Post-procedure Satisfaction Research Articles

A Randomized Trial of Cardiac Catheterization With Fasting Versus Liberal Oral Intake: The CALORI Trial

BackgroundRoutine preprocedural fasting before cardiac catheterization remains common practice, despite a lack of robust evidence to support this practice. We investigated the impact of a liberal nonfasting strategy vs a standardized nil per os (NPO) regimen prior to cardiac catheterization. MethodsAdult inpatients undergoing elective or urgent cardiac catheterization were randomized (1:1 ratio) to either NPO past midnight or ad libitum intake of liquids and solids (without dietary constraints) until immediately prior to the procedure. Only patients at high risk of aspiration or undergoing complex interventions were excluded. The primary end point was preprocedural patient-reported well-being scores (scaled 0-5, with 0 signifying absence of ailment and 5 the most extreme form), for variables including hunger, fatigue, anxiety, and nausea. A composite score summed the individual scores for hunger and fatigue. Other end points were periprocedural adverse events including emesis, aspiration, or intubation, in addition to postprocedural satisfaction. ResultsA total of 198 patients (65% male and 42% Black) were included in the final analysis. There were no differences in baseline characteristics between groups. Time from most recent oral intake (liquid or solid) to the start of the procedure averaged 148 minutes for the nonfasting group and 970 minutes for the NPO strategy (P < .001). The composite preprocedural well-being score was significantly better in the nonfasting arm (2.4 ± 2.4 nonfasting vs 6.0 ± 2.5 NPO, P < .001), as were the individual components of hunger (0.9 ± 1.5 vs 3.7 ± 1.5, P < .001), fatigue (1.5 ± 1.6 vs 2.3 ± 1.8, P < .001), and nausea (0.1 ± 0.5 vs 0.5 ±1.2, P = .006). There were no significant differences in adverse events between groups. Overall postprocedural satisfaction scores were significantly better in the nonfasting vs NPO group (0.3 ± 0.7 vs 1.0 ± 1.3, respectively, P < .001). ConclusionsIn this single-center randomized trial, a liberal nonfasting strategy prior to cardiac catheterization significantly improved patient well-being and satisfaction without compromising safety. Given the findings of this and other studies, routine fasting prior to cardiac catheterization should be reconsidered.

Informational video impact before caesarean delivery on anxiety and satisfaction: a systematic review and meta-analysis

ABSTRACT Background Anxiety prior to caesarean section can lead to a negative birth experience, which may affect different aspects of woman’s life in the long term. Improving preoperative information may result in lower anxiety leading to a more positive birth experience. Thus, we aimed to evaluate the impact of informational video before planned caesarean delivery on maternal anxiety and satisfaction. Methods Four different databases were searched from inception till March 2023. We selected randomised controlled trials (RCTs) that compared educational or informative videos about the aspects of the expected caesarean delivery process versus no preoperative information in the control group. No language restrictions were imposed. We used Revman software during performing our meta-analysis. Our main outcomes were preoperative and postoperative anxiety as well as maternal satisfaction post-procedure. Results Six RCTs were retrieved with a total number of 702 patients. Informative video significantly reduced the anxiety level before caesarean delivery in comparison with the control group (MD = −4.21, 95% CI [−5.46, −2.95], p<0001). Moreover, the postoperative anxiety level was significantly improved in the informational video group (MD = −4.71, 95% CI [−7.06, −2.36], p<0001). In addition, there was a significant improvement in maternal satisfaction score after caesarean delivery among the informational video group (p = 0.001). Conclusions Informational video prior to caesarean delivery decreases preoperative and postoperative anxiety levels with improvement in maternal post-procedure satisfaction. However, the existing evidence is limited by several shortcomings, chiefly small sample size. More trials with larger sample size are required to confirm our findings.

Incorporating a Patient Education Video With Provider Consultation to Improve Patient Satisfaction and Reduce Consultation Time Among New Patients Seeking Cosmetic Injections.

The field of aesthetics is expanding more rapidly than ever before, bringing with it an influx of new-to-aesthetics patients who lack industry knowledge. We investigated ways to bridge this gap in knowledge and provide patients with important procedural information and also increase their satisfaction and confidence. We implemented this project to improve the delivery of preprocedural patient education via the implementation of an educational video. We collected data over a 16-week period and analyzed the results of the pre- and post-video implementation. We found that implementing the educational video decreased the average time the provider spent consulting with new patients considering injectable neuromodulators or dermal fillers. We also found that using the video increased the patient's preprocedural confidence and postprocedural satisfaction. Based on the results of our quality improvement project, we concluded that implementing a patient education video before performing cosmetic injectable procedures improved patient confidence and satisfaction and decreased provider consultation times.

