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Hidalgo-Cabanillas M, Laredo-Aguilera JA, Cobo-Cuenca AI, Molina-Madueño RM, Santacruz-Salas E, Rodriguez-Muñoz PM, Carmona-Torres JM. Patient satisfaction and safety in the administration of sedation by nursing staff in the digestive endoscopy service: a cross-sectional study. BMC Nurs 2024; 23:953. [PMID: 39731089 DOI: 10.1186/s12912-024-02644-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 12/18/2024] [Indexed: 12/29/2024] Open
Abstract
BACKGROUND The 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. AIM To determine the level of patient satisfaction and safety with sedation via digestive endoscopies by nurses. METHODS This 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. RESULTS Patients 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). CONCLUSIONS Most 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.
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Affiliation(s)
- Miriam Hidalgo-Cabanillas
- Hospital Universitario de Toledo, Toledo, 45004, Spain.
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, 4507, Spain.
| | - José Alberto Laredo-Aguilera
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, 4507, Spain
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, 45071, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo, 45004, Spain
| | - Ana Isabel Cobo-Cuenca
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, 4507, Spain
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, 45071, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo, 45004, Spain
| | - Rosa María Molina-Madueño
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, 4507, Spain
- Hospital Universitario Rey Juan Carlos, Mostoles, 28933, Spain
| | - Esmeralda Santacruz-Salas
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, 4507, Spain.
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, 45071, Spain.
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo, 45004, Spain.
| | - Pedro Manuel Rodriguez-Muñoz
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, 4507, Spain
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, 45071, Spain
| | - Juan Manuel Carmona-Torres
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, 4507, Spain
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, 45071, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo, 45004, Spain
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Watanabe J, Ikegami Y, Tsuda A, Kakehi E, Kanno T, Ishikawa S, Kataoka Y. Lidocaine spray versus viscous lidocaine solution for pharyngeal local anesthesia in upper gastrointestinal endoscopy: Systematic review and meta-analysis. Dig Endosc 2021; 33:538-548. [PMID: 32573016 DOI: 10.1111/den.13775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/14/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES There are two major methods for local anesthesia by lidocaine before upper gastrointestinal endoscopy: simple spray and viscous solution. We aimed to assess the efficacy and safety by meta-analysis between these two methods. METHODS We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases through October 2019 to perform meta-analyses using random-effects models. The primary outcomes were participants' pain/discomfort, satisfaction, and anaphylactic shock. Three reviewers independently searched for articles, extracted data, and assessed the risk of bias. We evaluated the certainty of evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach. This study was registered in PROSPERO (CRD42020155611). RESULTS We included seven randomized controlled trials (2667 participants). The participants' pain/discomfort may be similar between the lidocaine spray and viscous solution [standardized mean difference 0.03, 95% confidence intervals (CI) -0.37 to 0.42; I2 = 93%; low certainty of evidence]. The lidocaine spray probably increased participants' satisfaction compared with the viscous solution (relative risk 1.22; 95% CI, 1.02 to 1.47; I2 = 47%; moderate certainty of evidence). No anaphylactic shock occurred in four studies (low certainty of evidence). Four studies had high risks of selection bias. CONCLUSION The use of lidocaine spray for local anesthesia provided better satisfaction scores than the viscous solution, and both methods have the same effect with regards to the control of discomfort and pain. Further studies in large multicenter randomized controlled trials with a pre-registration protocol are needed.
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Affiliation(s)
- Jun Watanabe
- Center for Community Medicine, Jichi Medical University, Tochigi, Japan
- Department of Surgery, Tottori Prefectural Central Hospital, Tottori, Japan
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yusuke Ikegami
- General Internal Medicine, Minami-Nara General Medical Center, Nara, Japan
| | - Ayumi Tsuda
- Department of Surgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Eiichi Kakehi
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Takeshi Kanno
- Division of Gastroenterology, Tohoku University Hospital, Miyagi, Japan
| | | | - Yuki Kataoka
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
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Watanabe J, Watanabe J, Kotani K. Early vs. Delayed Feeding after Endoscopic Submucosal Dissection for Gastric Cancer: A Systematic Review and Meta-Analysis. MEDICINA-LITHUANIA 2020; 56:medicina56120653. [PMID: 33261059 PMCID: PMC7760827 DOI: 10.3390/medicina56120653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 12/09/2022]
Abstract
Background: Endoscopic submucosal dissection (ESD) for gastric cancer is increasingly performed worldwide due to its efficacy and safety. This study aimed to assess the evidence of the impact of early vs. delayed feeding after ESD on quality of care, which remains to be fully determined. Methods: Electronic databases (PubMed, the Cochrane Central Register of Controlled Trials, EMBASE) and the trial registries (the World Health Organization International Clinical Trials Platform Search Portal and ClinicalTrials.gov) were searched for studies performed prior to September 2020. Study selection, data abstraction, and quality assessment were independently performed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Self-rated satisfaction and hospital stay were chiefly analyzed. Results: Two randomized controlled trials (239 patients) were included. The early and delayed post-ESD feeding groups had similar rates of post-ESD bleeding (risk ratio 1.90, 95% CI 0.42 to 8.63; I2 = 0%). Early post-ESD feeding resulted in increased patients’ satisfaction in comparison to delayed post-ESD feeding (standard mean difference (MD) 0.54, 95% CI 0.27 to 0.81; I2 = 0%) and reduced the length of hospital stay (MD −0.83, 95% CI −1.01 to −0.65; I2 = 0%). Conclusion: Early post-ESD feeding was associated with increased patients’ satisfaction and reduced hospital stay in comparison to delayed feeding, while the rate of complications did not differ to a statistically significant extent. As we must acknowledge the limited number of reviewed studies, various trials regarding the quality of care are further needed to determine the benefits of early feeding after ESD.
