Patient Satisfaction Survey Research Articles

In-Patient Satisfaction Analysis in an Indian Active Combat Zone Field Hospital Setting in South Sudan

Abstract Background: Patient satisfaction is often a subjective phenomenon. An objective method of assessment of patient satisfaction is by conducting surveys and obtaining patient satisfaction scores by means of feedback in the form of a questionnaire. Objective: To perform a patient satisfaction survey at a field hospital established by India in a conflict zone in South Sudan, where the healthcare setup is a challenge, as no such study has been performed previously. Materials and Methods: A total of 168 patients admitted into the hospital for necessary management were enrolled. The feedback was based on a questionnaire format which had six major criteria. Each criterion was defined by individual questions, and each question was scored on a scale of 1–5. Results: A total of 144 (85.7%) patients reported being satisfied with the overall hospital practices; 88% (n = 148) were satisfied with the overall quality of medical care provided by the hospital; and 89.3% (n = 150) were satisfied with the nursing care and care from the various service providers. A total of 97 (54.7%) patients were satisfied with the quality of food served. Conclusion: The majority of services and practices were comprehensively reported as satisfactory by the patients. However, satisfaction with the quality of food served was low and requires improvements by the service providers.

Patient satisfaction and safety in the administration of sedation by nursing staff in the digestive endoscopy service: a cross-sectional study

BackgroundThe satisfaction of patients with sedation by nursing staff is an issue of interest for the quality of health care, influencing the recovery and well-being of patients as well as their confidence in and adherence to treatment. One of the most frequently performed diagnostic and therapeutic tests requiring sedation are digestive endoscopies, so it would be interesting to study satisfaction in these services.AimTo determine the level of patient satisfaction and safety with sedation via digestive endoscopies by nurses.MethodsThis was a cross-sectional study in the Digestive Endoscopy Service at the University Hospital of Toledo, Spain. The sample consisted of 660 adult patients from the digestive endoscopy service who were sedated between June–September 2023. The degree of satisfaction with the service was measured by the questionnaire: Survey of patient satisfaction with the digestive endoscopy service. The study was approved by the ethics committee.ResultsPatients who reported satisfaction with the treatment were very satisfied with the sedation provided by the nurses. The most valued item was the attention of the nursing professionals. The least valued items were the waiting time for the appointment and the time spent in the waiting room on the same day. The incidence of complications recorded during the test were minimal (2% of all patients).ConclusionsMost patients are satisfied with the sedation administered by nurses via digestive endoscopies, and complications were rare, supporting the efficacy and acceptance of this practice. Clinical practice guidelines and consensus documents in Spain guarantee that nurses have autonomy to administer sedation in digestive endoscopy services, but there is a lack of national regulations to support this technique. The current consensus in Spain is that specific training is necessary for such nurses.

Dye Laser Applications in Cosmetic Dermatology: Efficacy and Safety in Treating Vascular Lesions and Scars

Cosmetic dermatology increasingly utilizes laser technologies to address various aesthetic concerns. This study evaluates the efficacy of the flash-lamp pulsed-dye laser (FPDL) in treating vascular and scar-related conditions. A cohort of 71 patients with diverse vascular lesions, including facial telangiectasia, port-wine stains (PWSs), striae rubrae, erythematous acne scars, facial traumatic scars, and keloids, was treated using the FPDL (Synchro Vas-Q, Deka MELA). Treatment protocols varied based on lesion type, with sessions ranging from one to eight at intervals of four to eight weeks. Clinical outcomes were assessed using a four-point grading scale and patient satisfaction surveys. Results indicated that 70.4% of patients achieved excellent clearance of lesions, while 16.9% and 9.9% showed moderate-good and slight clearance, respectively. Minimal or no improvement was observed in 2.8% of cases. High patient satisfaction was reported, correlating with effective lesion reduction and manageable side effects, primarily post-operative purpura. The study underscores FPDL’s selective efficacy for hemoglobin-rich lesions and its safety profile, advocating for its continued use in cosmetic dermatological practices. These findings contribute to the growing evidence supporting laser therapy as a pivotal tool in aesthetic medicine, emphasizing the importance of tailored treatment protocols and patient education for optimal outcomes.

