Abstracts

Rationale: The paucity of literature on patient experience of the Seizure Monitoring Unit (SMU) indicates that this is a poorly understood aspect of epilepsy care. The objectives of this study were to: (1) explore patient-perceived quality of SMU care and (2) determine whether a standardized hospital satisfaction questionnaire could be used to compare patient-perceived quality of care on the SMU with other neuroscience units.Methods: (1) The SMU Quality Improvement (QI) team developed a qualitative interview for SMU patients. Eligibility criteria included length of stay (LOS) ≥ 5 days and no developmental delay. 74.5% (n = 222) of patients admitted to the SMU were eligible. Nine were randomly selected. Interviews were transcribed verbatim and analyzed using qualitative methods. (2) The Hospital-Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) is a 27-item survey endorsed for use in acute care hospitals by the Agency for Healthcare Research and Quality (AHRQ). Issues addressed include staff responsiveness, nurse and physician communication, patient-centered care, and discharge information. H-CAHPS was administered via telephone to a random sample of SMU and general neurosciences unit (GNU) patients admitted for ≥ 24 hrs in 2006.Results: (1) Qualitative interviews - Four men and five women (M = 34.5 yrs, SD = 9.0) participated in the qualitative interviews. Mean LOS was 9.1 days (SD = 5.2). Qualitative analysis revealed the following themes: Admission procedures/information, staff responsiveness/communication, discharge procedures/information, impact on seizure management, physical set-up of SMU, issues related to being on the SMU, and patient and family involvement. Issues discussed in the interviews that were not covered by H-CAHPS included challenges with wait times and unknown admission date; change in seizure management; education about seizures; and family involvement. (2) H-CAHPS - Forty percent (n = 39) of patients discharged from the SMU and 10% (n = 81) of patients discharged from the GNU completed H-CAHPS. GNU participants were older (M = 51.1, yrs SD = 16.7) than SMU participants (M = 37.8 yrs, SD = 13.0). LOS was slightly longer for SMU participants (M = 8.2 days, SD = 4.5) than GNU participants (M = 7.6 days, SD = 5.8). Only 44% of SMU and 63% of GNU patients perceived that physicians always explained things in a way they could understand. Nurses received higher ratings (68% for both GNU and SMU). 75% of SMU patients believed that staff always responded to the call button compared to 63% of GNU patients. SMU patients were less satisfied with the quality of discharge information than GNU patients.Conclusions: This study demonstrated that H-CAHPS is a useful tool for assessing patient feedback and highlighted areas for improvement. It can be used to compare patient perceptions of the quality of services provided on the SMU with a GNU. Patient interviews revealed that there are unique aspects of the SMU admission that are not evaluated by H-CAHPS but should be incorporated into a SMU patient survey. Future initiatives will focus on developing a SMU-specific survey based on H-CAHPS.