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Affiliation(s)
- Jun Watanabe
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City 329-0498, Tochigi, Japan;
- Department of Surgery, Iwami Hospital, Iwami-Town, Tottori 681-0003, Japan;
| | - Joji Watanabe
- Department of Surgery, Iwami Hospital, Iwami-Town, Tottori 681-0003, Japan;
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City 329-0498, Tochigi, Japan;
- Correspondence: ; Fax: +81-285-44-0628
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Efficacy of Sedation by Midazolam in Association With Meperidine or Fentanyl and Role of Patient Distress During Elective Colonoscopy. Gastroenterol Nurs 2020; 43:258-263. [PMID: 32433429 DOI: 10.1097/sga.0000000000000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Meperidine and fentanyl are opioids currently used in addition to midazolam for sedation and analgesia during colonoscopy in Italy. The aim of the study was to assess the impact of patients' psychological state before elective colonoscopy on the efficacy of the sedation regimens. Eighty outpatients who underwent an elective colonoscopy were included in our study. The Hospital Anxiety and Depression Scale questionnaire was self-administered to evaluate basal anxiety and depression state. The rate of baseline discomfort was evaluated by a standard 100-mm visual analog scale. Sedation was obtained alternatively with a midazolam-meperidine or midazolam-fentanyl combination. There were no statistically significant differences between the fentanyl and meperidine groups on body mass index, age, and gender composition. Patients in the meperidine group reported less pain during colonoscopy than patients in the fentanyl group. There were statistically significant positive correlations in the meperidine group with the distress, anxiety, and depression. Our study has pointed out greater effectiveness of the midazolam plus meperidine regimen, equal recovery times, and no significant differences in the duration of the endoscopic examinations. The evaluation of patients' psychological status seems to predict the efficacy of sedation when the nociceptive component of pain is well controlled.
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Baudet JS, Aguirre-Jaime A. Effect of conscious sedation with midazolam and fentanyl on the overall quality of colonoscopy: a prospective and randomized study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:507-513. [PMID: 31117800 DOI: 10.17235/reed.2019.5735/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION a prospective, randomized study was performed to assess the influence of conscious sedation on the overall quality of colonoscopy, simultaneously quantifying its effect on the scientific quality, perceived quality and patient safety. METHODS patients referred for a colonoscopy were included in the study and were randomized to receive or not receive sedation. Demographic data, indication for colonoscopy, cecal intubation, introduction and withdrawal time, resected adenomas and complications during the exploration were collected. Thirty days later, a satisfaction questionnaire was performed (GHAA 9-me) and patients were asked about complications after the examination. RESULTS a total of 5,328 patients were included, the average age was 62 ± 15.22 years, 47% were male, 3,734 were sedated and 1,594 were not sedated. The sedated patients had a shorter endoscope insertion time (7'20 ± 2'15 min vs 6'15 ± 3'12 min, p < 0.019), a higher rate of cecal intubations (96% vs 88%, p < 0.05), longer withdrawal time (7'20 ± 2'15 min vs 6'15 ± 3'12 min, p < 0.01) and higher adenoma detection rates (22% vs 17%, p < 0.05). The use of sedation reduced discomfort during and after the exploration, without increasing the complications. The satisfaction questionnaire score was higher (23.6 ± 1.5 vs 16.6 ± 4.8, p < 0.001) in the sedated patients. CONCLUSIONS superficial sedation not only reduces patient discomfort but also improves the overall quality of the colonoscopy. Therefore, we must consider the use of sedation as an essential part of colonoscopy.
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Assessment of the Quality of Outpatient Endoscopic Procedures by Using a Patient Satisfaction Questionnaire. CURRENT HEALTH SCIENCES JOURNAL 2019; 45:52-58. [PMID: 31297263 PMCID: PMC6592669 DOI: 10.12865/chsj.45.01.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/15/2019] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Endoscopic procedures represent an important part of daily practice, both for gastroenterologists and nurses, enabling diagnosis and treatment of digestive diseases. An optimal level of quality needs to be obtained for endoscopic procedures to be efficient, which is reflected directly by patient satisfaction. The Gastrointestinal Endoscopy Satisfaction Questionnaire (GESQ) has already been validated in a multicenter trial as an efficient method for measuring patient satisfaction. Aim The aim of our study was to evaluate the quality of endoscopic procedures and patient satisfaction by applying a modified version of the GESQ in an outpatient facility, with or without deep sedation performed under the supervision of an anesthesiologist. MATERIAL AND METHODS Our study included 552 patients undergoing diagnostic and therapeutic upper and lower GI endoscopies, including endoscopic ultrasound procedures (EUS) performed under propofol sedation, from September 2015 to February 2016. Consecutive patients examined during these 6 months received the questionnaire which was handed by the endoscopy nurse two hours after procedure. The GESQ was modified to include different sections for: 1) communication skills with questions regarding the quantity and clarity of the information delivered to the patient before and after the procedures; 2) pain and discomfort related to the examination with an added question about the specific procedure the patient had undergone; 3) staff manners; 4) physician's technical skills; 5) facility organization (waiting time, comfort in the recovery room, good facilities and equipment) and 6) overall satisfaction. The questionnaire did not include personal data, while answers were analyzed in a confidential manner. RESULTS A total number of 552 patients agreed to answer our questionnaire, 192 (34,7%) underwent gastroscopies, 288 (52,1%) colonoscopies and 72 (13,2%) EUS examinations. Regarding the overall level of satisfaction (assessed on a five-point scale), 476 (86,2%) were very satisfied or satisfied, 69 (12,5%) dissatisfied and the remainder 7 (1,3%) were indifferently. For the communication section 16 (3%) patients were not satisfied with the explanations received before the procedure or with the answers to their questions. Pain and discomfort were mentioned by 29 (5,2%) of the patients, usually related to colonoscopies or EUS examinations. 13 (2,3%) of the patients considered the comfort or intimacy of the recovery room to be poor, and 11 (2%) patients were not satisfied with the waiting time before the procedure. CONCLUSION Our modified questionnaire showed good overall patient satisfaction with our endoscopy unit, while also suggesting some areas in need of improvement, such as staff communication skills, better time management and reorganization of the recovery area. Our study demonstrates the importance of such questionnaires in providing feedback information meant to improve standards in endoscopy, including staff skills and organization.