Optimal Treatment for Post-Surgical Cicatricial Alopecia: Autologous Hair Transplantation?

Scarring alopecia significantly impacts patients' appearance and psychological well-being. Surgery is a common cause of scarring alopecia, making positive treatment crucial for patients' overall health. To investigate the clinical efficacy of autologous follicular unit extraction (FUE) transplantation for postoperative secondary stable scarring alopecia and evaluate its effectiveness. A retrospective descriptive study was conducted, including 14 patients with postoperative secondary scarring alopecia. All patients underwent initial autologous FUE hair transplantation, and postoperative complications were monitored. Patient satisfaction surveys were also conducted. Satisfaction assessments were performed for all 14 patients. Two patients (14.3%) reported being very satisfied, 6 patients expressed satisfaction (35.7%), 4 patients reported being somewhat satisfied (28.6%), and 3 patients were dissatisfied (21.4%). Aesthetic complications included low follicular density post-transplantation, uneven density, and unnatural appearance. Solely using a single FUE hair transplantation for treating postoperative secondary scarring alopecia has limited effectiveness and may not always meet expectations, potentially requiring multiple transplantations. Further research is necessary to guide and improve follicular transplantation survival rates to ensure surgical efficacy.

Decreasing Patient Wait Time by Process Level Interventions in an Oncology Daycare Unit: A Quasi‐Experimental Study

ABSTRACTIntroductionThe DMAIC approach is a five‐phase improvement cycle which enables the advancement of pre‐existing processes and was implemented as part of the “lean” process improvement initiative. The present study aims to improve the work efficiency of chemotherapy daycare unit (CDU) at a cancer hospital. The objectives include studying the process flow of the CDU, estimating the patient wait time (PWT) before infusion at the CDU, and implementing new measures to improve its functioning.MethodsIn this quasi‐experimental study, PWT of the CDU process was assessed and its work efficiency was analyzed using other parameters of functioning. The research team implemented a planning system using “lean” methods for reducing the patient contact points in the hospital, streamlining the workflow of patient services at CDU and reducing the laboratory waiting time. The patient satisfaction survey enabled measuring the quality of care at CDU.ResultsThe study methodology was “lean‐DMAIC,” which enabled an improvement in the activities performed by the CDU staff. The mean difference in PWT between the two groups (pre‐ and postintervention) was 13.93 min, which is a significant (p < 0.001) reduction (19%) in the mean PWT values. Although the patient satisfaction survey did not show significant results for the general questionnaire conducted on study subjects (95 patients each in the pre‐ and postintervention groups), the intervention‐specific questionnaire on the cohort of 20 patients showed a significant mean difference (µ = 4.2 ± 0.3 and 4.8 ± 0.2, p < 0.001) between the pre‐ and postintervention groups.ConclusionThe results of the study implicate the potential of revising the process flow for a subset of oncology patients, and its impact on the efficiency of CDU. Adopting a lean technique in the study resulted in an improvised work approach and an anticipative growth in revenue generation.

Development and Evaluation of a Remote Monitoring Regional Adjuvant Abemaciclib Service for Patients With High-Risk Early Breast Cancer.

Adjuvant abemaciclib was recently approved in high-risk early breast cancer, leading to an increase in oncology resource utilisation. We thus developed a regional, remote monitoring clinical service. The set-up, delivery processes and outcomes from the first 6 months' consecutive patients are presented. A regional delivery model with remote monitoring using optional electronic patient outcome measures (ePROMs) and bloods closer to home (BCTH) was implemented. Electronic patient records of patients entering the service (October 31, 2022 to May 31, 2023) were reviewed. Time-in-motion and on-line patient satisfaction surveys were conducted with questions adapted from prior questionnaires used by our cancer center. An independent t-test was used to assess differences in creatinine levels whilst on abemaciclib and a Mann-Whitney test to determine whether the time taken to complete follow-up appointments differed with and without ePROMs. The first 103 patients to commence abemaciclib (median age 58 [range, 27-85], 66.0% White) had completed a median of 6 cycles (range, 0-9). 51.5% had treatment interruption, 52.4% a dose reduction and 15.5% discontinued therapy. Diarrhoea (90.3%), fatigue (84.9%) and anorexia (73.1%) were the most commonly reported toxicities on ePROMs. 10.8% of patients reported grade 3-4 toxicities. Neutropenia was also common and low grade. 89.5% of patients would recommend ePROMs and 98.0% found the BCTH service easy to use. Review appointments with ePROMs were a similar length to those without (P = .138). We have successfully implemented a remote, regional adjuvant clinical service which could serve as a blueprint for other NHS trusts for this and other cancer drugs.

