RESUMEN
OBJECTIVE: To explore the association between patients' body mass index (BMI) and their experiences with inpatient care. DESIGN: Cross-sectional. Mail survey. SETTING: University Hospital of Geneva. PARTICIPANTS: Questionnaires were mailed to 2385 eligible adult patients, 6 weeks after discharge (response rate = 69%). MAIN OUTCOME MEASURES: Patients' experiences with care were measured using the Picker inpatient survey questionnaire. BMI was calculated using self-reported height and weight. Main dependent variables were the global Picker patient experience (PPE-15) score and nine dimension-specific problem scores, scored from 0 (no reported problems) to 1 (all items coded as problems). We used linear regressions, adjusting for age, gender, education, subjective health, smoking and hospitalization, to assess the association between patients' BMI and their experiences with inpatient care. RESULTS: Of the patients, 4.8% were underweight, 50.8% had normal weight, 30.3% were overweight and 14.1% were obese. Adjusted analysis shows that compared with normal weight, obesity was significantly associated with fewer problematic items in the surgery-related information domain, and being underweight or overweight was associated with more problematic items in the involvement of family/friends domain. The global PPE-15 score was significantly higher (more problems) for underweight patients. CONCLUSIONS: Underweight patients, but not obese patients, reported more problems during hospitalization.
Asunto(s)
Hospitalización , Pacientes Internos , Calidad de la Atención de Salud , Adulto , Anciano , Índice de Masa Corporal , Continuidad de la Atención al Paciente , Estudios Transversales , Escolaridad , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Apoyo Social , Encuestas y CuestionariosRESUMEN
BACKGROUND: Quality improvement in healthcare organisations requires structural reorganisation and systems reform, and also the development of an appropriate organisational "culture". Beliefs and attitudes that are thought by experts to be conducive to quality improvement in hospitals include the understanding of healthcare as a complex system, recognition of the importance of coordination of healthcare processes, a positive attitude towards medical error, adherence to the concept of continuous improvement, and a central preoccupation with the patient's welfare. OBJECTIVES: To explore the ideas about quality held by hospital-based doctors and nurses in Geneva, Switzerland. METHODS: Semi-structured interviews were conducted with 21 doctors and nurses in five hospital departments to explore their ideas about the definition of quality in healthcare, their perceptions about the main barriers to achieving quality healthcare, the factors that facilitate delivery of quality healthcare, and notions of responsibility for ensuring quality healthcare. RESULTS AND CONCLUSIONS: Thematic analysis of the interview data suggested that doctors' and nurses' ideas bear little resemblance to models of quality developed by quality experts. Study participants considered quality of care to be primarily the responsibility of individual practitioners. Quality was seen as mainly dependent on the practitioners' mastery of the technical and interpersonal aspects of care. In contrast, the healthcare system was seen primarily as a source of obstacles to good quality care, providing insufficient resources and imposing an excessive administrative burden. The paper discusses the potential implications of these ideas for the implementation of quality management initiatives.
Asunto(s)
Actitud del Personal de Salud , Cuerpo Médico de Hospitales/psicología , Personal de Enfermería en Hospital/psicología , Calidad de la Atención de Salud , Competencia Clínica , Conducta Cooperativa , Hospitales Públicos , Hospitales Universitarios , Humanos , Entrevistas como Asunto , Motivación , Cultura Organizacional , Rol Profesional , Garantía de la Calidad de Atención de Salud/métodos , SuizaRESUMEN
OBJECTIVE: To assess whether patients' perceptions of a hypothetical medical error are influenced by staff responsiveness, disclosure of error, and health consequences of the error. DESIGN: Hypothetical scenario describing a medication error submitted by mail. Three factors were manipulated at random: rapid v slow staff responsiveness to error; disclosure v non-disclosure of the error; and occurrence of serious v minor health consequences. PARTICIPANTS: Patients discharged from hospital. MEASURES: Assessment of care described in the scenario as bad or very bad, rating of care as unsafe, and intent to not recommend the hospital. RESULTS: Of 1274 participants who evaluated the scenario, 71.4% rated health care as bad or very bad, 60.2% rated healthcare conditions as unsafe, and 25.5% stated that they would not recommend the hospital. Rating health care as bad or very bad was associated with slow reaction to error (odds ratio (OR) 2.8, 95% CI 2.1 to 3.6), non-disclosure of error (OR 2.0, 95% CI 1.5 to 2.6), and serious health consequences (OR 3.4, 95% CI 2.6 to 4.5). Similar associations were observed for rating healthcare conditions as unsafe and the intent to not recommend the hospital. Younger patients were more sensitive to non-disclosure than older patients. CONCLUSIONS: Former patients view medical errors less favorably when hospital staff react slowly, when the error is not disclosed to the patient, and when the patient suffers serious health consequences.
Asunto(s)
Actitud Frente a la Salud , Relaciones Paciente-Hospital , Hospitales Universitarios/normas , Errores de Medicación/psicología , Calidad de la Atención de Salud/clasificación , Administración de la Seguridad/normas , Revelación de la Verdad , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Errores de Medicación/efectos adversos , Persona de Mediana Edad , Alta del Paciente , Encuestas y Cuestionarios , Suiza , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate whether hospitalised patients would agree to wear an identification bracelet and whether patient acceptability is improved by more detailed explanations or by using a code instead of a name on the bracelet. DESIGN: Patient survey that tested two variables in a randomised factorial design. Explanations about identification bracelets were given (a) with or without examples of situations where patient identification may be important, and (b) with the patient name or an anonymous code appearing on the bracelet. SETTING: Swiss teaching hospital where wearing of identification bracelets was not systematic. PARTICIPANTS: Adult patients discharged from hospital (n = 1411). MAIN OUTCOME MEASURES: Patients' responses to the questions: (a) should the hospital introduce a compulsory identification bracelet? and (b) would the patient agree to wear such a bracelet? RESULTS: Globally, 83.9% of patients thought that the hospital should introduce bracelets and 90.2% stated that they would agree to wear one. Providing examples increased support for both the hospital policy (87.9% v 79.2%, p<0.001) and personal acceptance (92.2% v 88.1%, p = 0.015). Whether or not the bracelet carried the patient's name or an anonymous code did not influence patient choice. CONCLUSIONS: The majority of patients were in favour of wearing an identification bracelet during their hospital stay. This proportion increased significantly when an explanation based on examples of the consequences of incorrect patient identification had been provided.