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Weigel WA, Gluck M, Ross AS, Lin OS, Williams BL, Blackmore CC. Process improvement for a complex dual medical procedure. BMJ Open Qual 2018; 7:e000273. [PMID: 30167473 PMCID: PMC6112392 DOI: 10.1136/bmjoq-2017-000273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 07/25/2018] [Indexed: 01/29/2023] Open
Abstract
Pancreatic extracorporeal shock wave lithotripsy followed by endoscopic retrograde cholangiopancreatography is accepted worldwide as a treatment for a large, symptomatic, obstructing pancreatic stones. However, timely completion of the combined process requires coordination of equipment and personnel from two different complex procedures. We used Lean management tools in a week-long event to redesign the process around the patient. Using idea-generated Plan Do Study Act cycles to refine the process, from scheduling to postprocedure recovery, equipment and personnel were aligned to allow these two procedures to occur in immediate succession. The redesigned process resulted in all patients receiving both procedures without delay. This eliminated over 8 hours of wait time. Standard work and a newly created complex scheduler improved flow. We reduced the number of anaesthetics for patients without prolonging the procedure length.
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Affiliation(s)
- Wade Anthony Weigel
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael Gluck
- Department of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew S Ross
- Department of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Otto S Lin
- Department of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Barbara L Williams
- Center for Healthcare Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Craig C Blackmore
- Department of Radiology, Virginia Mason Medical Center, Seattle, Washington, USA
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Munjal A, Steinberg JM, Mossaad A, Kallus SJ, Mattar MC, Haddad NG. Post-endoscopic procedure satisfaction scores: Can we improve? World J Gastrointest Endosc 2018; 10:23-29. [PMID: 29375738 PMCID: PMC5769000 DOI: 10.4253/wjge.v10.i1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/25/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To organize post-procedure satisfaction data into a useful reference and analyze patient-centered parameters to find trends that influence patient satisfaction. METHODS A 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. RESULTS The 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. CONCLUSION Our 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.
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Affiliation(s)
- Ankita Munjal
- Department of Internal Medicine, Georgetown University Hospital, Washington, DC 20007, United States
| | - Joshua M Steinberg
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Afnan Mossaad
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Samuel J Kallus
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Mark C Mattar
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Nadim G Haddad
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
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Chan BP, Hussey A, Rubinger N, Hookey LC. Patient comfort scores do not affect endoscopist behavior during colonoscopy, while trainee involvement has negative effects on patient comfort. Endosc Int Open 2017; 5:E1259-E1267. [PMID: 29218318 PMCID: PMC5718911 DOI: 10.1055/s-0043-120828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 05/02/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Patient comfort is an important part of endoscopy and reflects procedure quality and endoscopist technique. Using the validated, Nurse Assisted Patient Comfort Score (NAPCOMS), this study aimed to determine whether the introduction of NAPCOMS would affect sedation use by endoscopists. PATIENTS AND METHODS The study was conducted over 3 phases. Phase One and Two consisted of 8 weeks of endoscopist blinded and aware data collection, respectively. Data in Phase Three was collected over a 5-month period and scores fed back to individual endoscopists on a monthly basis. RESULTS NAPCOMS consists of 3 domains - pain, sedation, and global tolerability. Comparison of Phase One and Two, showed no significant differences in sedative use or NAPCOMS. Phase Three data showed a decline in fentanyl use between individual months ( P = 0.035), but no change in overall NAPCOMS. Procedures involving trainees were found to use more midazolam ( P = 0.01) and fentanyl ( P = 0.01), have worse NAPCOMS scores, and resulted in longer procedure duration ( P < 0.001). Data comparing gastroenterologists and general surgeons showed increased fentanyl use ( P = 0.037), decreased midazolam use ( P = 0.001), and more position changes ( P = 0.002) among gastroenterologists. CONCLUSIONS The introduction of a patient comfort scoring system resulted in a decrease in fentanyl use, although with minimal clinical significance. Additional studies are required to determine the role of patient comfort scores in quality control in endoscopy. Procedures completed with trainees used more sedation, were longer, and had worse NAPCOMS scores, the implications of which, for teaching hospitals and training programs, will need to be further considered.
