Abstract

DO.17.03

Formal quantitative analysis of ophthalmological ward rounds under condition of German DRG system

Frank H. W. Tost1, InesPapsdorf1, Hans-Joachim Hannich2
1Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum AöR der Ernst-Moritz-Arndt-Universität Greifswald; 2Institut für Medizinische Psychologie, Universitätsklinikum AöR der Ernst-Moritz-Arndt-Universität Greifswald

Objective: Since 2004 inpatient health care in Germany is administrated according to calculated DRGs. The daily ward round is the central appointment of communicative interaction between doctor and patient during the hospital stay. We analyzed to what extent the round was capable to fulfil the patients’ needs for information and emotional support using the ophthalmologic ward of an university hospital as example.
Methods: For a period of 4 month in the year 2006 the doctor patient interaction in an ophthalmologic ward round was recorded with a dictating machine. 50 physician-patient-interactions of 50 patients and 5 different physicians were selected according to uniform criteria. After transcription they were evaluated using a formal-quantitative speech analysis. We examined the subjective patients’ perception by means of a standardised questionnaire.
Results: The average doctor-patient-interaction took just under 4 minutes. The formal-quantitative analysis of the effective verbal communication between physician and patient indicated an asymmetry to the advantage of the physician, who spoke 73 % of the words ((x 245,48 words). The patient remained rather incommunicative in the course of the conversation. Medical terms were only used in 0.53 % of the direct doctor-patient-dialogue. The ward round conversation was characterized by numerous personnel internal dialogues. In major parts of the round (46 %) the patients were not able to participate actively in the conversation. As a result the information could not reach the patients. Requests to speak were initiated in 83 % by the phy-sician and only in 33 % by the patient. Nevertheless the patients indicated high (22 %) and very high (66 %) satisfaction with the experienced ward round.
Conclusions: In the future the ophthalmologic ward round should satisfy the criteria of patient-centric conversation. Therefore the information value of the daily ward round has to be increased. Organizational and structural changes of the round are necessary, in order to promote the direct conversation between patient and eye specialist. A team conference before and after the eye specialist-patient interaction would allow focusing on team-referred and patient-referred interests within the ward round.

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