consistent reporting of Fitzpatrick skin type, and lack of comparison to the standard treatment of electrodesiccation or curettage. Ultimately, treatment should consider the patient's Fitzpatrick type, treatment area, associated costs, and potential adverse effects.

The cancer diagnostic clinic: A rapid access clinic to improve outcomes for patients with a suspected cancer diagnosis.

77 Background: Patients with suspected cancer often face challenges navigating complex health systems, resulting in delays in diagnosis and time to treatment, which are associated with adverse outcomes and patient dissatisfaction. To improve patient access and bridge this healthcare gap, the Cancer Diagnostic (CDx) clinic was established to streamline the evaluation for patients with a new suspected cancer. The CDx clinic prioritizes expedited cancer evaluation, timely and accurate diagnostic testing, and transition of care to subspecialty Oncologists, to improve the patient experience and cancer-related outcomes. Methods: Leaders in the Abramson Cancer Center (ACC) initiated a pilot project to facilitate timely appointments to Oncologists for patients in the Emergency Department with a new suspected cancer. Patient access lead time and time to diagnosis and treatment were tracked. This pilot was formally expanded across the health system to become the CDx clinic for eligible adult patients with suspicious symptoms, lab abnormalities, or imaging findings concerning for cancer. Patient data was extracted using an EMR-based form and supplemented by chart review. Study period was March 2023 to April 2024 and included socio-demographics, cancer subtype, referral type, time from referral to new patient appointment (access lead time), time from first appointment to diagnosis and treatment (surgery, systemic or radiation therapy), patient retention, complications, and mortality. Results: Over 12 months, 108 patients were evaluated in the CDx clinic. Most patients were male (56%), White (58%), and non-residents of Philadelphia County (65%). There were 8 referrals (range: 6-13) per month with the majority of patients from external referrals (60.2%). Compared to baseline, CDx resulted (median pre/post in days) in similar time to first appointment (7 vs. 7 days), improved time to diagnosis (21 vs. 8 days), and improved time to treatment (42 vs. 29.5 days). 71 patients were diagnosed with cancer with Gastrointestinal (47%) and Thoracic (24%) cancers being most common. 98.6% (70/71) of patients were retained at ACC and transitioned to subspecialty care. 80.3% (57/71) of patients received cancer-directed treatment. After the initial consult date, for the patients diagnosed with cancer, there were 4 ED visits and 20 hospitalizations within 30 days, 19 hospice enrollments, and 16 deaths. Conclusions: The CDx clinic has been a valuable resource for patients with suspected cancer by optimizing time to diagnosis and time to treatment. Additional navigation pathways are underway to expand the CDx patient population to target a more underserved population in an effort to promote health equity in cancer care.

Optimizing infusion experience for patients in GI oncology at Hartford Hospital Cancer Institute.

331 Background: Cancer Treatments have become increasingly complex and the volume of patients requiring infusion treatments have increased in the outpatient setting. As a part of our Clinical Care Redesign Quality Initiative, the Hartford Healthcare Team identified that our GI Oncology patients receiving chemotherapy at the Hartford Hospital Infusion Center were experiencing a mean wait time of 81 minutes from the start of check-in to the start of their first medication, resulting in patient and staff dissatisfaction and inefficient use of resources. Our objective was to reduce the mean wait time to less than 60 minutes from the start of check-in to the start of the first medication by December 2023, which in turn would improve patient and staff satisfaction. Methods: By process mapping, creation of a fishbone diagram, and multi-voting, we demonstrated that waiting for laboratory results for patients who had provider and chemotherapy visits on the same day was a large contributor to long wait times. We implemented an Advanced Preparation Process that included Unlinking infusion visits from Provider visits and obtaining patient labs prior to chemotherapy treatment day to achieve the goal. Results: By Unlinking visits beginning mid-October 2023, we were able to decrease the mean wait time from 81 minutes to an average of 53 minutes, reflecting a 54% reduction in wait time. This allowed Pharmacy and Infusion Nurses additional time to review orders and complete safety checks and spend more time with patients at the chairside. An estimated amount of 12.6 hours of chair time was made available per week, representing a potential revenue increase of $188,021 annually. Most patients appreciated the decrease in wait time even if it meant coming in two separate days. Conclusions: The project aim of reducing wait times for GI Oncology patients was achieved. A reduction in time to first drug for other patients receiving chemotherapy during our pilot period was also noted, which we attributed to Hawthorne effect. Patient and staff satisfaction were improved. Our next steps will include continuing to optimizing the process.

Quality intervention to facilitate clinician-patient discussions of lung cancer biomarker testing at safety net and non safety net centers.