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Affiliation(s)
- Brian P.H. Chan
- Queen's University, Department of Medicine, Kingston Ontario, Canada
| | - Amanda Hussey
- Queen's University, Department of Medicine, Kingston Ontario, Canada
| | - Natalie Rubinger
- Queen's University, Department of Medicine, Kingston Ontario, Canada
| | - Lawrence C. Hookey
- Queen’s University, Gastrointestinal Diseases Research Unit, GI Division Hotel Dieu Hospital, Kingston Ontario, Canada
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Tierney M, Bevan R, Rees CJ, Trebble TM. What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care. Frontline Gastroenterol 2016; 7:191-198. [PMID: 27429733 PMCID: PMC4941156 DOI: 10.1136/flgastro-2015-100574] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/28/2015] [Accepted: 05/04/2015] [Indexed: 02/04/2023] Open
Abstract
Understanding and addressing patient attitudes to their care facilitates their engagement and attendance, improves the quality of their experience and the appropriate utilisation of resources. Gastrointestinal endoscopy is a commonly performed medical procedure that can be associated with patient anxiety and apprehension. Measuring patient attitudes to endoscopy can be undertaken through a number of approaches with contrasting benefits and limitations. Methodological validation is necessary for accurate interpretation of results and avoiding bias. Retrospective post-procedure questionnaires measuring satisfaction are easily undertaken but have limited value, particularly in directing service improvements. Patient experience questionnaires indicate areas of poor care but may reflect the clinician's not the patient's perspective. Directly assessing patient priorities and expectations identifies what is important to patients in their healthcare experience (patient-reported value) that can also provide a basis for other forms of evaluation. Published studies of patient attitudes to their endoscopy procedure indicate the importance of ensuring that endoscopists and their staff control patient discomfort, have adequate technical skill and effectively communicate with their patient relating to the procedure and results. Environmental factors, including noise, privacy and the single-sex environment, are considered to have less value. There are contrasting views on patient attitudes to waiting times for the procedure. Implementing patient-centred care in endoscopy requires an understanding of what patients want from their healthcare experience. The results from available studies suggest implications for current practice that relate to the training and practice of the endoscopist and their staff.
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Affiliation(s)
- M Tierney
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - R Bevan
- Northern Region Endoscopy Group, Newcastle, UK
- South Tyneside NHS Foundation Trust, South Tyneside, UK
| | - C J Rees
- South Tyneside NHS Foundation Trust, South Tyneside, UK
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - T M Trebble
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
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Triantafyllou K, Gkolfakis P, Triantafyllou M, Ndini X, Melissaratou A, Moustafa GA, Xanthopoulou E, Tziatzios G, Vlachonikolou G, Papadopoulos V, Pantelakis E, Malli C, Dimitriadis GD. Long-term patient satisfaction of gastrointestinal endoscopic procedures. Ann Gastroenterol 2016; 29:188-195. [PMID: 27065732 PMCID: PMC4805739 DOI: 10.20524/aog.2016.0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/12/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND We prospectively assessed patient satisfaction in a Greek Academic endoscopy facility. METHODS Consecutive outpatients filled a satisfaction questionnaire right after their endoscopy (D1), 3 days (D3) and 3 months (M3) later. Overall patient satisfaction was measured by their willingness to repeat endoscopy in our facility and to further recommend it. Participant satisfaction regarding pre-procedural, procedural and post-procedural issues was measured using a five-step Likert scale in 19 items with 4 and 5 scores indicating favorable responses. Pareto analysis was used to determine service issues requiring improvement. Late adverse events were recorded at D3 and M3 assessments. RESULTS Over six months, 501 patients participated (89.4% and 87.8% response rate at D3 and M3 assessments, respectively). More than 97% of the participants would repeat the procedure in our facility and would recommend our endoscopy service, at all three assessments. Pareto analysis identified waiting time until the appointment and on the day of the examination, discomfort during and after the endoscopy, time to obtain the pathology report and overall management of the patient problems as the issues requiring improvement. No predictor of high satisfaction score has been identified. No serious late adverse events were reported. CONCLUSION Despite the overall high levels of patient satisfaction, management of patient discomfort and organizational issues need improvement.
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Affiliation(s)
- Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Maria Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Xhoela Ndini
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Anastasia Melissaratou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Giannis-Aimant Moustafa
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Eleni Xanthopoulou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Georgia Vlachonikolou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Vasilios Papadopoulos
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Evdoxos Pantelakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Chrysoula Malli
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - George D. Dimitriadis
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
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Patient-derived measures of GI endoscopy: a meta-narrative review of the literature. Gastrointest Endosc 2015; 81:1130-40.e1-9. [PMID: 25864891 DOI: 10.1016/j.gie.2014.11.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/25/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS GI endoscopy (GIE) is widely performed, with 1 in 3 people requiring an endoscopic procedure at some point. Patient experience of medical procedures is important, but, to date, experience measures of GIE are derived from clinician opinion rather than from patients themselves. In this meta-narrative review, the literature on methods of assessing patient experience in GIE is reported. METHODS ScienceDirect, MEDLINE, Web of Knowledge, Web of Science, CINAHL, and PsycINFO were searched to November 2013 using meta-narrative standards. Search terms included those related to endoscopic procedures, combined with those related to patient experience. RESULTS A total of 3688 abstracts were identified and reviewed for relevance. A total of 3549 were excluded, leaving 139 for full-text review. We subsequently included 48 articles. Three sub-groups of studies were identified--those developing original measures of endoscopy-specific patient experience (27 articles), those modifying existing measures (10 articles), and those testing existing measures for reliability or validity (11 articles). Most measures focused on pain, discomfort, anxiety, and embarrassment. Three studies explored wider aspects of experience, including preparation, unit organization, and endoscopist preference. Likert scales, visual analog scale scores, and questionnaires were used most commonly. The Global Rating Scale was validated for use in 2 studies, confirming that those domains cover all aspects of endoscopy experience. Other measures were modified to assess endoscopic experience, such as the modified Group Health Association of America survey (mGHAA-9) (modified by 5 studies). CONCLUSIONS No patient-derived and validated endoscopy-specific experience measures were found. Patient-derived and validated experience measures should be developed and used to model optimal healthcare delivery.
