Post-endoscopic procedure satisfaction scores: Can we improve?

ARTICLE HIGHLIGHTS

Research Background

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. A commonly used survey known as the modified Group Health Association of America patient satisfaction survey (mGHAA-9) focuses on key points throughout the patient’s experience, including, waiting time, manners of the staff and doctor, doctor skills and explanation of the procedure³. Currently, the mGHAA-9 is not in use at Georgetown University Hospital; rather, every patient that has an outpatient procedure receives a follow up call asking him/her to rank the experience on a scale of 1-3. This formal post procedural call system was implemented in January 2014 and is carried out by our administrative personnel. This data is filed in the electronic medical record and has been largely ignored to date.

Research motivation

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. Our primary outcome was to assess improvement in response rates from a mailed out survey via the postal service to telephone outreach to assess post-procedure satisfaction scores. The secondary analysis, and more informative aspect of the study, was to see if the use of predictive analytics could identify independent predictors of procedure length, which could then be focused on to optimize patient experience in the endoscopy unit at this tertiary care facility.

Research objectives

Our primary outcome was to assess improvement in response rates from a mailed out survey via the postal service to telephone outreach to assess post-procedure satisfaction scores. The secondary analysis, and more informative aspect of the study, was to see if the use of predictive analytics could identify independent predictors of procedure length, which could then be focused on to optimize patient experience in the endoscopy unit at this tertiary care facility. Statistical analysis of this information will allow for reflection on current practices and lead to process improvements in order to optimize the patient experience in our endoscopy suite at Georgetown University Hospital, and perhaps help to construct a universal protocol that could be adopted by other institutions nationwide that would enhance patient experience.

Research methods

A database of two cohorts of outpatients that underwent endoscopic procedures at Georgetown University Hospital was compiled. Several patient-related and procedure-related variables were recorded. For continuous and categorical variables, differences in averages were tested by two sample t-test, Wilcoxon rank sum test, ANOVA and χ² test as appropriate. Correlation test and linear regression analyses were also conducted to examine relationships between length of procedure and continuous predictors.

Research results

With the addition of post-procedure calls, instilled in January 2014, the response rate was 40.5%. 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. Upon analysis of patient-related variables, there was also a statistically significant relationship that was seen between age and procedure length. Our study proves that calling patients after they undergo endoscopy can drastically improve post procedure satisfaction response rates. However, the ideal method of obtaining post procedure satisfaction responses has yet to be implemented. The secondary aim of this study, to identify independent variables that directly affect length of procedure, which is often a surrogate for patient satisfaction, found statistical significance for patient age, but not body mass index (BMI).

Research conclusions

Our research demonstrates that following the January 2014 implementation of a formal post-endoscopic telephone call to patients, patient response dramatically increased (satisfaction survey response rate of 40.5% compared to 3.4%). This finding highlights the importance of provider-initiated follow-up in obtaining patient feedback. Implementing this phone call system as a means of direct communication with patients at other locations who do not currently utilize such a process could potentially increase response rates in patient feedback, as was seen in our center so that endoscopy centers, same day surgery centers, or entire hospital systems can better meet the needs of their patients. As our phone communication requires live callers from our endoscopy center, a future study to investigate whether the use of an automated system would similarly result in increased patient response rates, would be of particular interest for optimum resource management. Ultimately, a reporting system that approaches 100% response rate should be achieved. Even with the strides made in the implementation of post procedure telephone calls, we still fall far short of our goal of 100% response rate. This may require patient’s filling out surveys prior to discharge from the endoscopy suite, vs scheduling early, post procedure follow-up visits where this data can be obtained, vs email or text message response systems. Future studies on how best to meet the needs of our ever-changing population are needed to identify best practices. The secondary aim of this study, to identify independent variables that directly affect length of procedure, which is often a surrogate for patient satisfaction, found statistical significance for patient age, time of the day of the procedure and type of procedure, but not BMI or sex. We can conclude based on our data that changing the scheduling or time allotted for procedures based on these characteristics would not drastically change the flow in the endoscopy suite.

Research perspectives

The research is able to show that following the January 2014 implementation of a formal post-endoscopic telephone call to patients, patient response improves dramatically. This finding highlights the importance of provider-initiated follow-up in obtaining patient feedback. Implementing this phone call system as a means of direct communication with patients at other locations who do not currently utilize such a process could potentially increase response rates in patient feedback, as was seen in our center so that endoscopy centers, same day surgery centers, or entire hospital systems can better meet the needs of their patients. As our phone communication requires live callers from our endoscopy center, a future study to investigate whether the use of an automated system would similarly result in increased patient response rates, would be of particular interest for optimum resource management. Ultimately, a reporting system that approaches 100% response rate should be achieved. Even with the strides made in the implementation of post-procedure telephone calls, we still fall far short of our goal of 100% response rate. This may require patient’s filling out surveys prior to discharge from the endoscopy suite, vs scheduling early, post-procedure follow-up visits where this data can be obtained, vs email or text message response systems which should be studies in a prospective fashion. Future studies on how best to meet the needs of our ever-changing population are needed to identify the best practices. Limitations in this study also include analyzing data at only one endoscopic center in a retrospective fashion. As our center is a university affiliated tertiary referral center in a major metropolitan area, perhaps our findings would not be entirely generalizable or extrapolated to other smaller, community institutions or private practices in rural areas and should be studied in those settings in a similar fashion as ours.