Poor Patient Satisfaction Research Articles

Role of split thickness skin grafting in post burn contracture neck

Optimizing functional and aesthetic outcomes in post burn head and neck reconstruction remains a surgical challenge. Recurrent contractures, impaired range of motion, and disfigurement because of disruption of the aesthetic subunits of the face, can result in poor patient satisfaction and ultimately, contribute to social isolation of the patient. Despite advancements in post burn head and neck reconstruction, such as the advent of free-tissue transfer, split thickness skin graft remains the mainstay of cover in most burn care institutions around the world. Usually skin graft is required to cover raw area after release of contracture. But in case contracture is associated with non-healing ulcer which may become source of infection then skin grafting for non-healing ulcer should be done before release of contracture. In this study we are sharing our experience of post burn neck contracture associated with non-healing ulcer in which first skin grafting was done for ulcer & then release of contracture & skin grafting was done.

Patient-reported Outcomes of SARS-CoV-2 Positive Adult Orthopedic Trauma Patients Treated During the Ongoing Pandemic

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has become a matter of concern all over the world. It has resulted in delay in surgery or, at times, preference for nonoperative treatment for SARS-CoV-2 positive orthopedically injured adult patients which may adversely affect the clinical outcomes. In this study, we report the outcomes of orthopedic adult trauma patients who tested positive for SARS-CoV-2 at admission. Methods: We retrospectively reviewed the prospectively collected data from the period between April 1, 2020 and December 31, 2020. We reviewed 521 out of total 2435 patients presenting in the casualty that required orthopedic trauma surgery. Thirty-eight out of total 521 patients, that tested positive for SARS-CoV-2, were followed-up using telecommunication for final outcome of fracture treatment. A telecommunication patient satisfaction score after injury (TPSSI) was used to evaluate the patient satisfaction. Results: The mean age was 37.94 years (range: 18–72 years). They were followed-up for mean duration of 8.18 months (range: 6–13 months). Out of total 38, 23 underwent orthopedic trauma surgeries and rest 15 were managed nonoperatively. There was a mean delay in surgery of 5 weeks (range: 3–12 weeks). Five patients lost their lives and seven others had nonunion. The median TPSSI score was three. Conclusions: Nonoperative and delayed surgical management of adult orthopedic trauma patients, who tested positive for SARS-CoV-2 at admission, result adversely in activities of daily living and return to original occupation and, thus, have poor patient satisfaction.

Effect of acute postsurgical pain trajectories on 30-day and 1-year pain.

Untreated pain after surgery leads to poor patient satisfaction, longer hospital length of stay, lower health-related quality of life, and non-compliance with rehabilitation regimens. The aim of this study is to characterize the structure of acute pain trajectories during the postsurgical hospitalization period and quantify their association with pain at 30-days and 1-year after surgery. This cohort study included 2106 adult (≥18 years) surgical patients who consented to participate in the SATISFY-SOS registry (February 1, 2015 to September 30, 2017). Patients were excluded if they did not undergo invasive surgeries, were classified as outpatients, failed to complete follow up assessments at 30-days and 1-year following surgery, had greater than 4-days of inpatient stay, and/or recorded fewer than four pain scores during their acute hospitalization period. The primary exposure was the acute postsurgical pain trajectories identified by a machine learning-based latent class approach using patient-reported pain scores. Clinically meaningful pain (≥3 on a 0–10 scale) at 30-days and 1-year after surgery were the primary and secondary outcomes, respectively. Of the study participants (N = 2106), 59% were female, 91% were non-Hispanic White, and the mean (SD) age was 62 (13) years; 41% of patients underwent orthopedic surgery and 88% received general anesthesia. Four acute pain trajectory clusters were identified. Pain trajectories were significantly associated with clinically meaningful pain at 30-days (p = 0.007), but not at 1-year (p = 0.79) after surgery using covariate-adjusted logistic regression models. Compared to Cluster 1, the other clusters had lower statistically significant odds of having pain at 30-days after surgery (Cluster 2: [OR = 0.67, 95%CI (0.51–0.89)]; Cluster 3:[OR = 0.74, 95%CI (0.56–0.99)]; Cluster 4:[OR = 0.46, 95%CI (0.26–0.82)], all p<0.05). Patients in Cluster 1 had the highest cumulative likelihood of pain and pain intensity during the latter half of their acute hospitalization period (48–96 hours), potentially contributing to the higher odds of pain during the 30-day postsurgical period. Early identification and management of high-risk pain trajectories can help in ascertaining appropriate pain management interventions. Such interventions can mitigate the occurrence of long-term disabilities associated with pain.