The Impact of Virtual Reality on the Patients and Providers Experience in Wide-Awake, Local-Only Hand Surgery

Virtual reality (VR) is an emerging technology with the potential to enhance patient care by reducing pain and anxiety for a variety of medical procedures. The aim of this study was to evaluate an immersive VR program as a nonpharmacologic intervention to reduce anxiety and increase satisfaction in patients undergoing wide-awake, local-only hand surgery. The secondary aim was to assess providers' experience with the program. An implementation evaluation was employed to assess the experience of 22 patients who used VR during outpatient, wide-awake hand surgery at a veterans affairs hospital. We assessed the patients' anxiety scores and vital signs before and after the procedure as well as postprocedural satisfaction measures. The providers' experience was also assessed. Patients who used VR exhibited lower anxiety scores after the procedure compared with what they exhibited before the procedure and had high satisfaction levels with their VR experience. Surgeons who used the system reported that VR improved their ability to teach learners and better focus on the procedure. Virtual reality, as a nonpharmacologic intervention, reduced anxiety and contributed to the patients' perioperative satisfaction with wide-awake, local-only hand surgery. As a secondary finding, VR positively impacted the providers' experience by increasing their ability to concentrate on tasks during the surgery. Virtual reality represents a novel technology that can reduce anxiety and contribute to a positive experience for both patients and providers during wide-awake, local-only hand procedures.

Chronic Pelvic Pain, Quality of Life, and Patient Satisfaction After Robotic Sacrocolpopexy for Pelvic Organ Prolapse.

Background and objectiveWhen evaluating repair outcomes in robotic sacrocolpopexy (RSC) for the treatment of pelvic organ prolapse (POP), it has become evident that surgeons usually focus on anatomical improvements and neglect equally important parameters of patient satisfaction and quality of life (QoL). Investigating these factors would aid in achieving a more patient-centered approach to treatment. This study aimed to examine QoL and satisfaction outcomes in women after RSC.MethodsThis study analyzed self-reported patient data regarding RSC for POP performed between October 2009 and February 2017 by fellowship-trained urologists in female pelvic medicine and reconstructive surgery. These patients participated in a survey to assess overall satisfaction and QoL, as well as contributing factors, such as changes in bladder and bowel function, vaginal bulge, and vaginal pain on a 7-point Likert scale (ranging from markedly worse to markedly improved). Data were examined using multivariate regression analysis. Positive treatment response was defined as scores of 6 or 7, whereas negative response was defined as scores of 1 to 5.ResultsThe response rate was 41% (156/380), and the median age of the participants was 70 years [interquartile range (IQR): 63, 73]. Of note, 98.7% were Caucasian, with 73% currently in a significant relationship. The median duration since RSC was 2.12 years (IQR: 1.2, 3.7). Overall, 93 (66.9%), patients (23.0%), and 123 patients (88.5%) had a positive treatment response for bladder function, bowel function, and vaginal bulge, respectively. Furthermore, 66% of women had improved QoL, 84% reported improved overall satisfaction, and 91.4% stated that they would recommend RSC to a friend. After controlling for significant covariates, results of a multivariate analysis demonstrated positive treatment response for bladder function [odds ratio (OR): 14.6; p < 0.0001], bowel function (OR: 9.72; p = 0.003), and vaginal bulge (OR: 41.7; p < 0.0001), significantly associated with increased odds of having improved QoL, whereas positive treatment response for vaginal bulge (OR: 26.9; p = 0.023) and recommending RSC to a friend (OR: 175; p = 0.0009) were associated with positive overall satisfaction.ConclusionsOur findings endorse using RSC surgery for patients with POP based on both QoL improvement and overall post-procedure satisfaction perspective. This study may help encourage surgeons and clinicians to employ a surgical modality that incorporates each patient’s unique treatment desires and goals and provide patients with realistic post-procedure goals and expectations regarding treatment.

Noncontact magnetically controlled capsule endoscopy for infection-free gastric examination during the COVID-19 pandemic: a pilot, open-label, randomized trial.

Background and study aims Endoscopists have been at increased risk because of their direct contact with patients during the COVID-19 pandemic. For patients, being diagnosed with and monitored for gastrointestinal cancer and digestive diseases in timely fashion has been challenging, given pandemic-related adjustments in endoscopy departments. We developed a novel noncontact magnetically controlled capsule endoscopy (ncMCE) system in our medical center. In the current study, we aimed to evaluate the feasibility and safety of ncMCE for gastric examination. Patients and methods Patients were randomly assigned to groups that received ncMCE or MCE in a 1:1 ratio from March 26, 2020 to April 26, 2020. Primary endpoints were feasibility assessed by completion rate (CR) and safety based on the occurrence of adverse events (AEs) including infection. Secondary endpoints included maneuverability of endoscopists, pre-procedure perception and post-procedure satisfaction of patients, gastric examination time (GET), and diagnostic yield (DY). Results Forty patients were enrolled with 100 % CR in both groups without any AEs. Neither the endoscopist nor the patients were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 14 days after gastric examination. There were no significant differences in maneuverability (19.3 vs. 20.0, P = 0.179), pre-procedure perception (9 vs. 9, P = 0.626) and post-procedure satisfaction (45 vs. 44, P = 0.999), ord DY (20 % vs. 30 %, P = 0.465). Conclusions ncMCE is a feasible and safe method of gastric examination, which has the potential to protect both medical staff and patients from COVID-19 infection while providing serving as an essential endoscopy service.