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Pontone S, Tonda M, Brighi M, Florio M, Pironi D, Pontone P. Does anxiety or waiting time influence patients' tolerance of upper endoscopy? Saudi J Gastroenterol 2015; 21:111-5. [PMID: 25843198 PMCID: PMC4392571 DOI: 10.4103/1319-3767.153839] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND/AIMS Endoscopy is an essential and very commonly used procedure for the evaluation of a multitude of gastrointestinal symptoms. Although it is increasingly required, patients often wait on arrival at the endoscopy unit until they are called for the procedure. It is not clear whether or not this waiting time may have an impact on patient's tolerance during upper endoscopy. Our study attempts to address this. PATIENTS AND METHODS We studied consecutive outpatients who underwent endoscopy from September to December, 2013. Gender, age, body mass index (BMI), previous endoscopic experiences, antidepressant therapy, and the time interval between arrival at the endoscopy unit and the onset of examination was recorded. Anxiety before the procedure, pain, and discomfort were rated by a numeric rating scale (0 = no pain/discomfort encountered to 10 = extremely painful/uncomfortable). RESULTS One hundred and five consecutive outpatients (male = 52; mean age = 45.3 years; age range = 20-86 years) were included in the study. The mean BMI was 25 ± 4.8; mean waiting time from registration to the procedure was 172 min (time range = 30 - 375 mins). Mean patients' pre-examination anxiety level was 3 ± 3.84, mean discomfort score was 4.3 ± 3.09 and mean pain score was 3.4 ± 3.03. The level of pain and discomfort was significantly higher in patients with higher levels of pre-procedure anxiety. No differences were found in terms of anxiety, pain and discomfort among patients divided according to waiting time. CONCLUSIONS According to our data, waiting time does not have a significant impact on the perception of pain and discomfort related to the endoscopic procedure. On the other hand, high pre-procedural levels of anxiety were associated with a low tolerance. Further multicenter randomized trials are needed to clarify the impact of waiting time.
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Affiliation(s)
- Stefano Pontone
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy,Address for correspondence: Dr. Stefano Pontone, Department of Surgical Sciences, “Sapienza” University of Rome, V.le Regina Elena, 324-00161 - Rome, Italy. E-mail:
| | - Maya Tonda
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Manuela Brighi
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Matteo Florio
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Paolo Pontone
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
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Ramos L, Alarcón O, Adrian Z, Gimeno-García AZ, Nicolás-Pérez D, Jiménez-Sosa A, Quintero E. One-day versus two-day cleansing for colon capsule endoscopy: a prospective randomized pilot study. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:101-6. [PMID: 24388792 DOI: 10.1016/j.gastrohep.2013.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/15/2013] [Accepted: 10/22/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Standard bowel cleansing for colon capsule endoscopy (CCE) requires a liquid diet and bowel laxatives for at least 2 days, which is a major drawback of this procedure and affects tolerance and acceptability. OBJECTIVE To compare the quality of colon cleanliness achieved with one-day versus two-day bowel preparation in outpatients undergoing CCE. METHODS Patients were randomly assigned to one of two groups: group I (one-day schedule, n=20) received a fiber-free diet and 3 L of polyethylene glycol (PEG) on day 0; group II (two-day schedule, n=20) received a liquid diet and 3 L of PEG in the evening of day -1, and 1L of PEG in the early morning of day 0. In both groups, the patients received 15 mg bisacodyl on day -1 and one or two additional sodium phosphate (NaP) boosters following capsule ingestion. Each colon segment was assessed for cleanliness using a four-point grading scale (excellent=1, good=2, fair=3, and poor=4). For the final analysis, colon cleanliness was rated as adequate (good or excellent) or inadequate (fair or poor). RESULTS Overall colon cleanliness was adequate in 94% (CI 91-97) of patients in group I versus 80% (CI 72-88) in group II (P=0.27). No significant differences were observed in the per-segment quality of colon cleansing between the two groups. CCE reached the rectum in 80% (CI 73-87) of patients in group I versus 75% (CI 67-83) in group II (p=0.59). CONCLUSION The quality of colon cleanliness achieved with one-day bowel preparation is equivalent to that of the standard two-day schedule in patients undergoing CCE.
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Affiliation(s)
- Laura Ramos
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Onofre Alarcón
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Zaida Adrian
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Antonio Z Gimeno-García
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - David Nicolás-Pérez
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | | | - Enrique Quintero
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain.
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Chung SH, Park SJ, Hong JS, Hwang JY, Lee SA, Kim KR, Lee HS, Hong SP, Cheon JH, Kim TI, Kim WH. Comparison of double pants with single pants on satisfaction with colonoscopy. World J Gastroenterol 2013; 19:4177-4184. [PMID: 23864781 PMCID: PMC3710420 DOI: 10.3748/wjg.v19.i26.4177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/04/2013] [Accepted: 06/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To increase satisfaction and diminish anxiety and shame during colonoscopy, we developed novel double pants (NDP) which consist of doubled fabrics with an inner hole. The aim of study was to compare satisfaction, anxiety and shame between NDP and conventional single pants (CSP).
METHODS: Total 160 consecutive examinees were randomly divided into NDP and CSP group. Before colonoscopy, questionnaires identifying state and trait anxiety were completed. After colonoscopy, questionnaires for overall satisfaction (Group Health Association of America 9) and pants-specific satisfaction (5-20), state anxiety (20-80), and shame (6-24) were interviewed.
RESULTS: Pants-specific satisfaction scores regarding willingness to repeat colonoscopy using same pants (3.3 ± 0.8 vs 2.1 ± 0.9, P < 0.001) and recommendation of same pants to other people (3.3 ± 0.7 vs 2.0 ± 1.0, P < 0.001) were significantly higher in NDP than CSP groups. State anxiety (33.0 ± 7.0 vs 35.4 ± 6.9, P = 0.028) and shame (6.6 ± 1.5 vs 8.1 ± 3.2, P = 0.001) after colonoscopy was lower in NDP group compared with CSP group.
CONCLUSION: The NDP contribute to increase satisfaction and decrease anxiety and shame after colonoscopy.
