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Measuring Patient Satisfaction, Part 3

October 3, 2011 Leave a comment

Conversations with the QI Coordinator in these incidences (in part 2) resulted in significant changes in the entire education of the patients. In all of the centers the decision was made to conduct the postoperative teaching during the preoperative phone call or visit.   The QI Committee met to discuss what additional steps could be taken to enhance patient teaching and in all cases came to the realization that their teaching really had been only to cover the usual basics all patients experience during the first 48 hours postoperatively, but did not include effective discharge planning; i.e., care beyond the basic physical care of the wound, etc.  The next step was to identify the types of procedures where additional education and planning would be warranted.  The groups identified additional information that would be needed.  All of the groups admitted that they always asked if there was a caregiver and stressed that that person, or someone, had to be there to drive the patient home.  However, they never inquired regarding the health of the caretaker or much more beyond the driving the patient home conversation.  “Can your caretaker adequately care for you at home?  Can this person provide your meals?  Change your dressing?  Help you ambulate?”  These questions were added to the preoperative teaching.  Additional questions developed included the home environment; e.g., are there stairs to navigate to the TV?…to the bedroom?  Who will prepare your meals?  Help you bathe?  These questions became very helpful when in the course of interviewing one patient, it was discovered that his “caretaker” would be his wife.  He had planned to take a cab in for his cataract surgery and to return home where his wife would assume his care.  However, it was discovered that his wife was a cardiac patient and was bedridden!

The next step many of the groups made was to contact the various patient care coordinators in some of the physicians’ offices soliciting their help in getting this information from the patient at the time he was scheduled for his surgical appointment.

The pre-op staff in the centers revised their preoperative phone call process to make the call on the average two weeks prior to the scheduled appointment in order to allow adequate time for the patient to make his plans.  One center developed a service of adult care persons to serve as caregivers for their patients.  These persons were all known to the center staff.  Background checks were done on them. CPR certification was a requirement to be placed on the list.  The patients who had no caregivers were given the list and had the option to contract with one of these persons.  The patient paid the caretaker.  These persons were bonded and screened by the center leaders.  This alleviated cancellations at the last minute due to the unavailability of a caretaker, or the confrontation of the patient postoperatively when no caretaker arrived to take him home.  The caretaker brought the patient to the center for his procedure, stayed and participated in the postoperative instructions, drove the patient home, prepared him a meal, stayed the first night and brought him back for his first postoperative visit.  This program has been in place several years at this particular center resulting in high patient satisfaction rates.

Additional centers have begun asking their focus questions through postoperative e-mails to the patients and are reporting very positive results from this process.

Measuring patient satisfaction need not be a hair pulling, frustrating process, but, rather, can result in tremendous satisfaction on the part not only of the patient but of the center leaders and staff.

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Categories: Quality Improvement
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