A Patient-Centred Approach to Early Pregnancy Loss: The First 18 Months of a Canadian Outpatient Program for Early Pregnancy Loss (OPEL)

ObjectiveManual vacuum aspiration is a safe surgical option for the management of early pregnancy loss. To provide rapid, patient-centred access to MVA, an Outpatient Program for Early pregnancy Loss (“OPEL”) was established at our institution. Objectives were to (1) assess complete uterine evacuation rates; (2) assess complication rates, and (3) assess patient satisfaction with the program. MethodsWith REB approval, a retrospective study was performed. Patient records from the first 18 months of OPEL (November 2015 to April 2017) were reviewed. Anonymous patient satisfaction questionnaires were completed immediately post-procedure. ResultsA total of 162 patients received treatment. Missed abortions accounted for 94 cases (58%). Median delay from referral to clinic appointment was 4.0 (interquartile range [IQR] 2.0–6.0) days. Average length of stay was 3.0 (IQR 2.5–3.0) hours. Efficacy of the procedure was 95.1%. Complication rate (immediate and delayed) was 14.2% and included intraoperative hemorrhage (3.1%; 5/162), Asherman’s syndrome (1.9%; 3/162), retained products of conception requiring further treatment (4.9%; 8/162), and postoperative infection requiring antibiotic therapy (1.9%; 3/162). A total of 151 post-procedure satisfaction surveys were completed (93%); 100% agreed/strongly agreed that the nursing staff and physicians provided professional and compassionate care; 99.3% were satisfied with their care overall. Qualitative feedback was positive. ConclusionPregnant patients experiencing early pregnancy loss benefit from safe, timely, accessible, patient-centred care in the outpatient OPEL program. Similar models should be adopted nationally to ensure women experiencing this common pregnancy complication receive safe and compassionate care.

User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service.

BackgroundTeleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood.ObjectiveWe were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology’s usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures.MethodsWe designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures.ResultsIn total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111 of 140 (79.3%) cases. Specific examples were that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11 referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance were generally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%).ConclusionsUsers’ satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnical aspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes.

ID: 3521475 COMPARING PATIENT SATISFACTION AMONG TELEMEDICINE, DIRECT ACCESS, AND IN-PERSON CLINIC PRE-PROCEDURE VISITS FOR GASTROINTESTINAL ADVANCED ENDOSCOPIC PROCEDURES

Background and aims: With the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, healthcare providers abruptly changed their delivery of care to protect patients and staff from infection. One such change was to convert in-person advanced gastrointestinal endoscopy pre-procedure consultations to telemedicine visits. The use of telemedicine has been successfully used in the field of gastroenterology in managing symptoms and chronic conditions among established patients. However, to our knowledge, there is little literature on the utility of this modality for pre-procedure consultation visits, where patients often meet their proceduralists for the first time. The aim of this study was to compare overall patient satisfaction among those who had pre-procedure consultation visits by telemedicine, in –person, or a direct access procedure (instructions and procedure explained by a nurse practitioner or physicians assistant). Methods: Patients who had undergone an advanced endoscopic procedure at Long Island Jewish Hospital from the months of May 2020 to August 2020 were called by telephone and asked to complete a modified version of the validated patient satisfaction survey mGHAA-9. The survey was designed to assess patient satisfaction in their pre-procedure, intra-procedure, and post procedure experiences. Patients were grouped based on whether they had received an in-clinic consultation visit by the endoscopist, telemedicine consultation visit by the endoscopist, or direct access. Geographic location to the office, prior endoscopic experience, type of endoscopic procedure (diagnostic vs. therapeutic), and new gastrointestinal cancer diagnosis data were recorded. Results: Of the total 322 patients that were called, 123 agreed to participate (38%) and provided responses to the survey. There were 26 who had in person consultation visits, 32 who had telemedicine consultation visits, and 65 direct access visits. Overall mean satisfaction among the three groups did not reveal a statistically significant difference (p value= 0.983). Furthermore, sub-analysis of the preprocedure, intra procedure, and post procedure satisfaction scores did not reveal statistically significant differences (p=0.996, p=0.244, and p=0.998, respectively). However, patients with a new gastrointestinal cancer diagnosis had a statistically significant higher mean satisfaction score in those who had telemedicine visits with proceduralists compared to those who had direct access procedures (P=0.0116). Conclusion: Our study suggests that pre-procedure consultation visits by telemedicine, in-person, or direct access all have similar satisfaction scores among patients. However, telemedicine consultation visits with the endoscopist may be preferred over direct access in patients who have a clinically high suspicion for a new gastrointestinal cancer diagnosis. [Formula presented]

Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament.