Quality Improvement Project to Improve Patient Satisfaction and Opportunity to Attend Clinical Team Meetings

AimsClinical Team Meetings (CTM) are weekly multidisciplinary (MDT) meetings to review and discuss patients’ clinical care at Reaside Clinic, a medium secure inpatient forensic unit. Last year, there were significant difficulties in releasing nurses from ward duties to attend CTM, with effects on CTM efficiency and patients’ involvement and satisfaction in care. Furthermore, a hospital ‘protected mealtimes’ deadline commencing at 1230 meant additional pressure and further impacted patient attendance when meetings overran. The MDT (comprising doctors, nurses, psychologists, occupational therapists, pharmacists and admin staff) worked together to generate solutions, formulating a QI project to try to make improvements. Three primer drivers were: increasing patient satisfaction, increasing staff participation and increasing CTM efficiency.MethodsThe MDT generated multiple change ideas to test to improve CTM experience and outcomes. Actions implemented included review of timetabling of patients to ensure adequate timekeeping and ensuring availability of attending ward staff, defining patient expectations from CTM through increased communication, and seeking patient feedback on satisfaction or engagement after each CTM through anonymous questionnaires. Data were collected at CTMs from February to April 2022, retrospectively compared to reference data collected before QI actions were implemented. A Microsoft OneDrive document was shared between the MDT to ensure accurate data collection, with information collected on CTM finish time, number of patients offered to attend, number of patients who did attend and anonymous patient satisfaction feedback from questionnaires.ResultsEarly indications show improvement in meeting timelines and increased staff satisfaction with the CTM process, with data collection ongoing. Baseline results from September 2021 show an average of only 2 of between 13–15 patients attending weekly, in addition to finishing beyond the 1230 target on almost all occasions. Anecdotal evidence from the MDT showed poor patient satisfaction and engagement with the process before QI changes were implemented. Full results will be available by the time of presentation; currently, an average of 4 patients have attended CTM each week with all sessions finishing on time since implementation of changes.ConclusionPatient involvement in care and person-centred care are key to improving engagement and satisfaction with inpatient psychiatric management in forensic settings. Targeted multiple change ideas implemented by the MDT through this QI aim to improve patient satisfaction through enabling increased opportunity to attend weekly CTM, with modifications to the CTM process from key staff. Preliminary results show increased opportunity of patients to attend CTM, increased staff and patient satisfaction, and increased CTM efficiency.

Inflatable penile prosthesis infection successfully managed by non-operative novel treatment strategies: A case report