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Kolber MR, Wong CKW, Fedorak RN, Rowe BH, on behalf of the APC-Endo Study Physicians. Prospective Study of the Quality of Colonoscopies Performed by Primary Care Physicians: The Alberta Primary Care Endoscopy (APC-Endo) Study. PLoS One 2013; 8:e67017. [PMID: 23826186 PMCID: PMC3695091 DOI: 10.1371/journal.pone.0067017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 05/14/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The quality of colonoscopies performed by primary care physicians (PCPs) is unknown. OBJECTIVE To determine whether PCP colonoscopists achieve colonoscopy quality benchmarks, and patient satisfaction with having their colonoscopy performed by a primary care physician. DESIGN Prospective multi-center, multi-physician observational study. Colonoscopic quality data collection occurred via completion of case report forms and pathological confirmation of lesions. Patient satisfaction was captured by a telephone survey. SETTING Thirteen rural and suburban hospitals in Alberta, Canada. MEASUREMENTS Proportion of successful cecal intubations, average number of adenomas detected per colonoscopy, proportion of patients with at least one adenoma, and serious adverse event rates; patient satisfaction with their wait time and procedure, as well as willingness to have a repeat colonoscopy performed by their primary care endoscopist. RESULTS In the two-month study period, 10 study physicians performed 577 colonoscopies. The overall adjusted proportion of successful cecal intubations was 96.5% (95% CI 94.6-97.8), and all physicians achieved the adjusted cecal intubation target of ≥90%. The average number of ademonas detected per colonoscopy was 0.62 (95% CI 0.5-0.74). 46.4% (95% CI 38.5-54.3) of males and 30.2% (95% CI 22.3-38.2) of females ≥50 years of age having their first colonoscopy, had at least one adenoma. Four serious adverse events occurred (three post polypectomy bleeds and one perforation) and 99.3% of patients were willing to have a repeat colonoscopy performed by their primary care colonoscopist. LIMITATIONS Two-month study length and non-universal participation by Alberta primary care endoscopists. CONCLUSIONS Primary care physician colonoscopists can achieve quality benchmarks in colonoscopy. Training additional primary care physicians in endoscopy may improve patient access and decrease endoscopic wait times, especially in rural settings.
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Affiliation(s)
- Michael R. Kolber
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
| | - Clarence K. W. Wong
- Department of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Richard N. Fedorak
- Department of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H. Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
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McEntire J, Sahota J, Hydes T, Trebble TM. An evaluation of patient attitudes to colonoscopy and the importance of endoscopist interaction and the endoscopy environment to satisfaction and value. Scand J Gastroenterol 2013; 48:366-73. [PMID: 23320489 DOI: 10.3109/00365521.2012.758768] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Understanding patients' attitudes to their medical experience is essential for identifying value in the patient pathway, optimizing care and use of resources. This service evaluation was undertaken to determine patients' preferences and expectations for day case colonoscopy, a common gastrointestinal procedure for which there is limited such data. METHODS Patients attending for elective colonoscopy were invited to complete a composite, validated dedicated endoscopy questionnaire, with Likert-scale questions and a 15-point preference (ranking) scale of domains of endoscopy care that were considered most important (1) to least important (15) as contributing to a satisfactory experience. RESULTS Two hundred and sixteen out of 224 patients returned questionnaires. Moderate to severe anxiety was recorded in 56% of patients, commonly with respect to anticipation of pain or the results of the procedure. The median values for ranked preference scores consistent with greatest importance for satisfaction were technical skill of the endoscopist (1), discomfort during the procedure (4), and manner of the endoscopist (5). Factors considered of relatively low importance included the single-sex environment (15) (although this was more important to female patients), noise levels (13), and explanation of delay (11). Only 14% of patients responded that they would be prepared to delay an appointment for a single-sex environment. CONCLUSION Patients undergoing colonoscopy highly prioritize aspects of care relating to the interaction with the endoscopist and the procedure itself. Environment factors are considered to be less important. These findings may assist in service redesign around patient-identified value within the patient pathway.
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Affiliation(s)
- Jude McEntire
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
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Azmi N, Chan WK, Goh KL. Evaluation of patient satisfaction of an outpatient gastroscopy service in an Asian tertiary care hospital. BMC Gastroenterol 2012; 12:96. [PMID: 22839572 PMCID: PMC3444441 DOI: 10.1186/1471-230x-12-96] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/19/2012] [Indexed: 12/12/2022] Open
Abstract
Background There are limited published studies on patient satisfaction towards endoscopy from Asian countries. Different methods of evaluation of patient satisfaction may yield different results and there is currently no study to compare results of on-site versus phone-back interviews. Method On-site followed by phone-back interviews were carried out on consecutive patients attending the outpatient gastroscopy service of University of Malaya Medical Centre between July 2010 and January 2011 using the modified Group Health Association of America-9 (mGHAA-9) questionnaire. The question on technical skill of endoscopist was replaced with a question on patient comfort during endoscopy. Results Seven hundred patients were interviewed. Waiting times for appointment and on gastroscopy day, and discomfort during procedure accounted for over 90% of unfavorable responses. Favorable response diminished to undesirable level when waiting times for appointment and on gastroscopy day exceeded 1 month and 1 hour, respectively. Satisfaction scores were higher for waiting time for appointment but lower for personal manner of nurses/staff and explanation given during phone-back interview. There was no significant difference in satisfaction scores for other questions, including overall rating between the two methods. Conclusion Waiting times and discomfort during procedure were main causes for patient dissatisfaction. Phone-back interview may result in different scores for some items compared with on-site interview and should be taken into account when comparing results using the different methods.