To assess the effectiveness of ultrasound-guided decompression in managing symptomatic mucoid degeneration of the anterior cruciate ligament (ACL). Retrospective analysis of 55 patients who underwent ultrasound-guided ACL mucoid degeneration decompression between July 2013 and August 2019. Subjective satisfaction scores were gathered immediately post-procedure for all 55 patients; follow-up satisfaction scores (scale of 0-10, 10 being excellent) were gathered telephonically for 46 patients (83.6%) up to 63months post-procedure. Follow-up duration of each patient was classified as short (1-6months), intermediate (7-12months), or long (more than 12months) post-procedure. Forty-five patients (81.8%) MRI were retrospectively analyzed and classified into cystic (n = 13, 28.9%), mucoid (n = 11, 24.4%), or mucoid-cystic (21, 46.7%) types. Multivariate logistic regression was used to identify associations between follow-up satisfaction score, follow-up duration, patient age, and type of ACL degeneration. All patients had immediate marked post-procedure improvement, with excellent (>7/10) satisfaction scores. Forty-six of 55 patients were telephonically followed up: 21 (45.6%) short-term interval, 18 (39.1%) intermediate term, and 7 (15.2%) long-term. Thirty (65.22%) patients had excellent and eight (17.4%) patients had average satisfaction scores at follow-up. Eight (17.4%) patients had poor post-procedure satisfaction scores within six months. There were no significant associations between immediate or follow-up satisfaction score and duration of follow-up, age of patient, or type of ACL degeneration. Ultrasound-guided aspiration, fenestration, and injection are an effective, safe, minimally invasive and radiation-free technique for management of mucoid degeneration of ACL with excellent immediate- and long-term results.

Sedation-related complications during anesthesiologist-administered sedation for endoscopic retrograde cholangiopancreatography: a prospective study

BackgroundPatients undergoing endoscopic retrograde cholangiopancreatography (ERCP) require adequate sedation or general anesthesia. To date, there is lack of consensus regarding who should administer sedation in these patients. Several studies have investigated the safety and efficacy of non-anesthesiologist-administered sedation for ERCP; however, data regarding anesthesiologist-administered sedation remain limited. This prospective single-center study investigated the safety and efficacy of anesthesiologist-administered sedation and the rate of successful performed ERCP procedures.MethodsThe study included 200 patients who underwent ERCP following anesthesiologist-administered sedation with propofol and remifentanil. Procedural data, oxygen saturation, systolic blood pressure (SBP), heart rate, recovery score, patient and endoscopist satisfaction, as well as 30-day mortality and morbidity data were analyzed.ResultsSedation-related complications occurred in 36 of 200 patients (18%) and included hypotension (SBP < 90 mmHg) and hypoxemia (O2 saturation < 90%) in 18 patients (9%) each. Most events were minor and did not necessitate discontinuation of the procedure. However, ERCP was terminated in 2 patients (1%) secondary to sedation-related complications. Successful cannulation was performed in all patients. The mean duration of the examination was 25 ± 16 min. Mean recovery time was 14 ± 10 min, and high post-procedural satisfaction was observed in both, patients (mean visual analogue scale [VAS] 9.6 ± 0.8) and endoscopists (mean VAS 9.3 ± 1.3).ConclusionThis study suggests that anesthesiologist-administered sedation is safe in patients undergoing ERCP and is associated with a high rate of successful ERCP, shorter procedure time, and more rapid post-anesthesia recovery, with high patient and endoscopist satisfaction.

