Online Program

Does reduction of length of hospital stay in surgery influence patient satisfaction ratings? results of a regional study in Germany

Monday, November 4, 2013

Tonio Schoenfelder, PhD, Department of Public Health, Dresden Medical School, University of Dresden, Dresden, Germany
Tom Schaal, MPH, Department of Public Health, Dresden Medical School, University of Dresden, Dresden, Germany
Joerg Klewer, MD PhD, Dept. of Public Health and Nursing Science, University of Applied Science Zwickau, Zwickau, Germany
Joachim Kugler, MD PhD, Department of Health Sciences / Public Health, Dresden Medical School, TU Dresden, Dresden, Germany
Background: Concerns about the impact of shorter length of stay due to the introduction of the Diagnosis Related Groups in Germany in 2003 has garnered increased attention from clinicians, patients, and health politicians. The average hospital stay of surgical patients has been reduced from 8.5 days in 2002 to 6.7 days in 2011. While several national studies on the impact of the DRG on costs and medical outcomes have been conducted, yielding inconsistent results, the impact of reduced length of stay on subjective patient assessments has not been examined yet. Methods: The study sample included 4.162 surgical patients from 55 German hospitals who responded to a validated survey that was administered after discharge in 2012. The questionnaire assessed satisfaction with medical and service aspects on a six-point ordinal rating from excellent (6) to very poor (1). The survey also collected information about the actual length of stay in days (1-2, 3-7, 8-14, >14) and asked the patients to evaluate their length of stay (‘too short', ‘too long', ‘just right', ‘don't know'). The Kruskal Wallis test and Mann-Whitney-U test were used to determine whether patient satisfaction scores differed according to length of stay and according to perceived length of stay. All associations were considered to be statistically significant at p<0.05-level. Results: In total, 75% of the patients perceived their stay as appropriate, about 9.7% felt their stay was too short, 3.3% too long, and 12% could not decide. Overall satisfaction scores and patients' willingness to return to the provider were significantly higher for patients who felt their stay was just right (grouped median: 5.29; willingness to return: 91%) and were lower among patients who perceived their stay to be too short or too long. Patients perceiving their hospital stay as too long were significantly less satisfied and less likely to return than patients perceiving their hospital stay as too short (4.59; 62.8% vs. 4.90; 76.2%, p<0.05). In contrast, differences in satisfaction scores according to the objective length of stay measured in days were much smaller and did not remain statistically significant. Conclusion: Patient satisfaction did not differ regarding the time spent in hospital which implies that the reduction of length of stay does not significantly affect patients' perceptions of quality of care and services. However, patients' subjective perceptions of the appropriateness of length of stay are important for patient satisfaction. Study findings indicate that patients prefer shorter hospital stays.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health administration or related administration
Public health or related nursing
Public health or related research

Learning Objectives:
Explain the difference of length of stay and subjective perception of length of stay by the patient on satisfaction ratings

Keyword(s): Patient Satisfaction, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I made substantial contributions to conception and design, analysis and interpretation of the study data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3093.0: Health services