284 Background: Biomarker testing is critical for optimal therapy selection in non small cell lung cancer, but it takes time and may delay treatment, causing patient anxiety and dissatisfaction. Patients want to understand the necessity and timing of biomarker testing and therapy decisions, but clinicians find these discussions challenging, especially with lower health literacy patients. As a solution, we deployed 4R Oncology model (4R = Right Info/Care/Patient/Time) at 10 centers (4 safety net, 6 non safety net). Under 4R, clinicians discuss with patients a Care Sequence, a predeveloped care checklist with visual timing of care, emphasizing biomarker testing within the overall care plan. It includes social and supportive care to address Social Determinants of Health (SDOH). Methods: Interviews with clinicians to examine whether / how Care Sequence helped discuss the need and timing for biomarker testing with patients, including lower health literacy patients. The cohort of clinicians (N=18) included oncologists, fellows and nurses; 10 worked at safety net centers. Results: All clinicians reported that Care Sequence helped explain timing of biomarker testing and the need to wait for results (Table). The majority reported that it helped discussions with lower literacy patients and to train fellows how to discuss these issues and place related referrals. These benefits and most of the rationale were reported at a similar rate by safety net and non safety net clinicians. Conclusions: The 4R Care Sequence is a promising quality tool that helps clinicians, including fellows, manage patients’ awareness and expectations for timing of biomarker testing and therapy decisions in lung cancer. The benefits in discussions with lower health literacy patients at both safety net and non safety net centers suggest that 4R can address disparities in patients’ understanding of these complex issues and may reduce anxiety while awaiting treatment. Does Care Sequence help / rationale % of all clinicians N=18 % of safety net clinicians n=10 % of non safety net clinicians n=8 P value Helps Explain Timing of Biomarkers &amp; Decision, Need to Wait for Results 100 100 100 1 - Describes how biomarker testing fits into overall care plan 94 100 88 .4 - Visually depicts timing of testing &amp; treatment decision 83 80 88 1 - Recommends patients to be active preparing for treatment while waiting 78 80 75 1 - As a standard, normalizes timing of results, decisions 56 30 88 .02* Helps Discuss With Lower Health Literacy Patients 89 90 88 1 - Combines visual timeline &amp; succinct checklist 61 60 63 1 - Uses plain language as possible 39 60 13 .02* - Helps address SDOH while waiting 72 70 75 1 Helps Train Fellows 92 100 67 .2 - Reminds to order biomarkers, other workup 77 80 67 1 - Helps develop narrative, organize discussion of biomarkers 77 80 67 1 - Prompts to discuss SDOH, refer to related care 62 80 0 .04* *Statistically significant, p&lt;.05.

PROPEL Discharge: An Interdisciplinary Throughput Initiative

BackgroundIncreased care demands at a healthcare institution led to strained resources, emergency department (ED) congestion, safety events, and patient and employee dissatisfaction. Moreover, high volumes of afternoon discharges contributed to limited early morning bed availability and admission bottlenecks. MethodsA 29-month pre-post design quality improvement project on 19 acute care, adult medicine units across two campuses at a large academic medical center was implemented to improve discharge timeliness, length of stay (LOS), and ED throughput by increasing pre-11:00 AM discharges. Based on Lean Six Sigma methodology, interventions included standardized interdisciplinary discharge processes and roles, processes to ensure performance data transparency and access, a recognition program, and a barrier tracking and mitigation process for continued improvements. ResultsDuring the intervention period, pre-11:00 AM discharges increased from 5.1% to 21.8% (p < 0.001), discharge orders were entered 42 minutes earlier (p < 0.001), patients were discharged 56 minutes earlier (p < 0.001), the percentage of discharges completed within 90 minutes from discharge order improved from 26.2% to 38.1% (p < 0.001), the percentage of discharges by 3:00 PM improved from 44.7% to 55.9% (p < 0.001), ED admissions arrived to units 44 minutes earlier (p < 0.001), median LOS decreased by 0.46 days (p < 0.001), median O:E LOS decreased by 0.05 (p < 0.001), and opportunity day reductions contributed to increased bed capacity of 18.84 beds per day. ConclusionEarly morning discharges are associated with improved patient throughput and are safe, achievable, and sustainable via interventions focused on frontline engagement, interdisciplinary collaboration, standardization, barrier mitigation, data accessibility, and accountability.

Optimizing peripheral I.V. access outcomes - Part 2.

Peripheral I.V. access failure is a source of patient discomfort and dissatisfaction with a significant financial impact on healthcare. This article reviews the benefits and the risks of peripheral I.V. catheter (PIVC) utilization, infusate characteristics and their impact on peripheral vasculature, PIVC site assessment and management, and PIVC research priorities. Part 1 of this series was published in Nursing's September 2024 issue.

Uncovering patient dissatisfaction with Healthcare Services at a tertiary hospital in Uganda: Patient perspective in a descriptive cross-sectional study

Introduction: Patient satisfaction is a widely recognized standard for assessing the effectiveness of healthcare services in hospitals. This study aimed to discover factors associated with patient dissatisfaction with healthcare services offered at Masaka Regional Referral Hospital, Masaka District-Uganda. Methods: A descriptive cross-sectional study that employed quantitative data collection methods was conducted between February and March 2024. Using Systematic random sampling, 384 study participants were included. Data was collected using an interviewer-administered questionnaire analyzed and presented using Microsoft Excel 2019 Version. Results: Most respondents 120 (31.25%) were aged between 31-40 years, 56.77% were females, 67.71 were married or cohabiting with the majority of respondents in low-income class and, 194(50.53%) having a monthly income of less than 100,000Ug. Shs. As (53.13%) were unemployed, 221 (57.55%) were rural residents, and the majority 248(65%) traveled long distances of greater than 10 kilometers to reach the Hospital. The majority of respondents 298(77.61%) disagreed that there was an adequate seating area, the majority of respondents 304(79.17%) waited for long hours before getting services and 204(53.12%) disagreed upon being given adequate time and information regarding their health and 174(45.31%) reported that HCWs were rude to them. Conclusions: Majority of respondents were dissatisfied with the services they had received at the hospital as most of them 208(54.17%) rated the services provided as poor. Therefore, there should be Implementation of targeted Interventions to address socio-demographic disparities, Enhance Patient-Centered Care and Communication Practices, optimization of health institutional practices to improve service delivery, and further research studies are recommended to better understand the gaps in patient satisfaction with healthcare services in Uganda.