Timely Care is Patient-Centered Care for Patients with Acute Cholecystitis at a Safety-Net Hospital
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ORIGINAL SCIENTIFIC REPORT
Timely Care is Patient-Centered Care for Patients with Acute Cholecystitis at a Safety-Net Hospital Gabrielle E. Hatton1,2 Lillian S. Kao1,2
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Krislynn M. Mueck1,2 • Isabel M. Leal1,3 • Shuyan Wei1,2 • Tien C. Ko1
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Accepted: 16 August 2020 Socie´te´ Internationale de Chirurgie 2020
Abstract Background Multiple strategies exist to improve the timeliness and efficiency of surgical care at safety-net hospitals (SNH), such as acute care surgery models and nighttime surgery. However, the patient-centeredness of such approaches is unknown. Methods Adults ( C18 years) with acute cholecystitis were interviewed upon admission to a SNH. Interviews were semi-structured and designed to obtain both exploratory qualitative data and ratings of patient-centered outcomes, ranked by importance to the patient. Outcomes included for rating were general health, symptom status, quality of life, and return to prior functional status. Latent content analysis applying inductive coding methods were used to code and condense raw qualitative data from interview transcripts. Results Thematic saturation was reached with a sample size of 15 patients. Most participants were female (87%), Hispanic (87%), and had prior diagnosis of benign biliary disease (60%). Patients identified symptom resolution as the highest-ranked outcome in their treatment. Themes expressed by patients during the exploratory segments of the interview included: desire for pain alleviation, frustration with delays to both symptom resolution and surgical intervention, lack of perceived control over their health care, and reticence in discussing preferences with physicians. All patients preferred to have surgical treatment as soon as possible, even if that meant having nighttime surgery. Conclusions Effective and timely resolution of symptoms is of utmost importance to patients with acute cholecystitis at a SNH. Efforts to improve timeliness of surgical care are also perceived as patient-centered.
Abbreviations IOM Institute of Medicine SNH Safety-net hospital LBJGH Lyndon Baines Johnson General Hospital & Gabrielle E. Hatton [email protected] 1
Department of Surgery, McGovern Medical School at UTHealth, 6410 Fannin Street Suite 471, Houston, TX 77030, USA
2
Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
3
Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX, USA
Introduction Safety-net hospitals (SNH) are essential to the health care system in the USA by providing care for uninsured and vulnerable patients. High-quality surgical care for these patients is critical. However, recent studies reported surgical care at SNH lags is worse than at non-SNHs in five of the six quality domains, as defined by the Institute of Medicine (IOM): timeliness, equity, patient-centeredness, safety, effectiveness, and efficiency [1, 2]. Specifically, SNHs repeatedly perform the poorest in timeliness or
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World J Surg
provision of heal
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