Patient satisfaction survey in a public hospital: Remera Rukoma District Hospital, Rwanda, 2023

BackgroundPatient satisfaction is a crucial indicator of healthcare quality, influencing outcomes and providing insights for improvement. This study aims to assess patient satisfaction levels, and associated factors, and identify areas for enhancement at Remera Rukoma District Hospital (RRDH) in Rwanda, where such data was previously lacking.MethodsA cross-sectional study using a mixed approach of data collection was conducted, involving 384 participants (164 inpatients, 220 outpatients). Quantitative surveys and qualitative interviews were employed. Patient satisfaction was categorized as Very Satisfied (> 70%), Satisfied (50–69.9%), or Not Satisfied (≤ 49.9%). Data analysis included descriptive statistics, bivariate logistic regression, and thematic analysis of qualitative data.ResultsThe study comprised 37.8% male and 62.2% female participants. Overall, 52.6% were highly satisfied, 29% satisfied, and 18% not satisfied. Among outpatients, 35.9% were dissatisfied with cashier services, and 46.9% with pharmacy wait times. Inpatients showed 74.4% satisfaction with the admission process, but 69.5% reported delayed test result feedback. Educational level significantly influenced satisfaction, with uneducated participants showing lower odds of satisfaction compared to university-educated ones (cOR = 0.409, 95% CI: 0.186–0.897, p = 0.026). Qualitative findings highlighted issues with wait times, communication, and service consistency.ConclusionsWhile overall satisfaction at RRDH was positive, the study identified areas needing improvement, particularly in communication, wait times, and service delays. Education level was significantly associated with satisfaction level. Addressing these factors, beyond operational efficiency, may significantly impact patient satisfaction. Enhancing communication, managing expectations, and optimizing service delivery are crucial for maintaining satisfaction and improving service quality.

The Impact of Language-Discordant Care Upon the Patient Family Experience in Pediatric Plastic Surgery.

Patient satisfaction surveys usually overlook differences in patient family experience (PFE) for families whose spoken language is different from that of the treating physician. This study examines the relationship between language-discordant care and patient experience. A retrospective review of deidentified pediatric plastic surgery PFE survey responses from 2018 to 2021 was performed with permission from Lurie Children's Hospital's PFE Team. A total of 443 pediatric plastic surgery patients were included. The race breakdown was White (49%), Other (23.9%), Black (8.8%), and Asian (5.9%). Ethnic distribution included "Not Hispanic/Latino" (58.2%) and "Hispanic/Latino" (31.4%). Languages spoken were English (80.4%), Spanish (18.1%), and Other (2.3%). Eighty-seven (19.64%) patients were language-discordant with their providers; out of this group, 68 (78.2%) preferred interpreter services. Methods of interpreter services included in-person (54.4%), over-the-phone (27.9%), video (1.5%), and no services (16.2%). The language-discordant group was less likely to give the highest ranking to "provider courtesy and respect" [odds ratio (OR)=0.200, P<0.001], "provider listened carefully" (OR=0.202, P<0.001), and "knowing what to do with subsequent questions following visit" (OR=0.435, P<0.01). No differences in PFE ratings existed for: "enough information provided," overall provider rating, and whether they would recommend the facility. There were no significant differences in provider ratings by interpreter service method. Patient/provider language discordance results in significantly lower PFE ratings in areas involving patient teaching and perceptions of provider respect, courtesy, and careful listening. This underscores the importance of providers better accommodating families with limited English proficiency.

