Executive Summary
A hospital is reporting improved patient satisfaction from providing an information card in the surgery department. The card includes expected wait times.
- The card is provided by the patient transport team.
- Telephone numbers are included for more information.
- Staff update family members hourly during surgery.
Improving patient satisfaction can be challenging in any area of the hospital, but the surgery department can be especially difficult, with family members becoming increasingly anxious every minute without information. Baylor Jack and Jane Hamilton Heart and Vascular Hospital in Dallas has conquered that problem with a simple information card that is given to family members accompanying the patient to surgery.
The Family Care Card provides estimates on how long different procedures will take and how to get information about the patient’s status.
The idea for the cards was born several years ago when nurses realized that many patients and family members were complaining about a lack of information, says Nancy Vish, RN, PhD, NEA-BC, FACHE, president and chief nursing officer at Baylor Jack and Jane Hamilton Heart and Vascular Hospital. They expressed dissatisfaction after the procedures with how they had no idea how long the procedures would last or when they would be able to see the patient again.
A team of nurses worked to address the problem, and in 2011, determined that the best solution would be an information card that addressed the complaints most often heard in the waiting area and in the recovery room. The primary concern was with time and what family members should expect for a particular procedure, so the nursing team worked with physicians to determine reasonable estimates of how long different procedures last.
They ended up with estimates for 16 of the most commonly performed procedures at the hospital. A diagnostic angiogram will take 30 minutes to an hour, for instance, and a carotid endarterectomy will take about two hours. The Family Care Card emphasizes that these are only estimates.
Those times were not based simply on physician estimates of their procedures, Brenda Keeton, manager of service excellence at Baylor Jack and Jane Hamilton Heart and Vascular Hospital.
The team working on the card analyzed data on surgeries performed at Baylor, determining the average time for each procedure and for each physician performing that procedure. Combining those two figures, they determined the median time that the procedure takes, Keeton explains.
In compiling those estimated times, the nursing team also addressed another problem cited by patients: conflicting information.
“We found that nursing staff and physicians didn’t always give the same information on wait times, and sometimes they even conflicted,” Vish says. “By putting together this list of estimated times, we eliminate that variability and everyone is providing consistent information.”
A few of the times have been adjusted in the past few years, as a result of ongoing monitoring of procedure times. Baylor also tracks procedures in real time and responds when a procedure runs long. When an open abdominal aortic aneurysm repair goes beyond the estimated four hours, for example, a service alert automatically alerts staff members and one visits the family to explain that the procedure is taking longer than expected.
“We tell them that everything is OK but just taking a while longer, or if there is an issue to discuss we’ll have a physician come talk to the family and explain what is going on,” Keeton says.
Baylor also has volunteers in the waiting area to assist families with directions to the cafeteria and other food sources, and providing blankets for those waiting through a long procedure. The volunteers also watch for messages from the surgery staff and relay them to the family members.
The discussion about typical waiting times begins in the pre-operation area, and then the patient transport team takes the patient and family members to the OR. At the “kissing corner” where the family must say goodbye, the transport team gives them the Family Care Card from a supply on the wall at the procedure entrance.
Keeton notes that Baylor made this a specific expectation of the transport team, and they do more than simply handing over the card. The transport team gives the family member the card and shows where it indicates the time for that procedure, and where the card has instructions for more information. The transport team then directs the family member to the nearby waiting area.
“We chose that location to provide the Family Care Card because when someone is accompanying a loved one to surgery, there is growing anxiety and it peaks at that moment when you have to kiss and say goodbye. That’s when people can feel the most anxious and lost without information,” Keeton explains. “Addressing that critical moment has been a factor in improving patient satisfaction.”
When they arrive in the waiting room, volunteers greet them and gather information about the patient and procedure so they can help the family stay informed. Surgery staff make contact with the family at least once an hour to update them on the surgery’s progress and answer any questions, Keeton notes.
The Family Care Card originally did not have phone numbers for family members to call during the procedure, but Baylor added two dedicated phone lines for patients who couldn’t wait on the next progress report from staff.
“Even though our expectation was to touch base with the family once an hour, sometimes families are very close and have high anxiety, so we wanted to give them the opportunity to call back to us,” Keeton says. “Even if that means they want an update every 15 minutes, we want to make sure they connect with us about their loved one as much as possible.”
The phone lines empower the family, Vish says, helping avoid the feeling that they had no control and were just waiting for someone else to decide it was time for an update. The phone lines also act as a safety net in case something goes wrong and staff do not appear on time for the hourly update, she says.
To make the card accessible to most people, the Flesch-Kincaid grade level for the card is 8.5. To implement the Family Care Card throughout the hospital, the nurses who developed it conducted inservice programs to describe the process of using the card, its purpose, and the rationale behind it to staff members. In addition to the procedure room entrance, the cards are available at other key spots such as registration and guest services, and all staff members are encouraged to provide one to patients asking for information while waiting during surgery.
Staff members report that the cards have reduced the number of questions asked by family members, and Baylor published a survey report showing that patient satisfaction has improved. The hospital’s Press Ganey patient satisfaction scores also have increased steadily since the card was implemented.
The importance of keeping the patient’s family informed and minimizing their anxiety must not be underestimated, Vish says.
“When a family member comes to see the patient after surgery, the first thing the patient does is look into the eyes of that family member, and they can tell if the family member has been cared for or not. They can see the anxiety in their face and their eyes,” Vish says. “That correlates to their anxiety and satisfaction, and even their recovery. Our goal is to take care of the family while we’re taking care of the patient.”
- Brenda Keeton, Manager, Service Excellence, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX. Telephone: (214) 820-0629. Email: [email protected].
- Nancy Vish, RN, PhD, NEA-BC, FACHE, President and Chief Nursing Officer, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX. Telephone: (214) 820-0660. Email: [email protected].
