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Pelvic Floor Ctr., Dun Laoghaire, Ireland.

Introduction: Pelvic floor dysfunction is a global term used to describe conditions such as pelvic organ prolapse, and faecal or urinary incontinence1. The pelvic floor traditionally has been described as three separate compartments and problems in each compartment where managed separately and largely without communication. A more contemporary approach is to identify the entire pelvic floor and its organs as a single dynamic compartment. Each element is inextricably linked and requires a multidisciplinary approach to diagnosis and management.
Multidisciplinary pelvic floor clinics such as ours, with care provided by both colorectal and urogynecology surgeons, and with the support of physiotherapy, clinical nurse specialists, urodynamics, and endo-anal ultrasound are uncommon. Reduced outpatient attendances, surgical admission and bed days due to this multidisciplinary care will likely have cost saving implications.
Objective: The aim of this study was to assess overall patient satisfaction with a multidisciplinary approach to outpatients and surgery.
Methods: All patients who attended our service between 1st January 2015 and 31st December 2015 were identified. Only patients who saw both a colorectal surgeon and urogynecologist at the same clinic were included. The Satisfaction with Outpatient Services (SWOPS) questionnaire is a multi-dimensional outpatient survey, which was developed and validated for use in the outpatient setting2. An anonymous SWOPS questionnaire was mailed to all patients.
Patient satisfaction following surgery was assessed using the Surgical Satisfaction Questionnaire (SSQ-8), a validated survey tool developed for patients undergoing surgery to correct prolapse and/or incontinence3. Patients who underwent a joint colorectal and urogynecology procedure were identified. Patients in this group were contacted via telephone.
Results: 364 new patients attended our service between 1st January and December 31st, 2015. 136 (35.2%) saw both a colorectal surgeon and urogynecologist at the same visit. 15 patients underwent a joint colorectal and urogynecology procedure. There was a 64.7% (88/136) response rate to the postal SWOPS questionnaire, and a 100% (15/15) response rate to the telephone SSQ-8 questionnaire.
Overall 93.2% (82/88) patients responded to positively to all questions regarding their attendance at the pelvic floor clinic. All patients felt that they had enough time to discuss their medical problems, and that their diagnosis was explained clearly. 100% (88/88) of patients reported having confidence and trust in the doctor examining and treating them. 94.3% (83/88) reported that they felt seeing multiple specialists at the same time was of benefit to them. 96.6% (85/88) of patients would recommend our service to a relative or friend.
13/15 (86.7%) patients were satisfied with their surgery, and would recommend it to other patients with a similar condition. All patients were satisfied that their pain was well controlled after discharge. 11/15 (73.3%) patients were satisfied with the time taken to return to daily activities, work, and their usual exercise routine.
Conclusions: There is a high level of satisfaction amongst patients both attending our outpatient service, and those undergoing joint colorectal-urogynecology surgery. The ability to be seen by multiple specialities at a single clinic attendance was felt to be of benefit by the majority of patients, and all expressed physician confidence. Many women may wait years between treatments by individual surgeons, whereas a multidisciplinary service reduces waiting times, increases satisfaction and is likely cost effective.
While a smaller study, the present analysis has demonstrated that a high level of patient satisfaction can be achieved in a multidisciplinary team unit, and may potentially reduce the financial burden of pelvic floor dysfunction on hospitals.
References: 1. Sung VW, Hampton BS. Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 2009 Sep;36(3):421-43.
2. Keegan O, McGee H. A Guide to Hospital Outpatient Satisfaction Surveys. Practical Recommendations and the Satisfaction with Outpatient Services (SWOPS) Questionnaire. Dublin: Royal College of Surgeons in Ireland; 2003.
3. Haff RE, Stoltzfus J, Lucente VR, Murphy M. The Surgical Satisfaction Questionnaire (SSQ-8): A Validated Tool for Assessment of Patient Satisfaction Following Surgery To Correct Prolapse and/or Incontinence. J Minim Invasive Gynecol. 2011 Nov;18(6):S49-50.