Patient Satisfaction and Readmission to Hospital - Essay Example

Patient Satisfaction and Readmission to Hospital Readmission, also known as revolving door phenomenon is a common problem in psychiatric services. It is a source of frustration not only for the patients but also for their families and the hospital team. For more than 3 decades, extensive research has been done to evaluate the causes of readmission. Such an evaluation is important because it helps in improving the quality of health care delivered and also serves as a basis for any changes in intervention that need to be undertaken. One of the most intensely researched aspects of psychiatric services is patient satisfaction. There is much debate as to whether this aspect is related to hospital readmission. Though there is lot of literature pertaining to patient satisfaction, including factors affecting it and also predictors of patient satisfaction, there are not many studies correlating patient satisfaction to hospital readmission. This literature review aims to evaluate the association between patient satisfaction and hospital readmission. Admissions to psychiatric ward can occur due to many reasons. Bernado and Forchuk (2001) examined causes for hospital admission in psychiatric services. In their study, some of the frequently reported reasons for admission from a clinicians perspective were worsening of symptoms, aggression, suicidal risk concern, alcohol abuse, drug abuse, psychosocial stress, court-ordered assessment, medication adjustment, medication destabilization and medication compliance. From patients view, reasons for admission noticed were persistence of symptoms, difficulties with relationships, noncompliance of medication, alcohol abuse, drug abuse, medical problems and aggression. After treatment and recovery, the admitted patients are discharged with a hope and wish not to get readmitted to the hospital. But every wish is not granted and some patients do come back to the hospital for readmission. It is important for physicians to critically examine the factors for readmission so that appropriate steps are taken to prevent further readmissions. Also, it is important for the physicians to have good information on their patients outcome and what interventions work for them and under what type of circumstances so that this information can be used to improve the quality of health care delivered and in turn improve the quality of the lives of the patients suffering from mental illnesses (Smith et al, 1997). In the study by Bernado and Forchuk (2001), some of the factors affecting readmission were male sex, disrupted marital status, younger age, more than primary school education, unemployment status, worsening or persistence of symptoms, aggression on the part of the patient, alcohol/drug abuse, difficulties with relationships, medication noncompliance, a diagnosis of schizophrenia, personality disorder, mood disorder and schizoaffective disorder and previous history of readmission. The same study also identified patient dissatisfaction as a cause for readmission. The researchers of the study argued that inadequate assessment and interventions led to loss of focus on important patient-identified issues which contributed to patient dissatisfaction and readmission. Also, in some cases like alcohol abuse and drug abuse, the main psychiatric disorder might be masked leading to deficient intervention and patient dissatisfaction. In some cases, repeated admissions may make the staff lose interest in proper evaluation and intervention contributing to ineffective management which again triggers the cycle of patient dissatisfaction- readmission-patient dissatisfaction. Patient satisfaction is essential for maintaining and expanding practice. It is a major indicator of the health service quality (Rosenheck, 1997). The importance of patient satisfaction is growing and more and more psychiatric professionals want to know if their patients are satisfied with the services provided because patient satisfaction is associated with improved clinical outcomes and also improved administrative measures of good-quality care (Pellegrin et al, .2001). To evaluate patient satisfaction, several specific measures have been developed. However, there are many methodological problems as far as interpretation of the measurements of satisfaction is concerned. Research has shown that item response formats like Charleston Psychiatric Outpatient Satisfaction Scale are the most sensitive measures of patient satisfaction (Pellegrin et al, .2001). Also, domain specific measures of satisfaction are more useful than general measures of satisfaction (Ruggeri, 1994; qtd. in Gerber and Prince, 1999). Surveys conducted through mails are more appropriate than surveys conducted over telephone and other methods because mailed surveys are