Versatility of the Pedicled Thoracodorsal Artery Perforator Flap (TDAP) Anatomic Basis and Clinical Application in breast reconstruction

Background: the thoracodorsal artery perforator (TDAP) flap is relatively new member of perforator flap family in reconstructive surgery. TDAP flap used as pedicled flap in breast reconstruction. Advantages of the TDAP flap include homogenous flap thickness, minimal donor-site morbidity, and constant vascular anatomy with a long pedicle. Aim: to study versatility of the pedicled thoracodorsal artery perforator flap and evaluate its role in breast reconstruction. Methods: This prospective cohort study was conducted in Zagazig university Hospitals during the period from January 2018 till January 2019 on 20 patients with breast cancer who have been subjected to breast surgery and immediate breast reconstruction. Results: the mean time taken for flap elevation was 266 ± 18 minutes, flap elevated with single perforator in 85 % of the cases and with double perforators in the remaining 15%. The mean skin paddle diameters were 15.6 ± 3.3 cm in length and 7.2 ± 2.1 cm width. The donor side was closed by primary closure in 90% while two cases (10%) needed grafting for closure. Objective and subjective assessment for the post procedure satisfaction showed that around 90% of the population was satisfied by the result. Conclusion: The TDAP has several advantages that make it a work horse for many soft tissue reconstructions in appropriately selected patients. The drawback of the TDAP can be manipulated by some technical modification.

Real World Utilization of a Mobile Application-Based Bowel Preparation on Quality Indicators in Colonoscopy

Introduction: Adequate bowel preparation for colorectal cancer (CRC) screening can be challenging in direct-to-procedure colonoscopy due to barriers with patient engagement and communication, which can negatively impact colonoscopy quality indicators. With widespread use of smart phones, mobile delivery of prep instructions has potential to improve the patient experience and colonoscopy outcomes. Our study aimed to assess whether the use of a mobile application to disseminate bowel prep instructions influenced patient satisfaction and quality indicators for colonoscopy. Methods: An IRB-approved prospective pilot study of Twistle mobile application was conducted at our outpatient surgical center from October 2017 to January 2018. Patients scheduled to undergo a direct-to-procedure colonoscopy for CRC screening were eligible for enrollment. Patient demographics and procedural outcomes were collected including quality of prep, cecal intubation time, scope withdrawal time, and number of polyps or adenomas detected. Patients were matched 1:1 to historical controls that received standard mailed prep instructions as a comparison group. Patients that used Twistle were asked to complete a 5-question telephone survey after their colonoscopy to assess satisfaction. Results: 133 eligible patients were contacted by phone call (n = 80; 60.2%) or invitational letter (n = 53, 39.8%) to receive bowel prep instructions via Twistle (Figure 1). 12 patients, mean age 55.2 years, completed colonoscopy prep utilizing Twistle and a post-procedure satisfaction survey (response rate = 9.0%). No statistically significant differences were demonstrated on any procedure-related parameters between those using Twistle or mailed bowel prep instructions (Table 1). A post-procedure telephone survey revealed 91.7% (n = 11) of patients considered the Twistle application easy to follow, and 83.3% (n = 10) indicated they were “very satisfied” and would be very likely to utilize again for a future colonoscopy procedure (Table 2).253_A Figure 1 No Caption available.Conclusion: In this pilot study, we have demonstrated real-world challenges of implementing a mobile application-based bowel prep program for direct colonoscopy referrals in a large academic setting. Despite a low utilization rate, patients who completed bowel prep using Twistle reported high satisfaction. Further studies are needed to evaluate the role of a mobile application-based bowel prep and to develop improved processes to successfully integrate these tools into routine practice.253_B Figure 2 No Caption available.253_C Figure 3 No Caption available.

37: Barriers to care and reproductive considerations for female-to-male transgender gender confirmation surgery

The transgender population is one of the most marginalized and underserved populations in medicine. To provide the transgender community with adequate and compassionate care, it is important to identify barriers to gender confirming medical care. This study aimed to identify barriers to care for female-to-male transgender patients who desired gender confirmation surgery and to assess post-procedural satisfaction or regret, particularly with respect to fertility. We distributed an anonymous, cross-sectional survey to all female-to-male transgender patients who were at least 18 years old and underwent a total hysterectomy at our institution. Patients received surveys via email or paper from January through August 2017. We developed the survey to capture demographic characteristics, barriers to care, and experience before and after the surgery. We also used the validated Decision Regret Scale to assess feelings about having undergone the surgery; scores range from 0-100 with higher scores indicating more regret. Data are presented as median (interquartile range) or n proportion. A total of 91 surveys were distributed, and 48 (52.7%) were completed. Respondents were aware of their male gender by a median age of 14.0 (5.0-20.0) years and certain by age 21.5 (17.5-27.0). Sexual orientation was 50.0% heterosexual, 22.9% bisexual, 10.4% other, and 8.3% homosexual. Almost all respondents (93.8%) reported taking testosterone, but only 39.5% of those taking testosterone felt this was a prerequisite to surgery. The majority (75.0%) traveled less than 25 miles for their surgery and 95.8% reported that their insurance covered the procedure. The median time between the initial consultation and surgery was 6.5 (4.5-12.0) months. The most frequently cited barriers to surgical care were: stigma of being seen as a male patient in an obstetrics and gynecology practice (62.5%), insurance/financial support (48.7%), and difficulty taking time off from work (39.4%). The median score on the decision regret scale was 0.0/100 (0.0-5.0). Most (75.0%) respondents did not have children at the time of surgery and nine (20.5%) of these respondents planned to have children after surgery. Seven (77.8%) of those nine respondents planned to adopt or have their partner carry the pregnancy, while two (22.2%) planned to adopt or use a surrogate. Providers have expressed reservations to perform gender confirming surgery due to concern of patient regret for a permanent procedure with irreversible infertility. This study provides some reassurance in that none of the 48 participants expressed regret. The patients who did want to have future children all underwent the procedure with a plan. Diversity in sexual orientation was also present in this group with half of the participants identifying as bisexual, homosexual or other. Interestingly, in this study area where insurance covered the majority of the surgeries, the most frequently cited barrier to care was the stigma of being seen as a male patient in an ob-gyn practice. Changing clinical practice to decrease the perceived stigma is a major step to improve female-to-male transgender patients’ experience and willingness to access care.