Problems and level of satisfaction of patients during their stay in a tertiary care institute in Punjab

Patient satisfaction can be defined as the degree of congruency between a patient’s expectations of ideal care and his /her perception of the real care (s) he receives. It is a multidimensional aspect and represents a vital key marker for the quality of health care delivery.The cross-sectional study was conducted among the IPD patients in the indoor wards of SGRD Hospital which is a tertiary care hospital. A self-structured questionnaire was used to collect data. Questions regarding twelve potential problems were asked which could have been faced by the respondent during their stay in hospital.A total of 226 respondents were interviewed. 52.2% of the respondents were females and remaining (47.8%) were males. Overall satisfaction of the patients from the IPD services provided by the hospital was found to be 87.2%. Major problems faced by the respondent were difficulty in accessing the hospital (46%) and higher overall cost of treatment than expected (45.6%). Most of the respondents were satisfied with quality of food and water available (97.8%) and quality of linen provided by hospital and sanitary conditions of ward (97.3%).The study suggests that majority of In-patients are highly satisfied with the IPD services provided by the hospital which is highly motivating but every attempt must be made to form new policies and reform existing ones to achieve 100% satisfaction of patients. A number of potential barriers have been discovered in this study. Periodic patient satisfaction survey must be institutionalized in order to continuously improve hospital services. Patient counseling and health education cells could be open where patients and their relatives could solve their queries.

Correction of Infraorbital Dark Circles Using Autologous Adipose-Derived Collagen Filler: A Novel Regenerative Option.

Numerous intrinsic and extrinsic factors, notably the aging process, contribute to the development of infraorbital dark circles. These features, commonly associated with old age and fatigue, are caused by a disruption of dermal melanin and impairment of skin barrier function. Common aesthetic concerns affecting patients with infraorbital dark circles are primarily owing to lean and translucent lower eyelid skin overlying the orbicularis oculi muscle. This study aimed to present a novel technique for correcting infraorbital dark circles utilizing an adipose-derived extracellular matrix concentrate-adipose collagen fragment (ACF)-to correct infraorbital dark circles. Female patients (n = 94) aged 20-38 who presented infraorbital dark circles were enrolled to assess the efficacy of this technique for an eight-month follow-up. Following intradermal injections with ACF filler, the clinical outcome was determined by responses to GAIS and patient satisfaction surveys. Statistical analysis was performed with the one-way ANOVA test, and a p value of < 0.05 was considered statistically significant. Patients (n = 92) completed a single treatment session and underwent an eight-month follow-up. Eighty patients (86%) reported being "highly satisfied" or "satisfied" with the outcome and responded that the technique resulted in brighter, tighter, and smoother infraorbital skin. Over 97% of patients were rated as "improved," "much improved" and "Very much improved" throughout the follow-up on GAIS by three independent surgeons (p < 0.05). The statistical analyses demonstrated the percentage differences among groups are highly significant (p < 0.0001). No irregularity or lump was observed during the follow-up. Two patients were excluded from the study due to having undergone cosmetic eyelid surgery. Intradermal ACF filler represents a novel approach to addressing infraorbital dark circles and yields significantly high patient satisfaction. ACF fillers provide a degree of bio-stimulation, and adipose-derived concentrate is a natural filler with regenerative effects used in periorbital rejuvenation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Medial Breast Reconstruction after Breast Conserving Surgery with Local Flap: A Single Center Experience.

