Becker's Clinical Quality & Infection Control

Becker's Infection Control and Clinical Quality September 2015

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16 Executive Briefing and to outline the day of surgery payment at point of service for the procedure in terms of deductibles and co-pays for the technical and professional components of the hospital or ASC. Finally, the hospital or ambulatory surgical center staff can contact the patient at specific time intervals — three days and the day prior to the procedure — to inform the patient of the procedure day and time, outline the required preparation, including which medications to stop taking, ensure the patient has appropriate transportation, remind the patient of the co-pay and deductible requirements and answer any questions the patient may have. Day of Surgery The day of a patient's surgery is likely when the patient's anxiety is highest, but those involved in the perioperative process can help alleviate stress through patient contact and staged interaction. Key players involved in the day-of-surgery process that interact with the patient frequently include admissions, the pre-operative nurse or medical assistant, transport, circulating nurse, certified registered nurse anesthetist, anesthesiologist and the surgeon. Right off the bat, hospitals and surgery centers can improve satisfaction by providing patients with clear wayward signage and instructions — from the parking lot or entrance to the check-in desk. Some organizations even go so far as to have a volunteer, pre-operative nurse or medical assistant meet surgical patients at the entrance to escort them to registration or their patient room. "When patients have extended wait times greater than the times that were specified, hospitals run the risk of receiving lower satisfaction scores," says Mr. Dahl. "The times that are conveyed to the patient pre-surgically set expectations for the day of surgery. If times are delayed, it is imperative that the caregiver immediately explain the situation to the patient and family members and recalibrate the expected times for the revised surgical day. Consistent and staged communication is critical to improving patient satisfaction scores. That said, if there is a wait, patients should be alerted via pager, buzzer or text when a room does become available." The "staged" communication can be as simple as employing the Studer Group's AIDET patient interaction strategy coupled with the AIDET interaction assessment. Once patients arrive in their room and change into their surgical gowns, the certified registered nurse anesthetist, anesthesiologist and surgeon typically carry out their interviews and pre-surgical evaluation and checklists. This process can also be stressful and confusing for patients, according to Mr. Dahl, but if these healthcare workers interact either in unison or in a sequenced manner with minimal duplication to confirm the information gathered, it can make the process go much more smoothly. According to Mr. Dahl, keeping patients' family members or loved ones updated before, during and after surgery can also boost satisfaction the day of surgery. Post-surgical care The patient journey does not simply end upon completion of a surgery; patients still have to recover and prepare to navigate the discharge and recovery process. Key players involved in this step of care include the surgeon, anesthesiologist, certified nurse anesthetist, nurses, medical assistants and care management. Patient financial services or patient advocates also play a critical role at this point. Once the patient is awake and stable, surgeons can create a sense of comfort by explaining to both the patient and their family members or caregivers what exactly was performed and what the patient can expect going forward, along with the timeframe for the next patient follow-up visit or call. While the patient heals, both the nurses and the anesthesia providers should monitor the patient's symptoms and pain level, and inform the surgeon if pain medication or other intervention is required. "Patients don't remember their surgery but they do remember how comfortable they felt afterward, so monitoring symptoms and pain is crucial to making sure they feel comfortable to improve satisfaction scores," says Mr. Dahl. Another basic step that hospitals and ASCs should take is letting the patient know about both the billing expectations and recovery process. The best care can be administered, but if there are surprises in the billing process, all good will achieved through up to that point is lost. According to Mr. Dahl, this small gesture is frequently overlooked and, by consistently communicating these two aspects, hospitals can ease patients' anxiety and boost satisfaction. Following the surgery, the patient will eventually

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