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Affiliation(s)
- Najib Azmi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Abstract
AIM The aim of this research was to assess how the use of sedation during colonoscopy influences patient anxiety, fear, satisfaction, and acceptance of repeat examinations. MATERIALS AND METHODS A prospective case-control study quantifying the anxiety and fears of patients appointed for colonoscopy, comparing patients who had undergone previous colonoscopies with sedation (cases) with patients who had undergone previous colonoscopies without sedation and patients who had never had a colonoscopy before (controls). Following the examination, patients answered a satisfaction survey and were asked whether they would be willing to undergo future colonoscopies. RESULTS The study included 2016 patients (average age 50.05 ± 14.44 years; 47% men). Of these, 1270 patients (63%) were undergoing colonoscopy for the first time and 746 (37%) had undergone the procedure before; in the latter group, 313 patients (42%) had been provided sedation, whereas 433 (58%) had not. Patients who had been sedated for prior colonoscopies assigned significantly lower scores than patients who had undergone previous colonoscopies without sedation and those undergoing the procedure for the first time both in the anxiety survey (3.3 ± 2.5 vs. 7.5 ± 2.8 vs. 10.3 ± 3.5; P<0.01) and in the fears survey (7.1 ± 3.0 vs. 14 ± 2.8 vs. 20.3 ± 4.5; P<0.01). Satisfaction survey scores were significantly higher among sedated patients than among nonsedated patients (22.8 ± 2.7 vs. 18.6 ± 2.3). The percentage of sedated patients who would be willing to undergo colonoscopy again was significantly higher than that of nonsedated patients (70 vs. 25%; P<0.001). CONCLUSION Sedation reduces the anxiety and fear of undergoing a repeat colonoscopy and improves both patient satisfaction and the acceptability of future procedures.
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Evaluation of patient satisfaction of an outpatient colonoscopy service in an asian tertiary care hospital. Gastroenterol Res Pract 2012; 2012:561893. [PMID: 22606201 PMCID: PMC3347709 DOI: 10.1155/2012/561893] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/23/2012] [Accepted: 02/24/2012] [Indexed: 01/25/2023] Open
Abstract
Aim. To evaluate patient satisfaction towards an outpatient colonoscopy service and analyze areas of dissatisfaction for potential improvement. Method. Consecutive patients attending the outpatient diagnostic colonoscopy service in University of Malaya Medical Centre between 1st February and 31th July 2010 were interviewed using a questionnaire modified from the modified Group Health Association of America-9 (mGHAA-9) questionnaire. Favorable/unfavorable responses to each question, contribution of each question to unfavorable responses, and effect of waiting times on favorable/unfavorable response rates were analyzed. Results. Interview was carried out on 426 patients (52.1% men). Mean age ± standard deviation was 61.3 ± 12.9 years old. Mean waiting times for colonoscopy appointment and on colonoscopy day were 3.8 ± 2.7 months and 1.1 ± 0.8 hours, respectively. The main factors that contributed to unfavorable responses were bowel preparation followed by waiting times for colonoscopy appointment and on colonoscopy day (32.3%, 27.5%, and 19.6%, resp.). Favorable responses diminished to undesirable levels when waiting times for colonoscopy appointment and on colonoscopy day exceeded 1 month and 1 hour, respectively. Conclusion. Bowel preparation and waiting times were main factors for patient dissatisfaction. Waiting times for colonoscopy appointment and on colonoscopy day should not exceed 1 month and 1 hour, respectively, to maintain acceptable levels of patient satisfaction.
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A literature review of quality in lower gastrointestinal endoscopy from the patient perspective. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 25:681-5. [PMID: 22175059 DOI: 10.1155/2011/590356] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Given the limited state of health care resources, increased demand for colorectal cancer (CRC) screening raises concerns about the quality of endoscopy services. Little is known about quality in colonoscopy and endoscopy from the patient perspective. OBJECTIVE To systematically review the literature on quality that is relevant to patients who require colonoscopy or endoscopy services. METHODS A systematic PubMed search was performed on articles that were published between January 2000 and February 2011. Keywords included "colonoscopy" or "sigmoidoscopy" or "endoscopy" AND "quality"; "colonoscopy" or "sigmoidoscopy" or "endoscopy" AND "patient satisfaction" or "willingness to return". The included articles were qualitative and quantitative English language studies regarding aspects of colonoscopy and⁄or endoscopy services that were evaluated by patients in which data were collected within one year of the colonoscopy⁄endoscopy procedure. RESULTS In total, 28 quantitative studies were identified, of which eight (28.6%) met the inclusion criteria (four cross-sectional, three prospective cohort and one single-blinded controlled study). Aspects of quality included comfort, management of pain and anxiety, endoscopy unit staff manner, skills and specialty, procedure and results discussion with the doctor, physical environment, wait times for the appointment and procedure, and discharge. Qualitative studies eliciting the patient perspective on what constituted quality in colonoscopy⁄endoscopy were not found. CONCLUSIONS Factors related to comfort, staff, communication and the service environment were evaluated from the patient perspective using closed-ended questions that were designed by clinicians and researchers. Future research using qualitative methodology to elicit the patient perspective on quality in colonoscopy and⁄or endoscopy services is needed.