Breast-conserving surgery (BCS) and post-surgical radiotherapy are the treatment of choice in early-stage breast cancers. Surgeons use different techniques for the reconstruction of the breast after BCS. We aimed to present our novel reconstruction technique for medial breast defects and report the follow-up results of patients who underwent breast reconstruction using this method in the short and long term. Forty patients with medially located breast tumors under BCS referred to Shahid Modares Hospital in Tehran, Iran from 2018 to 2022 were enrolled in the study. The patients underwent breast reconstruction post-lumpectomy using the local transposition flap technique. We followed the patients for one year, and the satisfaction and complication results were assessed and reported post-operation, after radio-chemotherapy, and after one year. The patients' mean age was 48.4 (±12.3) years, and the mean BMI was 30.9 (±3.1). There were no cases of complication, including infection, seroma formation, hematoma, flap ischemia, or necrosis post-operation, one week and one month after discharge. The surgeon and patient satisfaction surveys conducted post-op, after the radio-chemotherapy course, and one year after BCS using the Breast-Q satisfaction domain showed that the excellent and good satisfaction rates are 88%, 92%, and 92%, respectively. Local transposition flap has remarkable cosmetic results with the least complication rate in the reconstruction of medial breast defects after breast-conserving surgery and is an excellent choice for surgeons.

Application of digital guide plate in repairing mandibular defects with free fibular myocutaneous flap

Objective:Exploring the clinical application effect of a series of digital designed guide plates in the repair of mandibular defects with free fibular muscle flap. Methods:A total of 32 patients who underwent fibular muscle flap repair of mandibular defects in the Head and Neck Tumor Surgery Department of Xi'an Jiaotong University Stomatological Hospital were selected as the research subjects. They were divided into a guide plate assisted group（16 cases） and a conventional surgery group（16 cases） according to the different surgical methods. The guide plate assisted group completed the surgery with the assistance of a digital design series of guide plates, while the conventional surgery group served as the control. Record the preparation and shaping time of two groups of fibular myocutaneous flaps, evaluate the surgical effect at least 6 months after surgery, and conduct a patient satisfaction survey. Use SPSS 16.0 software package to statistically process the data. Results:The preparation and shaping time of the fibular muscle flap in the guide plate assisted group were significantly shorter than those in the conventional surgery group（P<0.05）. The excellent and good rate（87.5%） of the guide plate assisted group in evaluating the surgical effect was significantly higher than that of the conventional surgery group（75.0%）（P<0.05）. The satisfaction scores of patients in the guide plate assisted group for facial shape and bite function recovery were significantly higher than those in the conventional surgery group（P<0.05）, while there was no significant statistical difference in the satisfaction scores of pronunciation function recovery between the two groups（P>0.05）. Conclusion:The design of digital guide plates can improve the accuracy of repairing mandibular defects with fibular flaps, shorten the preparation and shaping time of fibular flaps, restore good facial appearance and bite relationship of patients, and improve satisfaction. It is worth promoting and applying in clinical practice, but the design accuracy still needs to be continuously improved.

Patient-completed online “follow-up form” to assess continuation of anti-CGRP(r) antibody therapy in patients with chronic migraine: A pilot project

BackgroundThe introduction of new drugs that target the Calcitonin Gene-Related Peptide (CGRP) system has provided significant hope for patients with otherwise treatment-resistant migraine, but also resulted in significant capacity issues at the point of delivery, as patients require follow-up at certain timepoints. AimPilot a patient-completed “follow-up form” (FuF) to replace direct patient contact at the time of 1-year treatment review in patients receiving anti-CGRP (receptor (r)) antibody therapy for chronic migraine. MethodsPatients with chronic migraine already receiving anti-CGRP(r) antibody therapy and due for 1-year review were contacted by telephone and recruited into the project. Patients completed a simple online form, which mirrored questions asked at 1-year follow-up, and a patient satisfaction survey. ResultsThirty-nine (78 %) of 50 patients completed the FuF, which resulted in further telephone contact in 3 (8 %) patients. Over 90 % strongly agreed that the FuF was easy to understand and complete. 80 % strongly agreed that they felt confident in decision making regarding continuation or cessation of anti-CGRP(r) antibody therapy. Overall, 88 % rated their experience of the online form as “Excellent” and 12 % as “Good”. ConclusionsWithin our headache service, we have demonstrated that an appropriately designed online patient-completed form has the potential to replace direct patient contact at 1-year review in patients already receiving anti-CGRP(r) antibody therapy for chronic migraine.

