Same-day surgery patients have high expectations
Same-day surgery patients have high expectations
Patient-focused care through eyes of the patient
What do having same-day surgery and going on vacation have in common? You go with expectations, says Cheryl Dendy, RN, director of St. John Surgery Center in Detroit.
And those expectations make patient-focused care in the ambulatory surgery setting critical. Patients want good service. "They want to have all their questions answered; they want to feel comfortable; and they want to feel secure," Dendy says. But giving patients the level of care they want has some unusual challenges in the same-day surgery setting where patients are typically under your staff’s care for a few hours.
That high level of expectation is apparent in the results of a recent patient satisfaction survey of 10,000 patients at nearly 100 freestanding outpatient surgery centers and hospital-based outpatient surgery programs. By using the patient’s view from the survey, you can redesign your processes to make sure these itinerant patients get what they want while avoiding costly follow-up care episodes.
For example, 25% of patients reported unexpected side effects, which indicates a lack of satisfaction with the centers’ upfront education and communication, says Jerry H. Seibert, president of Parkside Associates in Park Ridge, IL, the health care research firm that conducted the survey. Some side effects of outpatient surgery should be expected, he explains. Seibert presented the research at the recent meeting of the Chicago-based American Association of Ambulatory Surgery Centers.
What happens before surgery?
The survey results point to the necessity of making preoperative education a stronger component of ambulatory surgery, Dendy says.
"What’s becoming alarmingly more important to us as we listen to our patients: They’re not getting all the education they require on the front end," she says.
While same-day surgery staff say patients are given written information, and the information is discussed with them, staff may need to overeducate patients, Seibert says. "One of the most important things [staff] have to understand: You can’t overcommunicate with patients, especially when it comes to side effects," he warns.
Making this a success requires careful planning for your preregistration or preadmission processes. "Repeat those instructions when patients arrive," Seibert suggests. "Don’t assume they’ll remember everything they were told."
A significant amount of preoperative education needs to come from the physician’s or surgeon’s office, Dendy says. At St. John Surgery Center, patient satisfaction data are separated by individual surgeons, and this information will be shared with doctors and their office managers, she says.
"It’s certainly helpful in a managed care world because we’re all going to be held accountable for some report card to payers."
Consider these additional suggestions based on Parkside’s patient satisfaction survey:
• Pick the right team members.
Clinical staff was the top quality indicator for patient satisfaction that includes nurses, anesthesiologists, and recovery room staff.
St. John staff are handpicked for the same-day surgery setting, Dendy says. Applicants undergo a personality profile test that measures such characteristics as nervous tension, ethics, work habits, sociability, emotional maturity, dominance, competitiveness, sensitivity, naivete, and motivation. This has been particularly important since the surgery center is relatively new in the community, she explains.
"We knew that establishing a new business, we needed people who marketed our facility well. Word of mouth is everything," she says. "You can advertise, but until you get people in the door who experience your care and service, the question marks are floating around about that facility."
The second most important quality indicator in the survey was the preadmission and registration process.
"How well people are treated right off the bat sets the tone for their visit at the center," Dendy says. "If you have people who are not customer-focused, the patients are not going to have a good experience, no matter what happens as the patient moves through the facility."
• Emphasize pain control.
Ten percent of patients reported dissatisfaction with pain control after outpatient surgery. Inpatient programs are ahead of most outpatient ones in that they have developed pain management departments, Dendy says.
"Those departments provide good education for the inpatient world," she says. "We haven’t really done well in the outpatient setting."
St. John is beginning a partnership with the pain management department at a tertiary care center to learn how to implement a pain management program in the outpatient setting.
Pain control is more critical in the outpatient setting, Dendy maintains. "We have to send patients home. We have to deal with patients’ pain," she says. "We have to be sure patients and caregivers are knowledgeable about how to handle pain once they get home."
Re-engineering this part of the process also gives St. John a head start on future needs, she says. As outpatient surgery programs perform increasingly invasive procedures with corresponding levels of pain, the challenge of pain control, and patient education will only grow, she points out.
• Ensure surgeons visit patients after the procedure.
Twenty-eight percent of patients reported the surgeons did not follow up with them while they were recovering at the facility.
"That conveys a lot to the patients," Seibert says. "Most surgeons do that, but it’s not a uniform practice by any means."
Seibert notes that timing could be a big factor in this area. Make sure you process calls for surgeons to visit when patients are awake and alert enough to remember the visit and understand any instructions the physician relays, he suggests.
• Expect more challenges as your outpatient volume grows.
The survey determined there is a "critical mass" in the number of procedures performed as it relates to quality. Patient satisfaction dropped after a facility reached an annual volume of more than 7,000 cases, according to the survey results.
But increasing ambulatory volume is a given in today’s managed care environment. The challenge comes in keeping the patient-focused care efforts under the demands of higher caseloads. That will mean revisiting any changes you make to ensure your solutions keep pace with your volume. And remember to keep patient care on a personal level so patients don’t know they are in a large busy facility.
"The way we work today and the care we provide today isn’t necessarily going to be the best care tomorrow," she says. "We always have to look at making changes.
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