Validierung und Feldtestung des Evaluierten Fragebogens Anästhesie (EFA) und Klärung möglicher Einflussfaktoren auf dessen Ergebnisse
Abstract
In this multicenter study, we reintroduced the Evaluierte Fragebogen Anästhesie
(Evaluated Anesthesia Questionnaire), originally piloted in 2008, into routine clinical
use at Klinikum Stuttgart and the University Hospital Marburg. The distribution and
evaluation of the questionnaires required minimal staffing and a manageable time
investment. The questionnaire was well accepted by the majority of patients.
Anesthesia-specific data were easily obtained from departmental daily records, and the
overall implementation of the questionnaire proved to be straightforward and practical.
Based on parallel analysis, six factors were extracted for exploratory factor analysis.
The initial analysis revealed some borderline item loadings and ambiguous factor
structures. Likewise, the subsequent confirmatory factor analysis (CFA) yielded only
moderate model fit indices. However, from a content perspective, the overall factor
solution appeared coherent and conceptually sound.
Item analysis then identified several critical items. Following careful content-based
evaluation and statistical review, the most problematic items were removed. The revised
model, still consisting of six factors, demonstrated significantly improved loadings and
clearer factor-item associations. These improvements were confirmed by the final CFA,
which showed good model fit indices.
The questionnaire items exhibited strong internal consistency, indicating good
correlations between each factor and its associated items. Item difficulty was well
distributed across the full range from easy to challenging.
Total questionnaire scores were robust against external influences. Demographic and
anesthesia-specific variables showed only minor effects at the dimensional level.
Therefore, comparisons at the factor or dimension level should be interpreted with
caution.
Due to its balanced structure, the questionnaire is suitable for use as a comparison or
benchmark tool between institutions. However, influencing variables—such as
population differences, the proportion of elective versus emergency procedures, types of
anesthesia, and other contextual factors—must be taken into account. The primary use
case remains internal performance evaluation. Benchmarking between institutions or
departments should be approached with great caution, particularly across different
medical specialties.
Thanks to its Z-score transformation, the EFA is also compatible with other satisfaction
measurement tools and remains easy to interpret.
In summary, the Evaluated Anesthesia Questionnaire is a valid and reliable tool for
measuring patient satisfaction with the multifaceted services provided by anesthesia
departments.
Among German-language instruments, the only tool of comparable quality is the
Heidelberg Peri-anaesthetic Questionnaire. While other tools may cover individual
aspects of anesthesia quality, they do not match the EFA and the Heidelberg
questionnaire in terms of content or methodological rigor.
Although the Heidelberg questionnaire benefits from a larger development sample and a
longer track record of clinical use, the EFA surpasses it in several key areas. Notably, its
validation process was more comprehensive, statistically sophisticated, and aligned with
modern standards.
Additionally, the EFA was tested and validated at multiple time points. Although the
main validation occurred in this study, the comparable outcomes across both testing
phases support the questionnaire’s test-retest reliability.
Another advantage lies in the smaller number of items (31 vs. 38), which shortens
completion time. This likely increases response rates and improves user acceptance and
practicality.
The use of Z-scores enhances comparability with other satisfaction metrics and
simplifies interpretation. Moreover, the study demonstrated no significant influencing
variables on the results, eliminating the need for adjustment—a clear advantage over the
Heidelberg questionnaire in terms of data analysis.
Overall, the Evaluated Anesthesia Questionnaire represents a new, high-quality
instrument for assessing patient satisfaction with anesthesia services.
Nonetheless, regular statistical reevaluation is recommended to ensure continued
robustness—especially as the tool is applied to larger sample sizes in the future.
Review
Metadata
Contributors
Supervisor:
Dates
Issued: 2025-12-05
Faculty
FB20:Medizin
Language
de
Keywords
Fragebogen EvaluationEvaluierter Fragebogen AnästhesieZufriedenheit FragebogenitemanalysefaktorenanalyseEinflussfaktoren auf Zufriedenheit
License
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Fritz, Kai-Uwe: Validierung und Feldtestung des Evaluierten Fragebogens Anästhesie (EFA) und Klärung möglicher Einflussfaktoren auf dessen Ergebnisse. : 2025-12-05.
License
Except where otherwised noted, this item's license is described as Attribution 3.0 Germany