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doi: 10.1097/ALN.0000000000000110

Pain-free Surgery or Pain-free Parking: Measuring Patient Satisfaction with Perioperative Care Is Humbling for the Anesthesiologist

Hyder, Joseph A. M.D., Ph.D.

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To the Editor:

Barnett et al.1 are to be thanked and congratulated for their attempted synthesis of efforts to quantify patient satisfaction with anesthesia care. The authors did not include the Surgical Consumer Assessment of Healthcare Providers and Systems® (CAHPS) in their assessment, which deserves discussion.2
Surgical CAHPS is the newest member of the CAHPS family and is the only tool measuring patient satisfaction with surgical (or anesthesia) care which is endorsed (in whole or in part) by the National Quality Forum, the main clearinghouse for performance measurement in health care.* Surgical CAHPS was designed by the American College of Surgeons with the Agency for Healthcare Research and Quality to be psychometrically rigorous. The instrument incorporates information from multiple care streams and providers of perioperative care—surgeon, nurse, anesthesiologist, hospital, and clinic.
Although four of the seven selected measures ask about the “surgeon,” none ask about anesthesia care. When adopting and endorsing Surgical CAHPS as a publicly reportable performance measure (NQF #1741), the National Quality Forum included fewer than half of the questions making up the tool. Psychometric properties were ignored. Our specialty and the care we provide for patients were also ignored. Although four of the seven selected components ask about the “surgeon,” none ask about anesthesia care.
Rather than feel “snubbed,” perhaps we anesthesiologists may find a pause point to imagine care from the perspective of the patient. For a “person” who becomes a “patient,” the lines separating surgery, nursing, anesthesia, and pain-free hospital parking can easily blur. This, of course, is why using a psychometrically rigorous instrument can be important, especially for targeting specific areas for improvement. But in practice, applying lengthy instruments for each component of perioperative care may induce survey fatigue in our patients and compromise the results of such surveys. More importantly, our patients are frequently unaware that we are physicians or that anesthesia care matters, as the American Society of Anesthesiologists’ “Physician Anesthesiologist” campaign points out. As physicians practicing medicine, our goal is not to meet quarterly anesthesia satisfaction benchmarks but to earn patient loyalty by assuring that our patients are cared for—period.3 Embracing this concept would cement our role as perioperative physicians and align our goals with those of surgeons, nurses, hospitals, and, most importantly, our patients.
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Competing Interests

The author declares no competing interests.
Joseph A. Hyder, M.D., Ph.D.
, Mayo Clinic, Rochester, Minnesota; Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts.
* Available at: Accessed September 12, 2013. Cited Here...
† Available at: Accessed December 3, 2013. Cited Here...
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1. Barnett SF, Alagar RK, Grocott MP, Giannaris S, Dick JR, Moonesinghe SR. Patient-satisfaction measures in anesthesia: Qualitative systematic review. ANESTHESIOLOGY. 2013;119:452–78

2. Hoy EW. The surgical CAHPS survey. Bull Am Coll Surg. 2009;94:6–7

3. If Disney Ran Your Hospital: Nine and a Half Things That Would Be Different. 2004 Bozeman Second River Healthcare Press

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