ABSTRACT Introduction IPP infections occur in approximately 1% of cases. The fundamental principle for treatment has always been surgical removal of all components. Explantation/reimplantation surgery, however, may be unsuccessful, require additional surgeries, and/or result in poor patient satisfaction, reduced penile sensation, and decreased penile length. A patient presented 4 weeks post-op with an obvious IPP infection. Culture of scrotal drainage prior to antibiotic administration grew serratia marcescens, enterococcus faecalis, and citrobacter freundii. The patient was informed explanation was required, but he refused and requested we “do what we can” first. He was made aware of the lack of data supporting non-operative strategies for IPP infection. Objective To present, likely for the first time, non-operative strategies including IV/oral antibiotics, low intensity shockwave therapy (LiSWT), and immune therapy can result in successful IPP infection treatment. Methods A 49 yo with a 14 year history of ED underwent insertion of an 20 cm Titan IPP (Coloplast) with submuscular reservoir placement. Four weeks post-op he presented with fever (101°F), elevated WBC (15,400), purulent drainage from a swollen, tender scrotum, and tenderness of all IPP components. We discussed non-operative management. He was admitted for broad spectrum IV antibiotics/antifungal agents: Vancomycin, Piperacillin and Tazobactam, and Fluconazole. After 6 days of IV antibiotics the patient became afebrile, WBC normalized (8,000) but he developed mildly abnormal renal and liver function tests. He was discharged on oral Levofloxacin daily for 30 days. Grayscale ultrasound showed fluid around the pump and scrotal tubing with significant device tenderness and scrotal drainage through two small sinus tracts confirming persistent infection. We assessed the degree of purulent scrotal drainage on gauze kept on the scrotum for 10 hour periods. LiSWT (Urogold 100 MTS, parabolic unfocused probe OPP 155, energy flux density 0.13 mJ/mm2, Hz 3.0, total shocks 6,600/treatment) was administered to the device components and scrotum for two weeks daily, then twice weekly x 2 weeks and then weekly x 4 weeks. Concomitantly he received immune therapy via subcutaneous peptide administration and ozone blood dialysis twice weekly x2 weeks and then weekly x 4 weeks. Results The patient progressively improved, remaining afebrile, with WBC (5,000) and liver and renal function tests normalized at 1 week. Scrotal drainage stopped at 2 weeks and scrotal sinus tracts healed. There was no pain/tenderness of device components or scrotum at 2.5 weeks. There was no skin fixation to any device component. The patient could easily inflate/deflate the device to full rigidity/flaccidity without pain at 3 weeks and intercourse with orgasm at 5 weeks. Grayscale ultrasound at 4 weeks showed absent fluid around the device components. Conclusions This is the first case report of successful management of an infected IPP using non-operative novel treatments. The effect of immune therapy is to enhance immune response to infection. Concerning the management of infection with LiSWT, it has been shown to have anti-infective properties, upregulate/recruit anti-bacterial/microbial peptide LL37, increase local blood flow, possibly inhibit biofilm, and result in salvage of infected breast and hip prostheses. Disclosure Work supported by industry: no.

Role of general anesthetic agents in postoperative nausea and vomiting: A review of literature.

Postoperative nausea and vomiting (PONV) is considered to be the most unpleasant experience associated with surgery and is believed to be one of the most common reasons for poor patient satisfaction in the postoperative period. It also results in prolonged hospitalization and increased use of resources such as intravenous fluids and drug supplements along with prolonged medical attention, all of which have psychological and financial implications. In addition to this, PONV can result in aspiration, laryngospasm, dehydration, electrolyte disturbances, gastric bleeding, increased intracranial pressure, increased intraocular pressure, and wound dehiscence particularly when the surgical intervention is performed through an intraoral approach. It is a well-known fact that there are many etiological factors as well as predisposing factors for PONV. Hence, this review is intended to evaluate as an individual factor what the role was played by the anesthetic agents used for GA in the incidence of PONV.

Quality Assessment of Online Resources for Thoracic Outlet Syndrome Patients

The internet has become a leading resource for patients, to research information about their medical conditions. Access to inaccurate information can lead to miscommunication, poor patient satisfaction and effect shared decision-making with the provider. This study seeks to evaluate the quality and readability of patient resources that appear in the top search results for Thoracic Outlet Syndrome (TOS). Searches were performed for "TOS" and "Thoracic Outlet Syndrome" on the search engines Google ©, Yahoo ©, and Bing©, and on the meta-search platforms Yippy© and Dogpile©. Websites were screened for exclusion and evaluated by 2 reviewers for accountability, interactivity, structure/organization, and content. Exclusion criteria included duplications, no original content on TOS, resources not intended for patients, foreign language, and inaccessible websites. Reviewers came to a consensus on scoring discrepancies. Four indices were used to evaluate readability. Statistical analysis was performed using the Rstudio with ANOVA. In total, 44 websites met inclusion criteria. There were 25 hospital/healthcare organization websites (57%), 11 open access (25%), 5 government agency (11%), 2 professional medical society (5%), and 1 industry sponsored (2%). Median scores were 5.00 out of 16.00 for Accountability (interquartile range IQR: 1.50-8.75), 1.50 out of 5.00 for Interactivity (IQR:1.50-1.50), 3.00 out of 4.00 for Structure/Organization (IQR: 2.00-3.13), 10.00 out of 25.00 for Content (IQR: 7.90-12.63) and 20.25 out of 50.00 for Total Score (IQR: 16.73-27.75). Websites performed well-describing TOS with 98% of websites providing a definition, 90% providing an etiology, 93% providing description or images of the anatomy, 98% providing symptoms of neurogenic TOS, 93% providing symptoms of venous TOS, and 93% providing symptoms of arterial TOS. Physical therapy was the most discussed treatment option (91%) followed by decompression surgery (86%), thrombolysis (41%), vascular repair (39%), interscalene injections (18%), and embolectomy (11%). There was no significant difference across website types for any category other than accountability where Open Access scored the highest (Table II). Readability was difficult with median Flesch Reading Ease formula score correlating to a college level (IQR: 10th-12th grade-college), median Flesch-Kincaid Grade Level of 10 (IQR: 9th-12th grade), median Standardized Measure of Gobbledygook (SMOG) grade of 10 (IQR: 9th-11th grade), and median Dale-Chall Readability Formula Score correlating to 11th-12th grade (IQR: 11th to 12th-college grade level). There was no significant difference between website types for readability. The top web results for TOS have varying degrees of quality with a clear gap in certain areas of information. While websites performed well-explaining the disease, they lacked discussion of the full scope of treatment that may be offered. In addition, readability was poor across all website types which will not help patients' understanding of their condition. Providers should take into account the variability in websites when entering into shared decision-making discussions with patients.

