title: Factors Influencing patient experience and satisfaction following surgical management of ankle fractures.
abstract: BACKGROUND
  Patient feedback is increasingly important to inform and develop effective healthcare within the United Kingdom. In order to optimise patient experience of ankle fracture care in our unit, we sought to identify elements of practice associated with poor patient experience and low levels of satisfaction.
  
  
  METHODS
  Adult patients with closed ankle fractures requiring fixation over a ten month period were prospectively identified. Prior to discharge all patients completed the Picker Patient Experience Questionnaire (PPE-15), satisfaction visual analogue scale (VAS: 0-10) and a demographic questionnaire. Operative delay and cancellation episodes were similarly noted. PPE-15 and satisfaction VAS data were collected concurrently from a control group of elective hip and knee arthroplasty patients.
  
  
  RESULTS
  52 patients (23 males) of average age 47 years (17-86) underwent ankle fracture fixation. Median pre-operative length of stay (LOS) was 3days (IQR 1-6). Ankle fracture patients had significantly worse experiences compared to arthroplasty patients (p<0.05 across all 15 PPE domains). Once pre-operative length of stay exceeded 3days patients reported more areas of concerns (6 of 15) than those waiting 3days or less (4 of 15) (p=0.02). Cancelled patients reported significantly worse experiences, with satisfaction VAS of 7 (versus 9 in those not cancelled [p=0.005]), and median of 6 PPE-15 domains of concern (versus 3.5 [p=0.03]).
  
  
  CONCLUSIONS
  Efforts to improve the healthcare experience of patients with ankle fractures should be focused on improving processes that minimise cancellation of surgery and the communication around delay management.
authors.affiliation: Department of Trauma & Orthopaedics, South Tees NHS Trust, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Ashton
authors.affiliation: Department of Trauma & Orthopaedics, South Tees NHS Trust, UK.
authors.forename: Khalid
authors.initials: K
authors.lastname: Hamid
authors.affiliation: Department of Trauma & Orthopaedics, South Tees NHS Trust, UK.
authors.forename: Shazali
authors.initials: S
authors.lastname: Sulieman
authors.affiliation: Department of Trauma & Orthopaedics, South Tees NHS Trust, UK.
authors.forename: William
authors.initials: W
authors.lastname: Eardley
authors.affiliation: Department of Trauma & Orthopaedics, South Tees NHS Trust, UK. Electronic address: paul.baker@stees.nhs.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000523:psychology*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Ankle fracture; Patient experience; Patient satisfaction