Study shows critical role of trauma and emergency surgeons in patient satisfaction

Trauma patients and patients who need emergency surgery have little to no opportunity to get acquainted with the surgeon and team that will perform their operation. However, a large study has found that effective and meaningful physician communication is a more important contributor to the overall satisfaction of trauma patients and those having emergency surgery than it is for patients admitted to the hospital for medical reasons or for elective procedures.

The study was selected for the 2020 Southern Surgical Association Program and published as an "article in press" on the website of the Journal of the American College of Surgeons in advance of print.

The researchers found an unexpectedly significant effect of physician communication among patients admitted through a hospital's trauma bay or emergency department. They analyzed patient survey data to determine how several factors, including interactions with nurses and doctors, contributed to satisfaction ratings in five different patient categories: trauma, direct-admit (elective) surgery, emergency department (ED)-admitted (emergency) surgery, ED-admitted medical, and direct-admit medical.

"Nurses uniformly come out as the most highly ranked, and that's because they provide wonderful bedside care and have so much contact with the patients," said lead study author Samir M. Fakhry, MD, FACS, vice president of the Center for Trauma and Acute Care Surgery Research for HCA Healthcare, a publicly traded company based in Nashville, Tenn., that operates 187 hospitals and other health care facilities. "But in the case of the trauma patients, and to a lesser degree the emergency surgical patients, physician communication ranked as the number two factor," he said.

Among elective surgery and medical admission patients, physician communication didn't register even as a third or fourth factor. "There's something about the way the trauma surgeons are delivering their care that is an important driver of the satisfaction scoring that is provided by our patients," Dr. Fakhry said.

The authors noted that no previous large study has investigated overall satisfaction among trauma and emergency surgery patients. Study investigators analyzed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data of 186,779 non-maternity patients discharged from 168 HCA Healthcare hospitals in 2018 and 2019. HCAHPS is a post-discharge survey that asks patients about their hospital experience. The Centers for Medicare and Medicaid Services uses HCAHPS data to generate hospital ratings reported on its Hospital Compare website. The survey captures patient impressions of a number of factors about the hospital experience, including communication with doctors and nurses.

The researchers found that physician communication had a greater impact on overall satisfaction after accounting for nursing factors among trauma and emergency surgery patients, representing a 12 percent boost in the former and an 8.6 percent boost in the latter. In categories in which physician communication received low ratings, it was unlikely that high scores in other factors could compensate to bring the overall satisfaction score above the 50th percentile.

"The things trauma surgeons and the people around them are doing seem to be very important to their patients," Dr. Fakhry said. "For many people in hospital leadership, the trauma service is an important mission of the hospital, but they wouldn't expect the trauma service to contribute very much to a positive patient experience because we're dealing with injured people. However, this study shows trauma care has a significant impact on hospital ratings."

The authors noted that future research should explore what specific aspects of the physician's behavior in trauma, emergency surgery, and ED admissions contribute to patient satisfaction.

We like to say in the world of trauma that the 't' in trauma is for team, so it would be important to stress that the team approach we employ in trauma may be an important part of the findings of the study. That's something we're going to explore in future studies to try to determine what it is, specifically, that trauma surgeons are doing, how they relate to the nurses, and if the interaction between the doctor and the nurse are all something we can turn into an even more positive experience for the patient."

Dr. Samir M. Fakhry, MD, FACS

In an invited commentary, Thomas J. Esposito, MD, MPH, FACS, a professor at the University of Illinois College of Medicine, Peoria, noted the study focuses attention on the importance of communication, but also expressed reservations about the "reliability and veracity" of surveys, citing the inaccuracy of pre-election opinion polls in the last two presidential election cycles. "I would encourage these investigators to expand their research and further dive into the data as well as the survey process," Dr. Esposito wrote.

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