How to rectify the convex coronal imbalance in patients with unstable dystrophic scoliosis secondary to type I neurofibromatosis: experience from a case series

BackgroundThere was a paucity of valid information on how to rectify the convex coronal imbalance effectively in dystrophic scoliosis secondary to Type I neurofibromatosis (DS-NF1), while postoperative inadvertent aggravation of CCI occurred regularly resulting in poor patient satisfaction. We aimed to identify the risk factors for persistent postoperative CCI in DS-NF1, and to optimize the coronal rebalancing strategies based on the lessons learned from this rare case series.MethodsNF1-related scoliosis database was reviewed and those with significant CCI (> 3 cm) were identified, sorted and the outcomes of surgical coronal rebalance were analyzed to identify the factors being responsible for failure of CCI correction.ResultsCCI with dystrophic thoracolumbar/lumbar apex was prone to remain uncorrected (7 failure cases in 11) when compared to those with thoracic apex (0 failure cases in 4) (63.6% vs. 0.0%, p = 0.077). Further comparison between those with and without post-op CCI showed a higher correction of main curve Cobb angle (65.9 ± 9.1% vs. 51.5 ± 37.3%, p = 0.040), more tilted instrumentation (10.3 ± 3.6° vs. 3.2 ± 3.1°, p = 0.001) and reverse tilt and translation of upper instrumented vertebra (UIV) to convex side (8.0 ± 2.3° vs. -3.4 ± 5.9°, p < 0.001; 35.4 ± 6.9 mm vs. 12.3 ± 13.1 mm, p = 0.001) in the uncorrected imbalanced group. Multiple linear regression analysis revealed that △UIV translation (pre- to post-operation) (β = 0.832; p = 0.030) was significantly correlated with the correction of CBD.ConclusionThoracolumbar/lumbar CCI in dystrophic scoliosis was prone to suffer high risk of persistent post-op CCI. Satisfying coronal rebalance should avoid UIV tilt and translation to the convex side, tilted morphology of instrumentation and over correction maneuvers for main curve, the upper hemi-curve region in particular.

Increased proximal vertebral rotation is associated with shoulder imbalance after posterior spinal fusion for severe adolescent idiopathic scoliosis.

Residual shoulder imbalance is associated with suboptimal outcomes following the surgical correction of adolescent idiopathic scoliosis (AIS) including poor patient satisfaction. In this retrospective study, we evaluate the radiographic parameters and the relationship between the global and local indices of spinal alignment with shoulder balance pre- and postoperatively utilizing EOS imaging and 3D reconstruction. A retrospective radiographic analysis was performed on patients with AIS, treated with posterior spinal fusion. Postoperative radiographs were obtained immediately following surgery, at 6months and final follow-up over 2years postoperatively. 3D Radiographic measurements included in the coronal plane radiographic shoulder height difference (RSHD), proximal thoracic Cobb angle (PT) and main thoracic Cobb (MT), in the sagittal plane T4-T12 kyphosis, T12-L5 lordosis, in the axial plane proximal thoracic (PT AVR) and main thoracic apical vertebral rotation (MT AVR). Sixty-six patients were included (63 females) with an average main thoracic curvature of 76 degrees. RSHD averaged 14mm ± 14 preoperatively, -15mm ± 12 postoperatively, -8.5mm ± 11 at 6months, and -8.3mm ± 8.7 at final follow-up, respectively. Statistical analysis revealed a significant correlation between RSHD and proximal thoracic Cobb angle, between RSHD and proximal thoracic apical vertebral rotation (PTAVR) (r > 0.20, p < 0.05). The significant correlation presented in this study suggests that PT Cobb angle and PT AVR are involved in postoperative shoulder imbalance. Level 4.