Post-endoscopic procedure satisfaction scores: Can we improve?

AIMTo organize post-procedure satisfaction data into a useful reference and analyze patient-centered parameters to find trends that influence patient satisfaction.METHODSA robust database of two cohorts of outpatients that underwent an endoscopic procedure at Georgetown University Hospital at two separate three-month intervals ranging from November 2012 to January 2013 and November 2015 to January 2016 was compiled. Time of year was identical to control for weather/seasonal issues that may have contributed to the patient experience. The variables recorded included age, sex, body mass index (BMI), type of procedure, indication for procedure, time of the procedure, length of the procedure, type of prep used, endoscopist, satisfactory score, and comments/reasons for score. For continuous variables, differences in averages were tested by two sample t-test, Wilcoxon rank sum test, and ANOVA as appropriate. For categorical variables, differences in proportions between two groups were tested by χ2 test. Correlation test and linear regression analyses were conducted to examine relationships between length of procedure and continuous predictors. A P value < 0.05 used to indicate statistically significant relationship.RESULTSThe primary outcome of this study was to assess if telephone outreach after an endoscopic intervention was a satisfactory method of obtaining post-procedure satisfaction scores from patients at a tertiary care center. With the addition of post-procedure calls, instilled in January 2014, the response rate was 40.5% (508/1256 patients) from a prior completion rate of 3.4% (31/918) with the mail out survey initially. There was a statistically significant improved response rate pre and post intervention with P < 0001. The secondary outcome of this study was to assess if we could use predictive analytics to identify independent predictors of procedure length, such as gender, age, type of procedure, time of procedure, or BMI. The combined pre and post intervention data was used in order to optimize the power to identify independent predictors of procedure length. The total number of patient’s data analyzed was 2174. There was no statistically significant difference in procedure length between males and females with P value 0.5282. However, there was a small (1 min), but statistically significant difference (P = 0.0185) in procedure length based on the time of day the procedure took place, with afternoon procedures having a longer duration than morning procedures. The type of procedure was an independent predictor of procedure length as demonstrated with P value < 0.0001. There is a statistically significant correlation between age and procedure length, although it is only a weak relationship with a correlation coefficient < 0.3. Contrary to patient age, BMI did not have a statistically significant correlation with procedure length (P = 0.9993), which was also confirmed by linear regression analysis.CONCLUSIONOur study proves calling patients after endoscopy improves post-procedure satisfaction response rates and changing procedural time allotment based on patient characteristics would not change endoscopic workflow.

Survey Satisfaction? A Look at Post-Endoscopy Satisfaction Scores

Introduction: Patient satisfaction is an important outcome measure for both the patient and endoscopy unit. Poor experiences may lead to non-compliance with endoscopic screening and/or monitoring. Quality measures are instated to ensure oversight and evaluation of processes guaranteeing continued improvement. The purpose of this study is to organize the post-procedure satisfaction data into a useful reference as well as analyze various patient-centered parameters to find trends that might influence the overall outcome and lead to process improvements in order to optimize the patient experience. Methods: A database of two cohorts of outpatients that underwent endoscopic procedures at Georgetown University Hospital at two separate three-month intervals ranging from November 2012-January 2013 and November 2015-January 2016 was compiled. The variables recorded included age, sex, BMI, type of procedure, indication for procedure, time of the procedure, length of procedure, type of prep used, endoscopist, satisfactory score, and comments/reasons for score. For continuous and categorical variables, differences in averages were tested by two sample t-test, Wilcoxon rank sum test, ANOVA and Chisquare test as appropriate. Correlation test and linear regression analyses were also conducted to examine relationships between length of procedure and continuous predictors. Results: With the addition of post-procedure calls, instilled in January 2014, the response rate was 40.5% (508/1256 patients). Prior to the calls, the documented post procedure satisfaction survey completion rate was 3.4%. There was a statistically significant improved response rate pre and post intervention. Figure 1 shows the relationship between age and procedure length. As is shown by a positive slope in the graph, there is a statistically significant relationship, albeit small and with little clinical significance.Figure: Figure 1 is a FitPlot of the relationship between age and procedure length. As is shown by a positive slope in the graph, there is a statistically significant relationship, albeit small. Using linear regression analysis, the relationship between age and procedure length was confirmed (data not shown) and it can be concluded that for every year increase in age, there is a 0.06 minute (3.6 second) increase in length of procedure.Conclusion: Our study proves that calling patients after they undergo endoscopy can drastically improve post procedure satisfaction response rates. The secondary aim of this study was to identify independent variables that directly affect length of procedure which often a surrogate for patient satisfaction. There was a statistically significant correlation with an increase in procedure length with increasing age, but interestingly, no association with BMI. We can conclude based on our data that changing the scheduling or time allotted for procedures based on age or weight would not drastically change the flow in the endoscopy suite.Table: Table. Comparison of Response Rate between Pre and Post InterventionTable: Table. Examining Gender and Time of Procedure as Independent Predictors of Procedure Length

