In the era of Facebook "Likes," Yelp, and quick online surveys on every topic imaginable, it makes sense that we'd turn to patient satisfaction scores to help us decide at what hospital we -- or a family member -- will have surgery. After all, who better to tell us about the patient experience than other people?
Unfortunately, a new study by Johns Hopkins University School of Medicine researchers found that there was a big disconnect between the quality of what happens in surgery and the perception of patients about a hospital. The study was published recently in JAMA Surgery.
Surgical patients who reported they had a positive experience in the hospital did not necessarily get high-quality surgical care, according to the research.
In other words, don't let a happy Facebook page or even a hospital's reports about patient satisfaction serve as a key factor in deciding where to go for surgery. The researchers found little evidence there was any correlation between patient satisfaction and quality.
There are certain factors -- typically not seen by a patient -- that contribute to high quality care.They don't sound very exciting, but research has shown that having certain routine procedures and safety factors in place make a big difference in how healthy you'll be after the surgery. Those factors include, for example, how well the hospital prevents potential complications like infections and blood clots, and how extensively staff are committed to and educated about providing safe, error-free care.
The researchers looked at quality measures and patient satisfaction data at 31 urban hospitals in 10 states. Medicare patient experience surveys were reviewed to identify the level of patient satisfaction. Quality was determined by how closely physicians and staff followed recommended standards of care.
Martin Markey, M.D., the lead author of the study, said satisfaction scores will mislead patients since they're going to feel that the "hospital with the best lobby and the best parking and customer service is going to have the best heart surgery."
The researchers looked at quality factors that have been shown to improve surgical outcomes, such as the use of antibiotics to prevent infections; prevention of deep vein thrombosis (such as blood clots in the legs); prompt removal of bladder catheters; and the hospital's commitment to safety.
They said that while patient assessments may tell you something about the overall patient experience at a hospital, don't count on them to give you guidance about the quality of care related to surgery.
And don't look to the Affordable Care Act to improve this problem. Patient assessments of quality account for 30% of the score that determines whether hospitals will get bonuses or penalties under the law's "value-based purchasing program."
What does this mean for you?
- When your surgeon tells you what hospital you will be going to for surgery, ask whether you have a choice. You may not. Some surgeons only do surgery at one facility. If you do have another option, ask about the pros and cons of each facility, especially in terms of surgical outcome.
- If you don't like the surgeon's answers or if you have concerns about the recommended hospital, consider getting a second opinion from another surgeon.
- Don't be impressed with frills like valet parking or free Wi-Fi. Understand that quality surgery care is a little like air travel: no matter how good (or bad) the in-flight entertainment or the mileage bonuses may be, your ultimate goal is to get where you want to go safely and with a minimum of drama.
- Be wary of hospitals advertisements and reports about patient satisfaction. Ask for hard data about key safety factors, including not just the ones the researchers used in this study (as noted above), but readmission rates, infection rates, adverse events, and average length of hospital stay for the surgery you're getting (longer stays are often correlated with complications).
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