Imaging of Neuropathic Pain

The International Association for the Study of Pain (IASP) defined neuropathic pain as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” The origin of neuropathic pain (NP) could be from the brain, spinal cord, or peripheral nerves. NP represents a major neurological problem, with a prevalence of 1%-2% of the total population. It is disabling, rendering an urgent need for non-addictive, effective new therapies, and is characterized by resistance to treatment and poor patient satisfaction. We aim to review the role of modern imaging in the diagnosis of NP and the potential advantages and limitations of each modality. Functional MRI is one of the commonly used imaging modalities for NP.

Traumatic Peroneal Nerve Injuries: A Systematic Review

Category:TraumaIntroduction/Purpose:The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in trauma patients. Traumatic CPN injuries have historically been associated with relatively poor outcomes and patient satisfaction, though recent outcome data appear promising. Given the variety of underlying injury modalities, treatment options, and prognostic variables, this study sought to evaluate and summarize current literature on traumatic CPN injuries and provide recommendations for treatment and future research.Methods:A systematic review was performed using PubMed, Embase and Cochrane databases per PRISMA guidelines. Search terms consisted of variations of 'peroneal nerve' and 'fibular nerve' combined with 'injury,' or 'laceration,' or 'entrapment,' or 'repair,' or 'neurolysis.' Information regarding treatment modality, outcomes and patient demographics were recorded and analyzed.Results:2,301 articles were identified in the initial search, 42 met eligibility criteria (Figure 1). Factors associated with better clinical outcomes included shorter pre-operative interval, shorter graft length when an interposed graft was used, nerve continuity and younger patient age. Sex or gender did not affect outcomes in any studies in this review. Motor grades of M3 or greater on the MRC scale are typically considered successful outcomes. In studies we analyzed, this was achieved in 81.2% of patients who underwent neurolysis, 78.8% of patients who underwent end to end suture, 49.8% of patients who underwent nerve grafting, 62.9% of patients who underwent nerve transfer, 86.0% of patients who underwent posterior tibial tendon transfer (PTTT) and 73.9% of patients who underwent surgery with concurrent PTTT.Conclusion:Included studies were heterogenous, complicating our ability to further analyze the data. It is not possible to uniformly advocate for the best treatment option given diverse injury modalities, presentations and prognostic factors. Many studies do not report outcomes with respect to specific injury modality. Future studies should clearly report outcomes based on injury modality and surgical treatment option. This would allow for greater analysis on the most appropriate treatment option for a given mechanism of injury. Newer surgical techniques, such as addition of growth factors to nerve repairs and concurrent tendon transfer are promising and should be further explored.

Traumatic Peroneal Nerve Injuries: A Systematic Review.

The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in patients with trauma. Traumatic CPN injuries have historically been associated with relatively poor outcomes and patient satisfaction, although improved surgical technique and novel procedures appear to improve outcomes. Given the variety of underlying injury modalities, treatment options, and prognostic variables, we sought to evaluate and summarize the current literature on traumatic CPN injuries and to provide recommendations from an analysis of the included studies for treatment and future research. A systematic review was performed using PubMed, Embase, and Cochrane databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms consisted of variations of "peroneal nerve" or "fibular nerve" combined with "injury," "laceration," "entrapment," "repair," or "neurolysis." Information with regard to treatment modality, outcomes, and patient demographic characteristics was recorded and analyzed. The initial search yielded 2,301 articles; 42 met eligibility criteria. Factors associated with better outcomes included a shorter preoperative interval, shorter graft length when an interposed graft was used, nerve continuity, and younger patient age. Gender or sex was not mentioned as a factor affecting outcomes in any study. Motor grades of ≥M3 on the British Medical Research Council (MRC) scale are typically considered successful outcomes. This was achieved in 81.4% of patients who underwent neurolysis, 78.8% of patients who underwent end-to-end suturing, 49.0% of patients who underwent nerve grafting, 62.9% of patients who underwent nerve transfer, 81.5% of patients who underwent isolated posterior tibial tendon transfer (PTTT), and 84.2% of patients who underwent a surgical procedure with concurrent PTTT. Studies included in this review were heterogenous, complicating our ability to perform further analysis. It is not possible to uniformly advocate for the best treatment option, given diverse injury modalities and patient presentations and a variety of prognostic factors. Many studies do not show outcomes with respect to injury modality. Future studies should show preoperative muscle strengths and should clearly define outcomes based on the injury modality and surgical treatment option. This would allow for greater analysis of the most appropriate treatment option for a given mechanism of injury. Newer surgical techniques are promising and should be further explored. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

