Evaluation of the quality perception of the patients in relation to the care received by the nursing staff in the Laboratory of Hemodynamic and Elettrostimulation: A cohort study

Introduzione: Il sistema di qualità in sanità è iniziato dal 1992 e continua in un complesso fenomeno di innovazione, necessario per migliorare il sistema sanitario. Questo studio ha lo scopo di valutare come i pazienti percepiscono la qualità delle cure fornite dal servizio di cardiologia interventistica e, se sono soddisfatti delle cure ricevute. Materiali e Metodi: Un questionario di 19 domande totali è stato elaborato e somministrato a 81 pazienti con l’obiettivo di valutare l’importanza della modalità di interazione del personale infermieristico con i pazienti sottoposti alla procedura di cardiologia interventistica nei momenti intra e procedurali. Risultati: Il campione raccolto era significativamente eterogeneo perché la componente maschile era più frequente (p<0.001), i pazienti con più di 61 anni erano significativamente meno frequenti (p=0.0161) e i pazienti con diploma di scuola elementare o inferiore (p<0.001) erano significativamente più frequenti. I pazienti hanno espresso un alto livello di soddisfazione per quanto riguarda la valutazione del personale infermieristico, la gentilezza e la cortesia mostrate loro e l’attenzione prestata ai loro problemi, il tempo a loro dedicato, il livello di informazioni ricevute sulla procedura e il post-procedura, l’aiuto per risolvere eventuali inconvenienti verificatisi al momento della procedura stessa. I pazienti sono stati moderatamente soddisfatti per gli infermieri che li hanno assistiti direttamente nella procedura e di come hanno compreso e risposto a tutte le loro domande. Anche per la valutazione di: privacy, informazioni ricevute per il postprocedura, valutazione degli ambienti, pulizia, silenzio e temperatura, i pazienti hanno più frequentemente espresso un moderato livello di soddisfazione. 2020, Volume 3, Nr.1 pp 1-22 Evaluation of the quality perception of the patients in relation to the care received by the nursing staff in the Laboratory of Hemodynamic and Elettrostimulation: A cohort study. 5 Discussione: Il presente studio ha mostrato un buon livello di soddisfazione per la percezione della qualità nei pazienti sottoposti a procedura cardiologica interventistica. Ulteriori sviluppi sono auspicabili al fine di generare un questionario validato che potrebbe essere adattato alle nostre realtà sanitarie e al campionamento più numeroso di pazienti. Parole Chiave: Prestazioni infermieristiche; Qualità percepita; Qualità per il paziente; Servizio di Cardiologia Interventistica. 2020, Volume 3, Nr.1 pp 1-22 Evaluation of the quality perception of the patients in relation to the care received by the nursing staff in the Laboratory of Hemodynamic and Elettrostimulation: A cohort study. 6 INTRODUCTION The definition of Quality in Healthcare originated immediately after the end of the Second World War. Deming W. Edward [1] had developed a critical view on production methods in the U.S.A. during the war, particularly on methods of quality control, since management and engineers controlled the process and line workers played a small role. In his lectures he promoted the new statistical tools in order to quantify quality in industrial world. In the early 1950s he traveled to Japan and began to spread and compare the Quality Management in Quality Control, extending to all business sectors the goal of quality. Ten years later, Deming received a high recognition from the Emperor of Japan and, its idea known as “Total Quality Management” (TQM) became widely involved in Japanese business organizations and entrepreneurial culture. It will take another twenty years for knowledge of TQM concepts and techniques to spread to the industrialized world of the West. Since then, a rich series of theoretical approaches have followed. Borrowing from Ceosby’s quality concept from industry, Avedis Donabedian implemented the concept of quality in the healthcare setting as: “the degree with care complies current criteria of good medicine”, by also including the concept of evaluation in its definition. Moreover, a specific definition of Quality in healthcare setting could be: “do only what is useful (theoretical efficacy), in the best way (practical efficacy) with the lowest cost (efficiency), to whom (accessibility), and only to those who really need it (appropriateness), having the care done by those who are competent to do it (competence), obtaining the results deemed best (satisfaction)”. Always borrowing the concept of quality from industry, the ISO9000 standards which are now a consolidated reference for this sector are also applicable to the healthcare sector. Moreover, thanks to the D.L. 502/92 and the D.L. 517/93 and the subsequent D.P.R. 801/97 (which introduces the concept of accreditation of healthcare structures and the systems for evaluating and improving activities) and D.L. 229/99 (which reaffirms the need to guarantee the quality of assistance and proposes the method of verification and revision, by providing agreements between 2020, Volume 3, Nr.1 pp 1-22 Evaluation of the quality perception of the patients in relation to the care received by the nursing staff in the Laboratory of Hemodynamic and Elettrostimulation: A cohort study. 