Implementing a multidisciplinary approach for older adults with multiple sclerosis: Geriatric neurology in practice

BackgroundOlder adults with multiple sclerosis (MS) face unique challenges arising from age-related changes in MS pathophysiology and overlapping geriatric syndromes. There is a need for geriatrics-focused multidisciplinary care for the rapidly growing older MS population. ObjectiveTo design and implement a geriatric multidisciplinary clinic for older adults with MS. MethodsWe describe the development of a multidisciplinary approach to geriatric MS care within a single institution through the implementation of the Aging with MS Clinic. The clinic model was conceived through collaboration between neurology and geriatric medicine to provide comprehensive care for older adults with MS who are uniquely affected by overlapping symptoms of aging and MS (e.g., frailty, falls, functional decline, multiple comorbidities, polypharmacy, cognitive impairment, nutritional deficits, barriers to access healthcare). Multidisciplinary specialists were recruited to staff the clinic, and initial patient satisfaction outcomes were collected. ResultsThe team of multidisciplinary specialists staffing the clinic consists of a MS advanced practice practitioner, MS pharmacist, physical therapist, neuropsychologist, dietitian, and social worker. A clinic template was devised where 4 patients with MS over age 60 are seen by each specialist during each half-day clinic session. Initial patient satisfaction surveys from 25 participants showed overwhelmingly positive feedback. A majority of participants (92%) agreed that the clinic was well-organized, while 92% felt they benefitted from attending. Additionally, 80% of participants reported that the clinic improved their overall quality of care. ConclusionThe Aging with MS clinic outlines a model for comprehensive geriatric assessment and care in older adults with MS by a team of multidisciplinary specialists. Initial feedback from patients who attended the clinic conveyed improved quality of care.

Scarless Enhanced Body Contouring.

A helium-based plasma device with minimal invasiveness selectively heats tissues via joule heating, ensuring safe external temperatures and eliminating the need to monitor the epidermal temperature. From December 2022 to January 2024, Forty-six patients without prior bariatric surgery, who had localized lipodystrophy and mild-to-moderate skin laxity in various body areas, were enrolled in this prospective work. Liposuction was paired with a helium-based plasma radiofrequency device used for all patients. Data on demographics and postoperative complications were disclosed. A patient evaluation was conducted objectively and subjectively, using an independent plastic surgeon assessment and a patient satisfaction survey, respectively. Our technique was performed on 40 females (87%) and six males (13%), in various body areas: arm (fourteen cases: 30.4%), neck (ten: 21.7%), thigh (nine: 19.6%), abdomen (seven: 15.2%), back (three: 6.5%), gynecomastia (three: 6.5%), their age ranges from 23 to 57years, and their body mass index (BMI) ranges from 24 to 34.6kg/m2. Patients' satisfaction at 6months after surgery was 82.6% (38) satisfied, 15.2% (7) borderline, and 2.2% (1) unsatisfied. Individual plastic surgeon evaluation was 69.6% (32) excellent, 28.3% (13) good, and 2.1% (1) fair. The overall complications rates were postoperative edema in 22 cases (47.8%), ecchymosis in 11 cases (23.9%), persistent skin laxity in one case (11.1%), mild seroma in three cases (6.5%), pain and tingling in six cases (13%), and mild subcutaneous emphysema in four cases (8.7%). Combined liposuction and helium-based plasma radiofrequency device usage are a safe, efficient, and minimally invasive substitute for excisional procedures in non-bariatric patients with localized lipodystrophy and mild-to-moderate skin laxity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

First Contact Physiotherapy: A 4-Year Service Evaluation of UK Primary Care Data.