An Assessment of Physician Well-Being and Burnout Among Army Obstetricians and Gynecologists.

Physician burnout is associated with unsafe patient care and poor patient satisfaction. Civilian studies show burnout rates of 46% among obstetricians/gynecologists (OB/GYNs). Army Active Duty (A-AD) physician burnout rates range from 7.7% to 26% across specialties, but no studies have assessed A-AD OB/GYN burnout. The objective of this study was to quantify well-being of A-AD OB/GYNs by determining rates of professional fulfillment (wellness) and burnout and detect factors of potential protective or risk for wellness and burnout. A cross-sectional survey-based study was designed to determine well-being of A-AD OB/GYNs. This Institutional Review Board-approved study used the validated Professional Fulfillment Index. The survey was shared anonymously via email to 197 A-AD OB/GYNs. Additional questions asked as possible risk factors for burnout include location, training status, fellowship training, and remaining active duty service obligation (ADSO). Wellness and burnout rates were determined using published scales. Mean rates of wellness and burnout were reported, and chi-square tests detected associations between wellness/burnout and other variables. Eighty-three A-AD OB/GYNs responded to the survey (42%), with 73 available for full analysis. 26.5% had positive wellness, and 50% reported burnout. Completing fellowship training and shorter ADSO (of 0-2 years compared to >5 years) had higher rates of wellness. There were no differences in burnout among groups. Burnout rates in A-AD OB/GYNs appear higher than A-AD physicians of other specialties but are similar to civilian OB/GYNs. Fellowship training may confer higher rates of wellness. Further research is needed regarding improvements in A-AD OB/GYN well-being and burnout.

Implementation and evaluation of a university&#x2013;hospital partnership program for Type 2 diabetes.

Objective The aims of this study were to determine whether a university-hospital partnership program for Type 2 diabetes (T2D) would: be well attended; reduce the number of patients on the diabetes out-patient waiting list who have been waiting longer than the recommended; increase discharge from the hospital clinic; increase university health clinic (UHC) occasions of service; be sustainable; and be acceptable to participants. Method A prospective observational study was conducted between 2016 and 2019. Participants with T2D were referred to a UHC, initially from a hospital diabetes wait list. The final program consisted of 10 weeks: before and after individual assessments, as well as 8 weeks of exercise and education facilitated by health professionals and students. Participant demographic characteristics and data on attendance, discharge and follow-up requirements, the percentage of patients waiting longer than the recommended for a new hospital out-patient appointment, university activity and patient satisfaction were collected. Results In all, 130 participants commenced the program, 80% completed at least six of eight group sessions and 80% attended the final assessment. The percentage of people waiting longer than recommended decreased from 63% to 16%. The hospital discharged 87% and 59% of participants from the dietitian and endocrinologist respectively. The UHC recorded 2056 occasions of service and 2056 student experiences including dietetics, exercise physiology, psychology, nursing, optometry, social work and podiatry students relating to the program. Satisfaction was high, as measured by the Short Assessment of Patient Satisfaction, with a mean score of 23.9 from a possible score of 28.0 (n = 93). Conclusion The partnership resulted in a new model of care for patients with T2D and increased learning experiences for students. What is known about the topic? Diabetes is the fastest growing disease in Australia, placing unsustainable demands on the health system. Access to patient-centred care and self-management education is essential to optimise glycaemic control, prevent or delay complications and maintain quality of life. The increasing demand of diabetes on the health system affects access to timely care, with unacceptably long wait times reported, resulting in an increase in morbidity and mortality and poor patient satisfaction. A potential solution is the use of clinical students to contribute to service delivery. Student-assisted and student-led health clinics have increased access to care across the globe for many years. What does the paper add? Although group education has the potential to reduce the burden on clinical service delivery, it was unclear whether a partnership program using students and university and hospital resources would be acceptable to people with T2D and whether this model delivered at a UHC would be sustainable and of benefit to both the health service and university. The results of the evaluation suggest that a university-hospital partnership program is well accepted by participants, well attended, reduces the number of patients waiting for a hospital appointment longer than the acceptable waiting times, increases UHC activity and provides interdisciplinary student experiences. As such, this paper provides evidence that this model of care offers a potential solution to increasing demands for health services for diabetes and student clinical experience. What are the implications for practitioners? Partnerships between UHCs and hospitals offer a sustainable solution to increasing demand for diabetes services and student training requirements. The description of the development, implementation and evaluation processes can be used by practitioners and educators as a framework for the translation of similar models of care to meet demands in other areas where demand for health services exceeds capacity.

