EXECUTIVE SUMMARY

An ASC offers overnight patients the option of staying with a caregiver. It provides convenience and an opportunity to reinforce caregiver and patient education.

• The guiding principle is to be patient-centric.

• A study comparing patient outcomes between those who stayed with caregivers overnight vs. those who did not revealed no major differences in clinical outcomes.

• An advantage was asking caregivers to observe nurses giving patients medication and physical therapists conducting therapy, both of which reinforced patient/caregiver education.


Surgery centers that keep some patients overnight might consider asking caregivers to stay, too. This can help improve caregiver training and reduce the time to discharge, according to the authors of a recent study.1

Making it possible for caregivers to stay with patients provides scheduling flexibility and can help resolve transportation issues. For example, some patients might travel hours to a surgery center. Dropping off a patient, driving home, and returning the next morning to pick up the patient could be a hardship for the caregiver, says Vincent Laudone, MD, chief of surgery at Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York City, and study co-author. “One of our guiding principles is to be as patient-centric as possible,” he says.

For example, Josie Robertson patients often arrive from a tri-state area. “It can be quite a commute, taking three to four hours to get here,” Laudone observes. “To have caregivers bring in their family members and then go home, coming back the next morning is not patient-centric.”

There is no extra patient fee if a caregiver spends the night. Caregivers can dine for free in the visitor’s café, which is open from 7 a.m. to 8 p.m. Caregivers staying overnight does not affect the nurse-to-patient ratio, either. Two or more nurses stay each night, regardless of patient population. “I would suspect it’s cost neutral,” Laudone says, noting the study did not include a full economic analysis. “The caregiver is occupying the same room as the patient, and the amount of extra food consumed is fairly minimal.”

Regarding security, there is only one entrance to the facility, which is guarded by security 24/7. All staff show their ID badges, and guests check in with the guards. Everyone wears badges at all times, and those badges show where people are inside at all times. Floor access is limited to the lobby elevator, and visitors must indicate their floor before entering. Also, patient rooms include individual bathrooms, and the entire building is handicap-accessible.

Josie Robertson Surgery Center, which opened in 2016, was created as a free-standing ASC close to the main hospital to provide any surgeries that did not require more than one-night stay, Laudone says. “It allows us to expand surgeries done on an ambulatory basis to include more complex cancer surgery,” he adds. “These include minimally invasive procedures like hysterectomy [or] mastectomy.”

The surgery center’s case mix includes 65% outpatient and 35% ambulatory extended recovery. Of patients who spend the night, 57% are accompanied by an overnight caregiver, says Susan Griffin, FNP/BC, perioperative nurse practitioner at the surgery center and another study coauthor.

There are 12 operating rooms and 28 overnight rooms. The center’s surgical services include urology, breast, gastric mixed tumor, gynecology, head and neck, and plastics. It was designed with the goal of considering the needs of caregivers, Griffin says. “Six months after we had our first patient, we were wondering if having the caregiver here overnight would have an impact on patient outcomes,” she says. “We wanted to make this a good experience, so we took time to figure it out.”

Griffin and colleagues asked these questions:

  • What difference would it make to ask caregivers to spend the night with patients?
  • Which outcomes could they study?
  • Which areas, if any, were caregivers visiting that affect patients’ stays and outcomes?

The study revealed no major differences in clinical outcomes between patients who stayed overnight alone and those who stayed overnight with caregivers. However, there were small but statistically significant differences: staying with a caregiver overnight contributed to a shorter length of stay, earlier discharge times, and lower rates of transfer from ambulatory to an inpatient setting.1

“The study looked for objective measurements,” Laudone says. “We didn’t find anything major because most of the benefit is in reducing anxiety, increasing patient and caregiver comfort and knowledge, and, ultimately, providing better care.”

Education was another potential benefit. “Having the caregivers there, overnight, allows for more opportunity for the patient and caregiver to learn,” Griffin says. For example, mastectomy patients need drainage emptied. “Caregivers need to learn how to strip and empty those drains, and that’s something they practice,” Griffin notes.

When caregivers spend the night with patients, they empty the drains in a setting where any problems they encounter could be resolved quickly. “Also, there are a lot of medications patients go home with,” Griffin adds. When caregivers spend the night with patients at the surgery center, they can observe nurses giving patients each medication. It helps reinforce the importance of each prescription. Also, this is less overwhelming than the usual experience of receiving a list of medications at discharge. “The caregiver sees medications given out multiple times in the 24-hour period, so it’s reinforced,” Griffin observes.

Another educational benefit is caregivers can observe patients in physical therapy. “Mastectomy patients get some physical therapy training before they leave the center,” Laudone explains. “The caregiver can witness those exercises and become a coach when the patient goes home, assisting the patient with exercises.”

Josie Robertson Surgery Center has created an atmosphere that lends itself to both patient and caregiver overnights. Each patient stays in an individual room with a bed and a small sleeper sofa and/or chair. “The whole building is just surgical, so it is a little quieter, Laudone says.

The building contains embedded technology that connects with radio frequency badges that patients, caregivers, and staff wear. Every six feet, there is a sensor in the ceiling. When a post-surgery patient starts walking around the center, the badge provides the patient with feedback on how far they have traveled. This information is sent to nurses and becomes part of their record. “You can walk anywhere in the building, and it monitors what you’re doing,” Laudone says. “Some patients take it as a challenge and try to walk more than anyone else.”

“We encourage people to think of this as an ambulatory facility. In the morning, on each floor, we have a common area where we put out a continental breakfast,” Laudone adds. “Patients and caregivers have to get out of bed and go get some food, just like they would in their own homes.”

REFERENCE

  1. Griffin S, McGrath L, Chesnut GT, et al. Impact of caregiver overnight stay on postoperative outcomes. Int J Health Care Qual Assur 2019;33:18-26.