Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.
BMJ Qual Saf. 2019 Mar;28(3):190-197. doi: 10.1136/bmjqs-2018-008159. Epub 2018 Sep 29.
To assess patient comfort speaking up about problems during hospitalisation and to identify patients at increased risk of having a problem and not feeling comfortable speaking up.
Cross-sectional study.
Eight hospitals in Maryland and Washington, District of Columbia.
Patients hospitalised at any one of eight hospitals who completed the Hospital Consumer Assessment of Healthcare Providers and Systems survey postdischarge.
Response to the question 'How often did you feel comfortable speaking up if you had any problems in your care?' grouped as: (1) during hospitalisation, (2) felt comfortable speaking up and (3) felt comfortable speaking up.
Of 10 212 patients who provided valid responses, 4958 (48.6%) indicated they had experienced a problem during hospitalisation. Of these, 1514 (30.5%) did not always feel comfortable speaking up. Predictors of having a problem during hospitalisation included age, health status and education level. Patients who were older, reported worse overall and mental health, were admitted via the Emergency Department and did not speak English at home were less likely to always feel comfortable speaking up. Patients who were not always comfortable speaking up provided lower ratings of nurse communication (47.8 vs 80.4; p<0.01), physician communication (57.2 vs 82.6; p<0.01) and overall hospital ratings (7.1 vs 8.7; p<0.01). They were significantly less likely to definitely recommend the hospital (36.7% vs 71.7 %; p<0.01) than patients who were always comfortable speaking up.
Patients frequently experience problems in care during hospitalisation and many do not feel comfortable speaking up. Creating conditions for patients to be comfortable speaking up may result in service recovery opportunities and improved patient experience. Such efforts should consider the impact of health literacy and mental health on patient engagement in patient-safety activities.
评估患者在住院期间主动提出问题的舒适度，并确定存在问题且主动提出问题时感到不适的风险较高的患者。
横断面研究。
马里兰州和哥伦比亚特区华盛顿的八家医院。
在八家医院之一住院且出院后完成医疗保健提供者和系统医院消费者评估调查的患者。
将回答“在您的护理过程中如果有任何问题，您通常有多频繁感到舒适主动提出问题？”这一问题的结果分为：（1）住院期间，（2）感到舒适主动提出问题，和（3）感到舒适主动提出问题。
在提供有效回复的 10212 名患者中，4958 名（48.6%）表示他们在住院期间经历过问题。其中，1514 名（30.5%）并不总是感到舒适主动提出问题。住院期间出现问题的预测因素包括年龄、健康状况和教育水平。年龄较大、报告总体和心理健康状况较差、通过急诊入院且在家不说英语的患者不太可能总是感到舒适主动提出问题。不总是感到舒适主动提出问题的患者对护士沟通的评分较低（47.8 分 vs 80.4 分；p<0.01）、医生沟通（57.2 分 vs 82.6 分；p<0.01）和整体医院评分（7.1 分 vs 8.7 分；p<0.01）。与总是感到舒适主动提出问题的患者相比，他们明显不太可能明确推荐该医院（36.7% vs 71.7%；p<0.01）。
患者在住院期间经常遇到护理问题，许多患者并不感到舒适主动提出问题。为患者创造舒适主动提出问题的条件可能会带来服务补救机会并改善患者体验。此类工作应考虑健康素养和心理健康对患者参与患者安全活动的影响。