Operationalizing Postdischarge Recovery From Laparoscopic Sacrocolpopexy for the Preoperative Consultative Visit

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:427–431) One of the most common questions from patients following surgery is: “What is my expected recovery time?” The answer serves as a benchmark to assess their progress against those undergoing similar procedures. Not addressing this expectation can result in poor patient satisfaction.

Pengaruh Kualitas Pelayanan Kesehatan terhadap Kepuasan Pasien Penerima Bantuan Iuran di Puskesmas Pahandut Kota Palangka Raya

The purpose of this study is to analyze the significance of the effect of service quality dimensions including reliability, responsiveness, assurance, empathy, tangibles to the level of poor people's health insurance patient satisfaction in Public Health Center of Pahandut Palangkaraya City. Based on the analysis of overall service gap dimensions, the fit between the services provided by health centers in the hope of Palangkaraya Pahandut community insurence patients there is a gap / level of satisfaction (- 10:54), these scores were categorized in groups, although not yet fully meet the expectations of patients community insurence, but service provided is good enough. Based on the results of the regression analysis above we can conclude that all the variables of service quality dimensions (Reliability, Responsiveness, Assurance, Empathy, Tangible) jointly have a significant positive effect on patient satisfaction and Public Health Center of Pahandut Palangka raya City. These results indicate that the alternative hypothesis (Ha) can be accepted and the hypothesis zero (Ho) is rejected. While the major effect is variable Assurance (1052), Reliability (1004), Tangible (1039), Responsiveness (1714), Empathy (1029) on patient satisfaction community insurence. The next is the R ² value of (0456) showed that 45.6% of patient satisfaction variables can be explained by service quality are Reliability, Responsiveness, Assurance, Empathy, and the remaining 54.4% Tangible while others described the other variables that are not included in this study model . Then, based on gap analysis (a match between expectations of the performance) of each dimension, are as follows, Responsiveness variable (-0.78) score was categorized as moderate. then followed the next variable Tangible variable (-0.88), variable Reliability (-0.57), assurance variable (-0.11), Empathy and the latter variable (-0.11). Although not yet fully provided the service as expected but the district Public Health Center of Pahandut Palangka raya City good enough but should be improved.

6 Improving Patient Flow in a Multi-Specialty Assessment Area by Introducing Referral Pathways for Orthopaedics and Plastic Surgery during the COVID-19 Pandemic

IntroductionThe COVID-19 pandemic has seen fundamental organisational changes to emergency departments internationally. Specialties throughout the hospital setting have been asked to change their working practice, often with the aim of adapting to new processes in emergency departments. Early in the pandemic, the orthopaedic team at one district general hospital were required to provide 24/7 onsite cover in a multi-specialty area. Confusion over the referral pathways of two specialties (orthopaedics and plastic surgery) led to increase waiting times, constrained patient flow and poor patient and staff satisfaction.MethodThis quality improvement project occurred over three cycles of data collection and intervention over a two-month period. A novel referral pathway was developed and implemented after discussion with consultants in orthopaedics, plastics, and emergency medicine. Interventions included staff teaching, clarifying of roles at morning meetings and the deployment of posters.ResultsIn cycle 1, 39% of orthopaedic referrals were inappropriately referred. By cycle 3, 0% of orthopaedic patients were inappropriately referred. Average time in department for patients referred to orthopaedics improved from 124 minutes to 88 minutes. Staff reported increased satisfaction, with appreciation for the clarification on referral criteria.ConclusionsThis QUIP demonstrates how simple interventions during times of crisis can solve complex organisational issues.

