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In the primary care setting, use of the BATHE (Background, Affect, Trouble, Handling, and Empathy) method of interviewing has been shown to increase patient satisfaction. This technique is a brief psychotherapeutic method used to address patients' physical and psychosocial problems. The BATHE technique has not been evaluated in the perioperative setting as a way of improving patient satisfaction. In this study, we sought to determine whether satisfaction could be enhanced by use of the BATHE technique during the preoperative evaluation by anesthesiologists.Fifty cardiac and 50 general surgery patients were interviewed in the preanesthesia clinic (PAC) of an academic hospital. They were randomly enrolled in the BATHE group or the control group and asked to complete an anonymous satisfaction survey after their visit. This survey was modified from current studies and not validated elsewhere. The relative influence of the BATHE condition was examined as it pertained to interview duration, patient satisfaction, and patient report of the BATHE items being asked.Ninety-two percent of patients approached by the study group voluntarily enrolled. Patients interviewed using the BATHE method reported being asked about all BATHE questions significantly more often than control patients: t(98)=19.10, P=0.001 (95% confidence interval [CI]=2.59, 3.20). Patients in the BATHE group were more satisfied with their visit to the PAC than those in the control group: t(98)=5.37, P=0.001 (95% CI=0.19, 0.41). The use of the BATHE method did not significantly increase the amount of time physicians spent evaluating patients: t(98)=0.110, P=0.912 (95% CI=-1.519, 1.359).Use of the BATHE method in an academic medical center's cardiac and general PAC showed promising results in this preliminary study. A validated and fully developed survey instrument is needed before we can convincingly conclude that the BATHE method is an effective way of improving patient satisfaction.

Low cardiac output is a continuing cause of mortality after intracardiac operation in patients coming to surgery with advanced myocardial dysfunction. A simple method using a left heart assist device (LHAD) after open heart surgery to manage low cardiac output resistant to all adjuvant therapy is described. Except for the special cannulas, all equipment necessary for the LHAD is available in any unit performing open-heart surgery. Fifteen patients who could not be separated from conventional cardiopulmonary bypass underwent postoperative support with the LHAD (up to 501 hours). Ten patients were weaned from the device and 6 were dismissed from the hospital. Four patients remain alive, the longest period after operation being 24 months. A major asset of the LHAD is that thoracic reentry is not required at termination of LHAD support, since their design permits the cannulas to remain permanently in situ. This is thought to be an important concept, since critically ill patients requiring support are precisely those in whom added risk would be imposed by a second operation.