Patient dissatisfaction recorded in hospital notes in New Zealand: their occurrence and pattern.

Aims: To describe the occurrence and pattern of patient dissatisfaction and/or litigation recorded in medical notes in New Zealand public hospitals.

Methods: An analysis was carried out on 173 incidents of patient dissatisfaction and/or litigation recorded in medical notes. These were identified from a representative sample of 6579 medical records for 1998 drawn from 13 public hospitals as part of a screening exercise designed to detect the occurrence of adverse events.

Results: Overall, 2.7% of medical notes carried mentions of patient dissatisfaction and/or litigation, varying slightly by hospital type and rising to a rate of 6.9% for adverse events. Such incidents were likely to be associated with other administrative and clinical complications, including the occurrence of an adverse event. Among diagnostic categories nervous system was predictive overall, and pregnancy or neonatal among adverse events. There was no consistent pattern by social background of the patient. A qualitative analysis showed that about a third of incidents were related to clinical matters, another third were more organisational in nature, and the remainder were mixed or non-specific. Issues of communication were more important for incidents that were not associated with adverse events.

Conclusions: Levels of patient dissatisfaction and/or litigation recorded in patient notes are low. Nevertheless they are associated with other indicators of administrative and clinical complications in hospital care, including the occurrence of adverse events, and thus may be suggestive of wider systemic issues in the quality and experience of care requiring attention. While clinical and organisational matters appear to predominate in case descriptions, communication issues are also important.