G. E. Hatton1, K. M. Mueck1, I. M. Leal2, S. Wei1, T. C. Ko1, L. S. Kao1 1McGovern Medical School at UTHealth,Houston, TX, USA 2University Of Houston,Houston, TX, USA
Introduction: The patient-centeredness of surgical care in safety-net hospitals is under-evaluated. Surgical care for acute cholecystitis is often delayed among patients presenting to a safety-net hospital due to lack of access to medical care and limited hospital resources. Multiple strategies exist to improve the timeliness and efficiency of surgical management of gallstone disease, such as acute care models and nighttime surgery. However, the patient-centeredness of such strategies is unknown. Our objective was to identify patient perceptions of their surgical care and the outcomes most important to them. We hypothesized that efforts to improve timeliness of surgical care are also patient-centered.
Methods: Adult patients with acute cholecystitis were interviewed upon admission to a safety-net hospital. 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 previously identified by the Patient-Centered Outcomes Research Institute: general health, symptom status, quality of life, and return to prior functional status. Purposive sampling was utilized until data saturation was reached. Latent content analysis applying inductive coding methods were used to code and condense raw qualitative data from interview transcripts. Triangulation methods were used to increase the validity and credibility of the results.
Results: Interviews were conducted until thematic saturation was reached with a sample size of 15 patients. The majority of participants were female (87%), Hispanic (87%), and had prior non-operative management of biliary colic (60%). Patients identified symptom resolution as the highest-ranked outcome in their treatment (Figure). Themes commonly 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 current health, and reticence in discussing preferences with physicians. All patients preferred to have surgical treatment for their gallstone disease 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 safety-net hospital. Efforts to improve timeliness and patient-centeredness of surgical care are concordant. Evaluation of the relationship between improvement in timeliness and other quality domains, such as safety, is needed.