Clinical Outcomes of Incidental Dural Tears During Lumbar Microdiscectomy.

Background: A dural tear (DT) is the most commonly encountered complication during lumbar spine surgery. The incidence of DT increases depending on the complexity of the surgical procedure and the presence of a DT is related to a poor outcome and patient satisfaction.Objectives: This study aimed to determine the incidence and clinical outcomes of DTs in those patients who undergo lumbar disc surgery.Methods: We retrospectively reviewed consecutive patients who underwent surgery for the management of a primary single-level lumbar disc herniation at a single institution between 2004 and 2014. Among the studied population, those with DTs were included in the study group. An age- and sex-matched group of randomly selected patients who underwent the same level and type of lumbar spine surgery, but did not develop DTs, were assigned as the control group. The outcomes were compared at 12 months postoperatively between the groups.Results: A total of 5,476 consecutive patients (2,608 female, 2,868 male; mean age, 54 ± 11.45 [range, 21-86] years) underwent surgery for primary single-level lumbar disc herniation. DT was noted in 192 (2.85%) cases. Of these, 102 patients with complete data were included in the DT group. The DT group had a significantly increased length of hospital stay (p = 0.001). Also, the duration of bed rest in the hospital was significantly higher in patients wherein DT was repaired using hemostatic material and fibrin glue, compared to the patients with primary closure with suturing of the tear.Conclusion: Incidental DTs, if recognized and treated appropriately, will not lead to poor clinical results and do not adversely impact postoperative outcomes.

The Impact of Facility Layout on Service Worker Behavior: An Empirical Study of Nurses in the Emergency Department

Problem definition: We study the impact of service facility layout on how service workers organize their tasks. We focus on the hospital emergency department (ED) as a service setting in which nurses (servers) have discretion over how they interact with patients (customers) in a facility that introduces significant heterogeneity in necessary walking distance. Academic/practical relevance: Prior studies on facility layout in operations have largely focused on the direct effect of transit times on reduced productivity. We extend this work to show how skilled service workers such as nurses adapt their work behavior to enhance their productivity in response to facility layout constraints. Methodology: To study this empirically, we utilize a unique data set consisting of infrared nurse location tracking data, patient electronic medical record data, bedside patient call data, and the architectural floor plan of a large academic ED. Results: Nurses working in a busy ED appear to reduce their walking distance by batching their tasks to distant patient rooms. Although the patients in these rooms receive the same amount of care time, this behavior results in longer wait times between nurse visits and more nurse call button activations, but it does not compromise the overall quality of care delivered. Nurse call button use is linked with poor patient satisfaction and interrupts nurse workflow. Managerial implications: These findings show that even in services, facility layout can lead to servers using task timing discretion in ways that help the server but lead to a additional waiting time for the customer. We propose countering the negative effects of distance-based task batching through proactive nurse rounding and operational transparency.

Understanding Gaps Between Daily Living and Clinical Settings in Chronic Disease Management: Qualitative Study.

BackgroundManagement of chronic conditions entails numerous activities in both clinical and daily living settings. Activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily living environments.ObjectiveThe aim of this study is to characterize gaps (from the patient’s perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an example. The causes, consequences, and mitigation strategies (reported by patients) were identified to understand these gaps. We conceptualized gaps as latent phenomena (ie, a break in continuity).MethodsPatients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain health care system were recruited. Data were collected through primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data were analyzed qualitatively using a theory-driven approach and framework method of analysis.ResultsThe causes of gaps included clinician recommendations not fitting into patients’ daily routines, recommendations not fitting into patients’ living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies.ConclusionsUnderstanding gaps, their consequences, and mitigating strategies can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health systems and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily living settings due to the limited number and types of routines that are tracked.