Factors that determine patient satisfaction after surgical treatment of ectopic pregnancy: improving the patient journey!

Objectives: The aim of our study is to identify factors that influence the woman's perception of satisfaction during the process of treatment for this potentially life threatening condition. To evaluate the patient characteristics and factors surrounding the diagnosis and subsequent management of women with ectopic pregnancy and the influence of these on the overall satisfaction rates after discharge from hospital in order to improve quality of care.

Study Design: This is a prospective cohort study undertaken over a period of 4 years (January 2009-December 2012) in a busy early pregnancy unit, in a London university hospital, catering to a multi-ethnic diverse population. Six weeks after surgery a self-administered satisfaction questionnaire was filled in either after a clinician face to face or telephone interview for women who had undergone operative laparoscopy for the treatment for ectopic pregnancy. The data was analysed using SPSS version 14.0.

Results: A total of 324 women underwent operative laparoscopy for the treatment of ectopic pregnancy during the study period. Of this cohort 299 (92.3%) were included in the study, as 25 women (8.4%) were lost to follow-up. 247 (82.6%) were followed up in the clinic and 52 (17.4%) by telephone interview. In 69.5% of the cases the diagnosis was made by a single ultrasound scan, and 69% were discharged within 24h of surgery. The amount of haemoperitoneum and subsequent need for blood transfusion had a significant influence on the overall satisfaction rates (blood loss <200ml - 94% satisfied, 200-800ml - 81% and >800ml - 72%, p=0.001). While age, parity, ethnicity, desire for future pregnancy did not affect the satisfaction outcome, waiting time from diagnosis to surgery (<6h - 87% satisfied, 7-12h - 70%, >13h - 67%, p=0.03), good communication pre-operatively (87% satisfaction with good communication vs. 30% without, p<0.001), provision of post-operative leaflets prior to discharge (90% vs. 68%, p=0.001) and adequate pain relief (89% vs. 64%, p=0.001) resulted in good patient experience. There was no statistical difference in the overall satisfaction in the clinic follow up group (85%), and the women followed up by telephone (86%).

Conclusions: With increasing surgical expertise and advanced diagnostic aids, patient satisfaction has become an important attribute of quality control and health care goal. Good communication and providing information leaflets and adequate pain relief have a positive influence on the woman's reaction to this stressful condition. Our study also suggests that telephone conversation for follow-up is quite an effective means to follow these women after the surgery.