The First Contact Physiotherapist (FCP) role offers patients direct access to musculoskeletal (MSK) specialists in primary care settings and is designed to reduce GP workload while providing high-quality care. Despite positive early evaluations of FCP services, there remains a need for up-to-date assessments of their impact. To evaluate the FCP model of care implemented in an NHS Primary Care Network (PCN) against pre-defined service objectives. A service evaluation was conducted using data from April 2020 to March 2024. Key performance indicators were based on national FCP evaluation criteria. Data included appointment utilisation, wait times, referral patterns, patient and staff satisfaction surveys, and audit results from clinical data. Over 4years, 12,185 patients were seen. Of these, 69% of patients were seen as true first contacts. The majority of patients (86.4%) were managed within primary care, with a referral rate of 8.5% to outpatient physiotherapy and 5.1% to orthopaedics. Patient satisfaction was high, with 82% rating their FCP experience as excellent or outstanding. The FCP service successfully met its objectives by reducing GP workload and providing effective care. However, there was an increase in outpatient physiotherapy referrals over the 4-year period. Staff satisfaction was generally positive, though some highlighted concerns about appointment duration and workload. This evaluation demonstrates that FCP services provide a viable solution for managing MSK conditions in primary care. Future research should explore the most effective MSK service delivery models and incorporate digital solutions for comprehensive outcome and experience measures.

Cost-Effectiveness Analysis of Operating Room and In-Office Reconstruction of Skin Cancer Defects.

Reconstruction of skin cancer and Mohs micrographic surgery (MMS) defects of the head and neck is performed in both in-office and operating room (OR). This study intends to understand cost differences between reconstructive surgery for skin cancer defects in the OR and clinic to perform a cost-effectiveness analysis with single-institution patient satisfaction data. Population-based retrospective analysis of cost data and an institutional, prospective survey of patient satisfaction. National insurance database and institutional survey. The Merative® MarketScan database was queried to identify claims involving the reconstruction of skin cancer defects of the head/neck between 2013 and 2020 for cost-analysis by setting (OR vs clinic). Patients undergoing operative and clinic-based reconstruction of MMS defects by 3 different surgeons at a single institution in 2023 were surveyed for satisfaction using a 5-point Likert scale. Data was coupled for cost-benefit analysis. Analysis was performed using propensity-matched samples. Using Marketscan, 1206 patients were analyzed for cost data. OR cases had a higher median baseline cost of $2308 (interquartile range [IQR]: 1484-3889) compared to procedures in the office (median $987, IQR: 784-1454, P < .001). Survey data from 116 patients revealed no significant difference in scores between OR and clinic cases (clinic: 4.57 vs OR: 4.60, P = .8752). Using propensity-matched subsets, providers incur an additional $4744 for a reduction in satisfaction of 0.083 when performing cases in the OR. Lower cost is associated with reconstructive procedures performed in the office. This study is the first cost analysis of head and neck skin cancer reconstruction based on procedural settings and will be valuable to surgeons in considering practice patterns and resource utilization.

Comparative Study of Staples vs Plate and Screws for Arthrodesis of the First Metatarsophalangeal Joint

Category: Midfoot/Forefoot; Other Introduction/Purpose: Nitinol technology has revolutionized foot and ankle orthopaedic surgery, offering a quick and low-profile means of achieving bone healing. One application of this technology has been in the development of a first metatarsophalangeal (MTP) joint staple, utilized in place of crossing screws or a plate and interlocking screws constructs to achieve fusion at the first MTP joint. The objectives of this study were to compare radiographically and subjective outcomes for patients who had a first MTP joint fusion treated with an Enovis Dynaclip Delta staple vs those treated with a plate and interlocking screws. The hypothesis is the staple provides a quicker surgical time and equivalent rate of union compared to patients who were treated with standard plate and screws. Methods: A single-surgeon, consecutive case series of prospectively collected data was reviewed retrospectively for patients who underwent primary first MTP arthrodesis using a staple. Patients were age and gender matched to those who underwent primary first MTP arthrodesis with a plate and associated interlocking screws. Dates of surgery were November 2017 - December 2023. Exclusions included revision surgeries, prior forefoot/midfoot fusions, and ancillary fusions at the time of the index surgery. Preoperative and postoperative patient-reported outcome measures (PROMs) [Foot and Ankle Ability Measure (FAAM), Veterans-Rand 12 (VR-12) General Health Survey, visual analog pain scale (VAS), and radiographs (hallux valgus angle, dorsiflexion angle) were evaluated to compare the two groups. Comorbidities, operative time, fusion rates, and a patient satisfaction survey were also collected. Statistical analysis was performed using sutdent’s t-tests. Results: Twenty-two feet were included in both groups. Preoperative and postoperative PROMs between groups demonstrated no significant differences in all questionnaire categories assessed. The staple group demonstrated significant differences from preoperative to postoperative in FAAM ADL (p=0.004), FAAM sport (p=0.010), and VAS (p&lt; 0.001) while plate and screws demonstrated significant differences in FAAM ADL (p=0.032) and VAS (p=0.033). The radiographic measurements revealed a significant difference in the postoperative dorsiflexion angle for staple vs plate and screws 21.81±5.72 vs 26.47±6.99, respectively (p=0.012) and there were no other significant differences noted (table). Operative time revealed a significant difference between staple vs plate and screws (30.0 minutes vs 35.73 minutes, respectively) (p=0.006). The fusion rate was 95% in both groups. Conclusion: This study reports early results for a comparison of first MTP joint fusion treated with an Enovis Dynaclip Delta staple vs those treated with the standard plate and interlocking screws. While there were statistical differences within each group between most of the preoperative and postoperative PROMs, comparing the two groups, there was none. The fusion rate was the same in both groups. The staple group had an average of 5.7 minutes less operative time. Staple fixation achieves similar union rates to plate and screw constructs with a shorter operative time. Further patients are needed to expand this cohort.