more efficient and non-intrusive (Gerber and Prince, 1999). Patient satisfaction is a widely studied subject is psychiatric services. It is often related to social functioning, quality of life and one-year prognosis of the mental illness (Berghofer et al, 2001). Patient satisfaction is dependent on many factors in the health care like coordination, information, timeliness and access, courtesy, emotional support, respect for patients preferences, physical comfort, family involvement, transition from hospital, involvement of staff, practical orientation and therapeutic alliance. Other factors which affect patient satisfaction are the interaction between interdisciplinary teams that provide services. The quality of services provided by these teams is dependent on the leadership quality of the team managers. Research has shown that transformational and transactional leadership approaches are associated with good patient satisfaction (Corrigan et al, 2000). According to Rosenheck et al (1997), some of the strong predictors of positive patient satisfaction are married status, old age, mild illness and longer duration of hospital stay. Good relationship between staff and patient also enhances patient satisfaction (Kuosmanen et al, 2004). Many researchers are pointing to mental illness as a predictor of patient satisfaction. A study by Hoff et al (1999) reported that patients with a diagnosis of psychiatric diagnosis at the time of discharge had lower rates of satisfaction than when compared to patients with a medical diagnosis at the time of discharge. Non-compliance of medication is another factor influencing patient satisfaction which merits attention. Some of the factors predicting non-compliance are education status, hospital status and previous patient-initiated changes in medication (Ruscher et al, 1997). Patient satisfaction is also dependent on treatment outcomes. The association between patient satisfaction and outcomes of treatment has been widely studied. Predictors of treatment outcome are demographic factors, psychiatric status, functional quality of life, subjective quality of life and level of care (Russo et al, 1997). From this literature review, it is evident that patient satisfaction is affected by many factors, the most important being clinical outcomes. Patients come to the hospital for getting rid of bothering symptoms. They get admitted with the trust that the treatment instituted will relieve them of symptoms and cure them of the disease. When the expected outcome is not met, patients are not satisfied, and they come back to the hospital. References Bernado, A.C., and Forchuk, C. (2001). Factors Associated With Readmission to a Psychiatric Facility. Psychiatric Services, 52(8), 1100- 1102. Berghofer, G., Lang, A., Henkel, H., Schmidl, F., Rudas, S., and Schmitz, M. (2001). Satisfaction of Inpatients and Outpatients With Staff, Environment, and Other Patients. Psychiatric Services, 52(1), 1102- 1104. Chakraborty, N., and Aryiku, C. (2006). Reasons for rapid readmission to general adult psychiatry wards. Progress in Neurology and Psychiatry, 14- 18. Corrigan, P.W., Lickey, S.E., Campion, J., and Rashid, F. (2000). Mental Health Team Leadership and Consumers’ Satisfaction and Quality of Life. Psychiatric Services, 51(6), 781- 785. Gerber, G.J.and Prince, P.N. (1999). Measuring Client Satisfaction with Assertive Community Treatment. Psychiatric Services, 50(4), 546- 550. Hoff, R.A., Rosenback, R.A., Meterko, M.and Wilson, N. (1999). Mental Illness as a Predictor of Satisfaction With Inpatient Care at Veterans Affairs Hospitals. Psychiatric Services, 50(5), 680- 685. Kuosmanen, L., Haronen, H., Jyrkinene, A.R., Katajisto, J., and Valimaki, M. (2006). Patient satisfaction with Psychiatric Inpatient Care. Journal of Advanced Nursing, 55(4), 655- 663. Pellegrin, K.L., Stuart, G.W., Maree, B., Frueh, B.C., and Ballenger, J.C. (2001). A Brief Scale for Assessing Patients’ Satisfaction With Care in Outpatient Psychiatric Services. Psychiatric Services, 52(6), 816- 819. Rosenheck, R., Wilson, N. J., and Meterko, M. (1997). Influence of patient and hospital factors on consumer satisfaction with inpatient mental health treatment. Psychiatric Services, 48(12), 1553- 1561. Ruscher, S.M., Wit, R., and Mazmanian, D. (1997). Psychiatric Patients Attitudes About Medication and Factors Affecting Noncompliance. Psychiatric Services, 48(1), 82- 85. Russo, J., Roy-Byrne, P., Jaffe, C.,Ries, R., Dagadakis, C., and Avery, D. (1997). Psychiatric Status, Quality of Life, and Level of Care as Predictors of Outcomes of Acute Inpatient Treatment. Psychiatric Services, 48(11), 1427- 1434. Smith, G.R., Manderscheid, R.W., Flynn, L.M., and Steinwachs, D.M. (1997). Principles for Assessment of Patient Outcomes in Mental Health Care. Psychiatric services, 48(8), 1034- 1036. Read More