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Hydes T, Yusuf A, Pearl DS, Trebble TM. A survey of patients' attitudes to upper gastrointestinal endoscopy identifies the value of endoscopist-patient interactive factors. Frontline Gastroenterol 2011; 2:242-248. [PMID: 28839618 PMCID: PMC5517240 DOI: 10.1136/fg.2011.004325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2011] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To determine patients' self-reported preferences and expectations for outpatient upper gastrointestinal (UGI) endoscopy, including patients' priorities in obtaining a satisfactory healthcare experience, preprocedure anxiety and its causes, and preferred staff roles. DESIGN A composite, dedicated endoscopy questionnaire was used. This included demographic information, validated Likert scale anxiety-related questions and a 15-point ranking scale of aspects of care (1=most important to satisfaction; 15=least important). SETTING AND PATIENTS Unselected patients attending for an elective UGI endoscopy at two separate units were surveyed on randomly identified days. RESULTS A total of 202 out of 254 patients agreed to participate (79.5%). The values identified as most important to patients included technical skill (2.8) and personal manner of the endoscopist (4.9) and the nurses and support staff (5.8), control of discomfort (5.6) and adequacy of the preprocedure explanation (5.8). The factors considered least important included noise levels (12.5), privacy (10.7) and cleanliness (8.7). Moderate to severe anxiety was recorded in half of the patient cohort, predominantly due to anticipation of pain or the results of the procedure. Most patients preferred the endoscopist to discuss the findings of the endoscopy but expressed no preferences regarding the preprocedure explanation. CONCLUSION Patients undergoing UGI endoscopy appear to highly prioritise aspects of care relating to interaction with the endoscopist and the procedure itself. Environmental factors are considered to have much less value. These findings may assist in service redesign around patient-centred care and the development of patient satisfaction surveys in endoscopy.
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Affiliation(s)
- T Hydes
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - A Yusuf
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - D S Pearl
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - T M Trebble
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
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Lee HY, Lim SM, Han MA, Jun JK, Choi KS, Hahm MI, Park EC. Assessment of participant satisfaction with upper gastrointestinal endoscopy in South Korea. World J Gastroenterol 2011; 17:4124-9. [PMID: 22039328 PMCID: PMC3203365 DOI: 10.3748/wjg.v17.i36.4124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 05/19/2011] [Accepted: 05/26/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To measure the perceived satisfaction with gastric cancer screening as part of the National Cancer Screening Program (NCSP) in South Korea.
METHODS: Data were derived from the participants in a satisfaction survey of the Quality Evaluation of National Cancer Screening in 2009. This is a population-based nationwide telephone survey of participants who were screened by the NCSP between May and October 2009. This study included 4412 participants who provided full sets of data and who had upper endoscopies for the purpose of gastric cancer screening.
RESULTS: The negative appraisal percentages for each of the seven questions were as follows: explanation in preparation for the upper endoscopy, 12.3%; explanation about the process and procedure of the upper endoscopy, 13.8%; explanation about any pain or discomfort related to the upper endoscopy, 27.5%; level of pain during the procedure, 30.3%; physical environment, 16.2%; manner of the staff, 11.2%, and privacy protection, 8.8%.
CONCLUSION: The critical issues identified by the Pareto analysis include the adequacy of the explanation about any pain or discomfort associated with the upper endoscopy and the level of pain experienced during the procedure.
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Abstract
BACKGROUND Familial adenomatous polyposis (FAP) is an inherited condition that requires prophylactic surgery (colectomy) followed by a lifetime program of endoscopic surveillance to prevent colorectal cancer. Patients are normally free of symptoms before surgery but a majority report problems related to bowel function postoperatively. OBJECTIVE The aim of the study was to gain a deeper understanding of how FAP affects life by exploring patients' view of what it is like living with the illness and being committed to a lifelong screening program. METHODS Three focus group interviews were conducted, and data were analyzed using descriptive qualitative content analysis. RESULTS The analysis resulted in two categories related to the participants' view of living with FAP. The first category was associated with concerns related to the hereditary and lifelong nature of the disease as well as to the prophylactic surgery and the second category was related to patients' ways of managing life. CONCLUSION Most participants expressed unmet needs, such as lack of healthcare providers with good knowledge about FAP, practical and psychosocial support, FAP educational programs, and organized meetings with other persons with the condition. IMPLICATIONS FOR PRACTICE One important aspect of living with FAP shared by the participants concerned ways of managing life concerns, something that healthcare providers caring for patients with FAP should identify and support. Furthermore, continuity of care by health care providers with good knowledge about FAP can be an important way of reducing patient concerns.
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Abstract
INTRODUCTION Gastrointestinal endoscopy causes discomfort and pain in patients. Sedation reduces anxiety and pain. Its use, however, continues to be a controversial issue and it varies greatly from one country to another. The use of sedation in Spanish gastrointestinal endoscopy (GIE) units is unknown. AIM To determine the use of sedation in Spanish GIE units. MATERIALS AND METHODS A 24-question survey on the use of sedation was distributed among 300 Spanish GIE units. RESULTS Surveys were answered by 197 GIE units (65%), which had performed 588,326 endoscopies over the past 12 months. Sedation was used in more than 20% of gastroscopies performed at 55% of the GIE units, and more than 20% of colonoscopies were sedated at 71% of the units; endoscopic retrograde cholangiopancreatography (ERCP) is almost always performed under sedation. The most common drugs were midazolam for gastroscopy and midazolam and pethidine for colonoscopy and ERCP; propofol is used by anesthetists; pulse oximetry is used at 77% of GIE units; 42% of the GIE units fill in a nursing record; 52% of GIE units have recovery rooms and 91% have a cardiac arrest trolley. CONCLUSION The use of sedation in endoscopy varies greatly in Spain. It is seldom used in gastroscopy; it is more frequent in colonoscopy, and in ERCP it is the norm. In most GIE units sedation is controlled by the endoscopist with pulse oximetry. The most commonly used drugs are benzodiazepines, on their own for gastroscopy and combined with opioids for colonoscopy and ERCP.
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Water-assisted unsedated colonoscopy: does the end justify the means? Gastrointest Endosc 2009; 69:551-3. [PMID: 19231498 DOI: 10.1016/j.gie.2008.10.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 10/27/2008] [Indexed: 02/08/2023]
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