Luo Jessica, West Nicholas C, Pang Samantha, Robillard Julie M, Page Patricia, Chadha Neil K, Gan Heng, Correll Lynnie R, Ridgway Randa, Broemling Natasha, Görges Matthias
Research Institute, BC Children's Hospital, Vancouver, BC, Canada.
Department of Anesthesia, BC Children's Hospital, Vancouver, BC, Canada.
JMIR Perioper Med. 2024 Dec 20;7:e65198. doi: 10.2196/65198.
Qualitative experience data can inform health care providers how to best support families during pediatric postoperative recovery. Patient experience data can also provide actionable information to guide health care quality improvement; positive feedback can confirm the efficacy of current practices and systems, while negative comments can identify areas for improvement.
This study aimed to understand families' perspectives regarding their children's surgical recovery using qualitative patient experience data (free-text comments) from a prospective cohort study conducted within a larger study developing a postoperative-outcome risk stratification model.
Participants were parents or guardians of children aged 0-18 years who underwent surgery at a pediatric tertiary care facility; children undergoing either outpatient or inpatient procedures were eligible to be enrolled. Participants with English as a second language were offered translational services during the consent process and were included if any family member could translate the surveys into their preferred language. Participants were ineligible if they and their families could not understand English or the child had a neurodevelopmental disability. Perioperative data were collected from families using web-based surveys, including 1 preoperative survey and follow-up surveys sent on postoperative days 1, 2, 3, 7, 15, 30, and 90. Surveys were completed until the family indicated the child was fully recovered or until postoperative day 90 was reached. Follow-up surveys included opportunities to leave free-text comments on the child's surgical experience.
In total, 91% (453/500) of enrolled families completed at least 1 postoperative survey; 53% (242/453) provided at least 1 free-text comment and were included in the presented analysis, based on a total of 485 comments. The patient's age distribution was bimodal (modes at 2-3 and 14-15 years), with 66% (160/242) being male. Patients underwent orthopedic (60/242, 25%), urological (39/242, 16%), general (36/242,15%), otolaryngological (31/242, 13%), ophthalmological (32/242, 13%), dental (27/242, 11%), and plastic (17/242, 7%) surgeries. Largely positive comments (398/485, 82%) were made on the recovery and clinical care experience. A key theme for improvement included "communication," with subthemes highlighting parental concerns regarding the "preoperative discussions," "clarity of discharge instructions," and "continuity of care." Other themes included "length of stay" and "recovery experience." Feedback also suggested survey design amendments for future iterations of this instrument.
Collecting parental recovery feedback is feasible and valued by families. Findings underscored the significance of enhancing communication strategies between health care providers and parents to align expectations and support proactive family-centered care. Our postoperative surveys allowed families to provide actionable suggestions for improving their experience, which may not have been considered during their hospital encounter. Our longitudinal survey protocol may be expanded to support continuous quality improvement initiatives involving near-real-time patient feedback to improve the health care experience of patients and families.
定性经验数据可以告知医疗保健提供者如何在儿科术后恢复期间为家庭提供最佳支持。患者体验数据还可以提供可操作的信息，以指导医疗保健质量的改进；正面反馈可以确认当前做法和系统的有效性，而负面评论则可以识别需要改进的领域。
本研究旨在利用一项前瞻性队列研究中的定性患者体验数据（自由文本评论），了解家庭对其子女手术恢复情况的看法。该前瞻性队列研究是在一项更大的研究中进行的，该研究正在开发一个术后结果风险分层模型。
参与者为在儿科三级护理机构接受手术的0至18岁儿童的父母或监护人；接受门诊或住院手术的儿童均有资格入选。在同意过程中，为以英语作为第二语言的参与者提供翻译服务，如果任何家庭成员可以将调查问卷翻译成他们喜欢的语言，则将其纳入研究。如果参与者及其家人不懂英语或孩子有神经发育障碍，则不符合入选条件。围手术期数据通过基于网络的调查问卷从家庭中收集，包括1份术前调查问卷以及在术后第1、2、3、7、15、30和90天发送的随访调查问卷。调查问卷一直填写到家庭表示孩子已完全康复或直到术后第90天。随访调查问卷包括就孩子的手术经历留下自由文本评论的机会。
总共91%（453/500）的入选家庭完成了至少1份术后调查问卷；53%（242/453）提供了至少1条自由文本评论，并被纳入本分析，共计485条评论。患者的年龄分布呈双峰型（峰值在2至3岁和14至15岁），其中66%（160/242）为男性。患者接受了骨科（60/242，25%）、泌尿外科（39/242，16%）、普通外科（36/242，15%）、耳鼻喉科（31/242，13%）、眼科（32/242，13%）、牙科（27/242，11%）和整形外科（17/242，7%）手术。对恢复和临床护理体验的评论大多是积极的（398/485，82%）。一个关键的改进主题包括“沟通”，其子主题突出了家长对“术前讨论”、“出院指导的清晰度”和“护理连续性”的担忧。其他主题包括“住院时间”和“恢复体验”。反馈还建议对该工具的未来版本进行调查设计修正。
收集家长的恢复反馈是可行的，并且受到家庭的重视。研究结果强调了加强医疗保健提供者与家长之间沟通策略的重要性，以使期望一致并支持积极主动的以家庭为中心的护理。我们的术后调查问卷使家庭能够提供改善其体验的可行建议，这些建议在他们住院期间可能未被考虑到。我们的纵向调查方案可能会扩大，以支持涉及近乎实时患者反馈的持续质量改进举措，从而改善患者和家庭的医疗保健体验。