Improving the detection and documentation of patients’ symptoms in an integrated gastrointestinal oncology and palliative care clinic.

336 Background: Patients with gastrointestinal (GI) malignancies experience a high burden of disease-related symptoms and treatment side effects. We established an integrated GI oncology and palliative care (PC) clinic in which a PC physician is co-located with the oncology team and can provide timely response to patient distress and facilitate communication with the interdisciplinary palliative care team. Yet, even in the integrated clinic, patient symptoms were unreliably assessed, leading to missed opportunities to address patient suffering. Between October 2023 and January 2024 for patients seen in-person in the integrated clinic for oncology or PC visits, the median rate of symptom documentation was 45%. Emotional, financial, and spiritual distress documentation rates were lowest. We hypothesized that by implementing a systematic, comprehensive patient-reported symptom assessment tool, we could increase the detection and documentation of symptoms, and in turn, improve communication around patient distress and timely response to symptoms. Methods: We measured the rate of symptom documentation (primary outcome) and the use of a patient-reported symptom assessment tool for adults with GI cancers seen in-person in the integrated clinic in Spring 2024. Based on the Edmonton Symptom Assessment Scale (ESAS) and expert consensus, we determined which symptoms were most important to identify. Documentation rates were assessed via manual chart review of visit notes and flowsheet data. Prospective post-intervention data (March to May 2024) were compared to retrospective pre-intervention baseline data (October 2023 to January 2024). Interventions included modification of the ESAS to include GI oncology-specific symptoms, implementation of the tool in paper format to encourage patient-clinician communication, frequent staff education and feedback sessions, creation and dissemination of a resource guide for clinicians to respond to identified distress, and patient satisfaction surveys. Results: 126 patients were included in the study (31 pre-intervention and 95 post-intervention). During the post-intervention period, the median rate of symptom documentation increased from 45% to 83% and the median rate of ESAS survey completion increased from 9% to 68%. Documentation of financial and spiritual distress increased from 13% to 71%, for both, and documentation of emotional distress increased from 35% to 72%. On satisfaction surveys (N=20), most patients reported the tool was helpful in sharing their symptoms (70%), was easy to read and understand (100%), and that their clinician was engaged in addressing their symptoms (67%). Conclusions: The implementation of a patient-reported symptom assessment tool in an integrated GI oncology/PC clinic increased documentation of important symptoms, potentially increasing clinician awareness of patient distress.

Improving routine mental health screening for depression and anxiety in a paediatric lupus clinic: a quality improvement initiative for enhanced mental healthcare

BackgroundMental health (MH) conditions are prevalent in adolescents with childhood-onset SLE (cSLE). Early identification is crucial in preventing poor patient outcomes; however, MH screening rates remain low.Local problemFrom July 2021–January...