PTH-047 The Effect of Patient’s Level of Anxiety and Knowledge on Their Experience of Colonoscopy: A Questionnaire Survey

Introduction This was a descriptive study on how patient’s pre-procedure anxiety and understanding affect experience and post procedural satisfaction of colonoscopy. Colorectal cancer is the fourth leading cancer in the UK in terms of incidence accounting for 33,765 new cases in 2013. Colonoscopy plays a major role in the prevention and management of colorectal cancer. However, patient uptake of colonoscopy has been shown to be adversely affected by anxiety and lack of knowledge. Post procedure satisfaction which can affect compliance to treatment, has been shown to be affected adversely by procedure discomfort and long wait times.The bowel cancer-screening programme (BCSP) aims to detect bowel cancer at an early stage where treatment is most likely to be effective. Patients are offered a colonoscopy after positive faecal occult blood testing. Prior to the procedure they are seen by a specialist nurse, and during a lengthy consultation the risks and benefits of the procedure are explained.Symptomatic patients referred from clinic will not receive such an in depth discussion regarding the procedure, although this may vary from physician to physician.Patients undergoing surveillance colonoscopy (previous polyps, family history, inflammatory bowel disease) may undergo no further discussion prior to their repeat procedure. Methods Over a month period (June 2015), patients undergoing colonoscopy at the Endoscopy Unit of St. George’s Hospital were identified. They were asked to complete a questionnaire before and after their procedure. Questions were asked to gather data on: patient demographics, purpose of having colonoscopy, patient’s awareness of the benefits and risks of the procedure, level of anxiety and level of satisfaction following their colonoscopy. Results 133 patients participated in the study. 71 patients were male. The mean age was 62.3 years (range of 22–83 years). 43 patients were invited as part of the BCSP, 49 were symptomatic from clinic and 41 were undergoing surveillance. Patients invited through the BCSP had the highest rate of awareness of the benefits at 76.7%. Symptomatic patients from clinic had the lowest rate of awareness of benefit at 53.1%. In contrast, the symptomatic patients had the highest understanding of risks at 67.3% compared with the lowest rate of 60.5% in the BCSP group. 96% of the referral group reported a low level of anxiety compared with 88.4% of the BCSP group. 73.1% of patients in the surveillance group reported no or mild discomfort. 68% of the BCS group reported no or mild discomfort BCS group with 68.9%. The referral group recorded the highest level of moderate to severe discomfort at 36.8% There was a high level of procedure satisfaction with 92% recorded in the surveillance group, 86% in the BCSP group and 94% in the referred group. 85% of the surveillance and 79% of the BCSP group were happy to have the procedure with a slightly lower rate of 75% of the referral group. 8.2% of the referral group would prefer to avoid a repeat procedure compared with whereas the rate were 7.3% of the surveillance group and 4.6% of the BCSP group. Conclusion Colonoscopy remains the most accurate tool in diagnosing and managing bowel disease. The BCSP can help to significantly reduce morbidity and mortality from CRC. However, patient uptake of colonoscopy can be adversely affected for a number of reasons. Our study emphasised the importance of explaining the benefits and risks of colonoscopy, to reduce pre-procedural anxiety in an attempt to improve patient satisfaction and further compliance. Disclosure of Interest None Declared

Visual distraction alone for the improvement of colonoscopy-related pain and satisfaction.

