EditorWe have previously reported on starting a routine follow-up after critical care in this hospital.1 We now report the results of the first year of our routine anonymous patient satisfaction survey.
Each week there are two follow-up ward rounds when all discharges are seen by the outreach team consisting of a consultant, a senior nurse and a trainee doctor who was on duty the preceding weekend. At the patient visit a questionnaire is completed by the outreach team and any other problems dealt with. When this has been finished the patient is handed a letter. The letter is signed by the Consultant and the patient invited to complete an open text section and write anything that is good but also anything that could be improved. The next section is for the visitors and they are asked to complete it in the same way. Under the signature is a question that asks if this visit was of value with a yes/no tick box. A self-addressed envelope is attached to enable the reply to be sent using the hospital mail system. It is stressed verbally and in the letter that this is anonymous from the patient unless they want to fill in their name, in which case a reply is promised. Because this is an anonymous questionnaire and completion is optional, ethical approval was thought unnecessary.
From January 1 to December 31, 2004, 557 patients were visited after an ICU admission and 315 comment letters given out. Of the 242 patients not given a letter, 88 had died, 55 had either been discharged to another unit or already home, 39 patients were not given a letter (too unwell or not able to understand the letter) and in a further 60, it was unclear if a comment letter had been issued.
In total, 118 (37%) replies were received and 111 (94%) contained positive comments. Some contained both positive and negative comments. Eighteen (15%) contained a comment about things that could be improved including; frustration at the long delay for a ward bed, creaking doors, small relatives room, lack of a fan, visiting during ward rounds and the Doctors office should not be in a clinical area. There were other comments about pain relief, one that a patient found it difficult to give their own pain relief, another that the patient was told not to use too much morphine. One complaint involved an inter-relative dispute. The final two comments were about excessive noise.
All of these comments were discussed where appropriate and remedial measures taken if necessary. Patients were written to when their name and address had been supplied.
Only 71 letters had the tick box completed about the usefulness of the visit, the majority of the patients (67) found it of value. The low response rate may reflect the design of the letter, with the question appearing under the signature. Future versions will have the question displayed more prominently.
Customer satisfaction surveys are common in many consumer industries. We are unaware of any routine survey of this type in patients after admission to an ICU. Inviting comments, rather than waiting for a complaint, does seem to be better. Patients might not make comments unless invited to do so and the improvements these make missed. It also defuses any problems early on, possibly preventing difficulties escalating into formal complaints. During the time of this survey there were no complaints made to the Patient Advice and Liaison Service.
The cost of this type of survey is very small and most patients comment positively on the care they received. This is passed on to the staff. The other comments are also invaluable as they help the ICU to improve.
Cambridge, UK
References
1 Park GR, McElligot M, Torres C. Outreach critical carecash for no questions? Br J Anaesth 2003; 90: 7001[ISI][Medline]