How can changes made in the OR positively affect patient satisfaction?

[This content is sponsored by Surgical Directions]

At every patient care touchpoint, healthcare providers have an opportunity to improve the patient experience and boost satisfaction. This is especially true for surgical patients, who may be particularly nervous and in need of extra assurance from those who will be in the operating room.

Caring for patients is always providers No. 1 priority, but as the industry shifts from a volume-based to a value-based reimbursement model, caring for patients encompasses a whole lot more than healing wounds and treating illness.

"Creating a positive experience and making sure patients leave the hospital satisfied is becoming increasingly important," says Robert M. Dahl, senior vice president and COO for national perioperative consulting firm Surgical Directions. "Throughout the perioperative process, there are countless opportunities for providers to improve care, put patients at ease and make a good overall impression."

According to Mr. Dahl, there are four major perioperative steps along any patient's journey: Pre-surgical evaluation, the surgical procedure, post-surgical care and discharge. The care team, including care coordinators, nurses, technicians, surgeons and anesthesia providers, is carefully orchestrated to optimize each of these respective steps.

"Every player involved in perioperative surgical care can make a difference for patients," says Mr. Dahl.

Following the patient journey, Mr. Dahl highlighted who is involved in each step and what improvements can be made to boost patient satisfaction.


Even before the patient's surgery, there are a lot of people and moving parts involved in ensuring that the surgery and clinical outcomes are optimized within the perioperative process. Key players involved in the pre-surgery process include the hospital or ambulatory surgical center staff within pre-admission or pre-anesthesia testing, the surgeon, surgeon's staff, hospitalist, OR director, anesthesiologist, CRNAs, nurses, and staff members in patient financial services and admissions.

"More often than not, the prospect of surgery can be a bit stressful for patients," says Mr. Dahl. "Orchestrating and streamlining all areas within the hospital that require patient information and patient dialogue prior to surgery is key to reducing anxiety, setting expectations for the day of surgery, improving clinical outcomes and improving patient satisfaction."

All areas of pre-surgery should be coordinated through a streamlined process, and the triggering of each pre-surgical event should be tied to the scheduling process when the patient is identified as a candidate for surgery. For instance, the PAT department can ensure all pre-admission testing and clearances have been completed and evaluated prior to surgery. When a patient is scheduled for surgery, a PAT call or visit can be scheduled with the patient along with a brief explanation of the service that will be performed. Full patient preparation reduces delays and cancellations. It also has the potential to reduce complications that require additional care that can lead to hospital readmissions and increased length of stay.

PAT is the critical component to manage patients' comorbidities and risk factors prior to surgery. The PAT team can also work with the OR director to make sure adjustments to the OR staff, supplies and equipment have been made to cater to the specific procedure needs. Hospitalists and other advanced practice professionals can assist the clinic with patient and chart evaluations to ensure each patient is "touched" either through a phone triage screening or in-person evaluation. Anesthesia personnel typically oversee this function.

Patient financial services and admissions can be tethered to the PAT process by being addressed at the conclusion of the PAT call or visit. The purpose of this interaction with the patient is to go over insurance matters, set expectations for billing and payment 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 receive their bill (or, more often, bills) including those from the hospital and those for professional fees and ancillary charges. Billing can really make or break satisfaction scores as it can leave the patient coming away feeling totally overwhelmed and confused. Why am I receiving a pathologist bill for laboratory tests? Why is there a separate radiologist and anesthesiologist bill? These types of questions, if left unresolved, can damage satisfaction scores.

"Without the help of patient financial services integrated within the process, issues can arise and days in accounts receivable can be protracted. Patient advocacy is important to make the process as painless as possible. Dealing with billing can be daunting for patients," said Mr. Dahl.

Discharge and beyond

Once patients have begun healing and received their post-surgery care instructions, many hospitals have a nurse navigator help patients ensure compliance with recovery instructions. Post-surgical communication with a patient's family, skilled nursing facilities and the patient him or herself is a critical component of patient satisfaction scores.

As more reimbursement is tied to value- or performance-based contracts with insurers, hospitals and ASCs alike have to pay more attention on post-discharge care to ensure patient satisfaction and treatment adherence and, ultimately, to prevent readmissions, reduce length of stay and reduce surgical site infections.

Balancing the value-based equation will take all stakeholders' involvement. Already, organizations have begun experimenting and implementing different post-discharge care models — some of which are automated whereas others require key players such as nurses, care managers or office staff to follow-up with patients. Specific models, such as perioperative or surgical home models, focus caretakers' attention on performance objectives to reduce surgical site infections, length of stay and hospital readmissions. Bundled payments mandate oversight of the entire continuum of care to optimize patient outcomes.

"The post-surgical communication is critical to how patients may respond to satisfaction surveys," says Mr. Dahl." Post-surgical calls to the patient the following day should include asking how they are feeling, if there are any symptoms, answering any questions that they may have and providing support and/or a referral if needed."

"What matters most is the choreography of care that is consistently provided throughout the care continuum," he says. "A true market disrupter and point of differentiation that can create meaningful change in both patient satisfaction scores and market share is defining the patient experience from each department and service line, and devoting resources and tools to implement the patient care strategy."

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