To evaluate the effect of a relaxing visual distraction alone on patient pain, anxiety, and satisfaction during colonoscopy. This study was designed as an endoscopist-blinded randomized controlled trial with 60 consecutively enrolled patients who underwent elective colonoscopy at Yokohama City University Hospital, Japan. Patients were randomly assigned to two groups: group 1 watched a silent movie using a head-mounted display, while group 2 only wore the display. All of the colonoscopies were performed without sedation. We examined pain, anxiety, and the satisfaction of patients before and after the procedure using questionnaires that included the Visual Analog Scale. Patients were also asked whether they would be willing to use the same method for a repeat procedure. A total of 60 patients were allocated to two groups. Two patients assigned to group 1 and one patient assigned to group 2 were excluded after the randomization. Twenty-eight patients in group 1 and 29 patients in group 2 were entered into the final analysis. The groups were similar in terms of gender, age, history of prior colonoscopy, and pre-procedural anxiety score. The two groups were comparable in terms of the cecal insertion rate, the time to reach the cecum, the time needed for the total procedure, and vital signs. The median anxiety score during the colonoscopy did not differ significantly between the two groups (median scores, 20 vs 24). The median pain score during the procedure was lower in group 1, but the difference was not significant (median scores, 24.5 vs 42). The patients in group 1 reported significantly higher median post-procedural satisfaction levels, compared with the patients in group 2 (median scores, 89 vs 72, P = 0.04). Nearly three-quarters of the patients in group 1 wished to use the same method for repeat procedures, and the difference in rates between the two groups was statistically significant (75.0% vs 48.3%, P = 0.04). Patients with greater levels of anxiety before the procedure tended to feel a painful sensation. Among patients with a pre-procedural anxiety score of 50 or higher, the anxiety score during the procedure was significantly lower in the group that received the visual distraction (median scores, 20 vs 68, P = 0.05); the pain score during the colonoscopy was also lower (median scores, 23 vs 57, P = 0.04). No adverse effects arising from the visual distraction were recognized. Visual distraction alone improves satisfaction in patients undergoing colonoscopy and decreases anxiety and pain during the procedure among patients with a high pre-procedural anxiety score.

Pain and satisfaction during rigid cystoscopic ureteral stent removal: a preliminary study.

BackgroundCystoscopy evokes discomfort and pain, especially in males. The cystoscopic retrograde approach is standard in the removal of ureteral stents. However the satisfaction and degree of pain during the procedure according to the use of several pain controlling methods are unclear.MethodsThis is a cross-sectional survey of 60 patients who underwent cystoscopic ureteral stent removal under intravenous analgesics (group 1, n = 20), midazolam induction (group 2, n = 20), and propofol (group 3, n = 20). Procedural pain and post-procedure satisfaction were determined, and cost differences between the approaches were clarified.ResultsGroup 2 and 3 showed significantly less pain than group 1 (P < 0.001) and significantly higher satisfaction rate than group 1 (P < 0.001). Comparison of groups 2 and 3 revealed showed significantly less pain and higher satisfaction rate in group 3 (P < 0.001 for both). In Group 1, 17 (85.0%) patients wanted other treatment modalities, compared to eight group 2 patients (40.0%) and no group 3 patients.ConclusionsConsidering the potential pain and dissatisfaction of rigid cystoscopic ureteral stent removal, procedures utilizing moderate sedation with midazolam or general anesthesia using propofol without muscle relaxation should be considered.Trial registrationKCT0001260.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2490-14-90) contains supplementary material, which is available to authorized users.

Comparison of Procedural Sequence in Same-day Consecutive Bidirectional Endoscopy Using Moderate Sedation

A sequential bidirectional endoscopy is commonly performed. However, the optimal sequence of procedures for same-day bidirectional endoscopy using moderate sedation has not been established. The aim of this study was to characterize the optimal sequence of endoscopies for sequential bidirectional endoscopy. This was a single-center, prospective, randomized study. A total of 163 patients aged 18 to 80 years, who were referred for bidirectional endoscopy for any indication, were randomized to start with upper or lower endoscopy. Initially, all patients received intravenously 50 mg of meperidine and 2.5 mg of midazolam. Patient's discomfort and satisfaction, as expressed by the amount of analgesia added to sustain conscious sedation, and the postprocedure satisfaction reported by the patients were set as primary outcomes. There was no significant difference in the total dose of midazolam added, patient's pain assessment and satisfaction from the anesthesia and the procedure, duration of endoscopies, or the time to cecal intubation between the esophagogastroduodenoscopy first and colonoscopy first groups. The rate of diagnosis of significant pathologies and the rate of procedures performed during the examinations were similar in both the study groups. Evaluation of patient's postprocedural recovery did not reveal significant differences. There was no significant variance between the performing physicians regarding anesthetic dosing, duration of examination, pain scoring, and the related patient's pain postprocedural assessment. There were no significant differences in the patient's discomfort and satisfaction, regardless of the procedural sequence.