Boost patient satisfaction: Keep families informed
Boost patient satisfaction: Keep families informed
Liaisons keep everyone up-to-date and informed
(Editor’s note: This is the first of a two-part series that looks at improving communications with family members of patients. This month, we look at nurse liaisons that are responsible for updating family members. Next month we will evaluate different technological ways to keep family members updated.)
What staff position can be described as beneficial to your outpatient surgery program by 82% of your surgeons, 93% of your RN circulators, and 99% of your PACU staff, and 100% of your preop staff? And by the way, this same staff person also is described as very beneficial by 88% of your patients.
These are the results of a survey conducted by Lexington Medical Center in West Columbia, SC, two months after implementing a clinical nurse liaison program in the surgery department.
"Many family members express their appreciation for the information provided by the clinical nurse liaison both at the time of surgery and in follow-up surveys," says Maureen Spangler, RN, CNOR, director of perioperative services at the hospital. "We’ve found that a real bond develops between families with lengthy surgeries and the liaison," she adds.
While most outpatient surgeries are not lengthy, some orthopedic procedures can last longer than other outpatient procedures, Spangler adds. "Surgeons also appreciate having a RN to be able to communicate with regarding information they wish to be relayed to families."
For example, having the liaison tell the family that the procedure is starting late due to previous procedures running long will keep family members less anxious and they won’t assume the worst when the surgeon takes longer than expected to complete the procedure, she explains.
Kingston General Hospital in Kingston, Ontario, Canada, uses a combination of technology and nurse liaisons to keep families informed, says Lorraine Osborne, RN, CPN[C], perioperative clinical educator. "Our electronic board in the waiting room can give general information that shows the patient moving from pre-op to the operating room to recovery, and family members appreciate that information, but the real comfort is hearing from the nurse liaison and being able to ask questions."
While Canadian surgery departments do not have to meet Health Insurance Portability and Accountability Act (HIPAA) privacy requirements, patients are identified only by a combination of letters that the family knows so that the patient’s privacy is protected, Osborne explains.
The responsibility for nurse liaison rotates among certain staff members, with Osborne, as department educator, being the default liaison when no one else is available. "We have several nurses who handle the responsibility for two days to one week at a time," she says. "They keep family members for outpatient and inpatient surgical patients up to date on where their family member is and what is happening."
At Lexington Medical Center, there are two RNs handling the position, says Spangler. One works each day for a 12-hour shift, she says. "One RN works 36 hours a week and the other works 24 hours a week, and they each cover for the other when one wants time off," she explains.
The surgeries start at 8 a.m., so the nurse liaison starts rounds about 8:45 a.m., explains Osborne. "The liaison goes from area to area and into operating rooms to check on patients and find out where they are and how soon they will move to the next area," she says. "Then the liaison goes to the waiting room and talks with families to let them know how things are progressing," Osborne says.
Rounds and talking with family members continue throughout the day, she says. "We try to go to the waiting room every two hours — more if a family member is especially anxious," Osborne adds.
At Lexington Medical Center, there is no set schedule; instead, the nurse liaison is continuously in contact with surgical staff and family members, says Spangler. "Information is provided at the request of the family or at the start of the visit to prevent issues or alleviate anxiety," she says.
Due to the high volume in their department, there is no set routine for a time the liaison will speak to a family. "It truly is a continuous process as these nurses are very proactive — making sure they can spend as much time as necessary with the families," Spangler says.
The most important thing to remember about a nurse liaison’s schedule is that he or she shouldn’t disappear for long periods of time, says Osborne. "The frequent visits to the waiting room, even to see other families, lets people know that the liaison is still checking on all patients," she adds.
Be discreet, give general info
Nurse liaisons at Lexington Medical keep a written record of the times the patient enters each area and of the patient’s condition, says Spangler. This record enables the liaison to keep track of the patients and give family members information that keeps them from becoming anxious, she adds.
Information at Kingston and Lexington is given in the waiting room but privacy is always kept in mind. "The information is usually given in a discreet manner, directly to the family without other families being able to hear what is said," says Spangler. "If there is a problem with the patient or if the information is very personal or sensitive or needs to confidential, then the conference room is used."
Spangler says the type of information given to family members is general and includes:
— reasons for delays preoperatively;
— condition of patient during surgery;
— response to anesthesia;
— progress of surgery;
— condition of patient in post-op ambulatory care unit (PACU);
— explanation of what the physician told the family;
— explanations of hospital routines;
— post-op instructions and teaching.
Kingston’s nurse liaison program started in January 2005 and after some minor adjustments in June, the program is going well and is appreciated by family members and staff, says Osborne.
"Because we perform inpatient and outpatient procedures in the same department, we found that some of our outpatient family members were getting too many visits at first," she says.
Outpatient procedures usually aren’t lengthy, so getting one or two visits from the liaisons was enough, Osborne says. "Now, we adjust the number of times we talk with family members based on their need for information."
Spangler and Osborne use only RNs for the nurse liaison position at this time because they believe that an RN’s clinical knowledge is important as the liaison answers questions. "We are evaluating the use of LPNs or OR techs to handle the position with proper training, and in time, we may move that way to address staffing needs," says Osborne.
Family members often are fearful, and they usually feel powerless, says Osborne. "Sometimes, it helps to have the nurse liaison come to them and explain that it will be a while before the patient is out of the operating room so they should go get some breakfast and take care of themselves."
They don’t know what to do, so they feel as though need the staff’s permission to leave the waiting room, Osborne says. "With the liaison looking out for them, they know they won’t miss any information," she adds.
Sources
For more information about nurse liaisons, contact:
- Lorraine Osborne, RN, CPN[C], Perioperative Clinical Educator, Kingston General Hospital, 76 Stuart St., Kingston, Ontario, Canada K7L 2V7. Telephone: (613) 549-6666, ext. 4396. E-mail: [email protected].
- Maureen Spangler, RN, CNOR, Director, Peri-operative Services, Lexington Medical Center, 2720 Sunset Blvd., West Columbia, SC 29169. Telephone: (803) 791-2363. Fax: (803) 939-4561. E-mail: [email protected].
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