7 the Region and Healthcare Organizations) the regulatory framework on quality in healthcare defined better the fields of action. It is on the basis of these legislative guidelines that Healthcare Companies have started to encourage the discussion on organizational quality and on the quality perceived by the user / patient [2-4]. As part of a project to improve clinical care pathways in the Interventional Cardiology Service of the “Madonna delle Grazie” Hospital sited in Matera, a questionnaire was developed and administered that aims to assess the importance of the way the nursing staff interacts with the patient who undergoes the interventional cardiology procedure in the intra and periprocedural. The purpose of our study is to investigate how patients perceive the quality of care provided in the interventional cardiology service, and therefore, whether they are satisfied with the care received. MATERIALS AND METHODS Study Population By considering the Dossier of the Regional Health Agency of Emilia Romagna, entitled: “The perceived quality in Emilia Romagna” (2006) [5], a questionnaire of 19 items (Appendix I) was elaborated and subsequently administered to 81 consecutive patients belonging to the Interventional Cardiology service of the “Madonna delle Grazie” hospital who underwent interventional cardiology procedures. The study was conducted from April 2017 to April 2018.The patient’s consent was requested and, only after his authorization was it administered anonymously and no economic incentives were offered or provided for participation in this study. Informed consent was obtained by all patients included in this study. For all patients anonymity was guaranteed. No economic incentives were offered or provided for participation in this study. This study was performed in accordance with the ethical considerations of the Helsinki Declarations. A formal authorization was requested from the hospital for data collection and Local Ethical Committee ruled that no formal ethics approval was required in this case. The questionnaire administered 2020, Volume 3, Nr.1 pp 1-22 Evaluation of the quality perception of the patients in relation to the care received by the nursing staff in the Laboratory of Hemodynamic and Elettrostimulation: A cohort study. 8 investigated four salient areas of perceived quality, listed in Table 1. The initial section of the questionnaire collected the socio-personal data of participants, as: sex, age, educational level, professional condition, nationality, marital status and condition of coexistence. In addition, the duration of treatment and the cardiac invasive interventions (as: coronary angiography and PTCA or implantation or replacement of PM or electrical cardioversion) were requested. In the most consistent part of the questionnaire, relating to the quality of care and treatment, in order to investigate the particularity of the patient's condition, a section was included listing some of the typical ailments that patients could experience during the procedure and asked to indicate for each of these the possible onset, the level of tolerability and, if some intervention had been carried out and, finally, the evaluation of the latter. Table 1. Scheme of the investigated dimensions. Investigation area Quality dimensions investigated Staff  Kindness  Caution  willingness to listendedicated timeconfidence  clarity / comprehensibility of information  information on type-related benefits / disorders of treatment Involvement in the care path  involvement in device management of hemostasis  possibility of receiving information and speaking with the nursing staff Cures and treatments  effectiveness in resolving disturbances  information on device management  hemostasis and precautions  behaviors related to the immediate post-procedure Environments  cleaning the rooms  silence of the rooms  room temperature  environment care  availability of spaces  comfort of the spaces 2020, Volume 3, Nr.1 pp 1-22 Evaluation of the quality perception of the patients in relation to the care received by the nursing staff in the Laboratory of Hemodynamic and Elettrostimulation: A cohort study. 9 Instruments A first part of the questionnaire concerned the collection of the demographics of the participants, as the gender, the age group to which the respondents belong, if up to 40 years old, from 41 to 60 years old or above 61 years old; the qualification, also grouping this variable in 3 possible answers: if he had either an elementary or lower secondary school diploma, or if he had a diploma or a degree. The questionnaire elaborated “ad hoc” and used for the first time in this research, contained also 19 questions investigating four dimensions of healthcare quality, such as: the nursing staff evaluation, the privac