Survey shows outpatients have high expectations

Attitudes, pain management are big worries

A 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.

For example, 25% of patients reported some unexpected side effects, which indicates a lack of satisfaction with the centers’ education and communication, says Jerry H. Seibert, president of Parkside Associates in Park Ridge, IL, the health care research firm that conducted the survey. Few side effects of outpatient surgery should be unexpected, he says. Seibert presented the research at the recent meeting of the Chicago-based American Association of Ambulatory Surgery Centers. The survey results point to the need for more extensive preoperative education, says Cheryl Dendy, RN, director of St. John Surgery Center in Detroit. "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 communication about side effects," he says.

For example, in the preregistration or preadmission process, patients often are given verbal and written instruction. "Repeat those instructions when patients arrive," Seibert says. "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 being separated by individual surgeons, and this information will be shared with surgeons and their office managers, she says.

"Perhaps surgeons can provide more education to patients and improve the overall ability for their practice to do well," Dendy 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 staff with the right qualities. The top quality indicator was patient satisfaction with the clinical staff, including nurses, anesthesiologists, and recovery room staff. At St. John, staff are handpicked for the same-day surgery setting, Dendy says. Applicants undergo a personality profile 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 procedures. 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. 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." The challenge will grow more difficult as outpatient surgery programs perform increasingly invasive procedures with corresponding levels of pain, she points out.

Ensure surgeons visit patients after the procedure. Twenty-eight percent of patients reported that 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." Be sure your surgeons aren’t stopping by too soon, however, because patients may be too groggy to remember, 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. However, same-day surgery managers can bet on increasing volumes of procedures, Dendy points out. Managers will have to constantly determine new ways to improve their patient satisfaction, she says.

"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 looking at making changes."