Real-Time Surgical Communication

At Connecticut Children’s Medical Center in Hartford, an urban freestanding pediatric hospital with 135 beds, timely communication to families about the safe care of their family members helps to allay fears and reduce anxiety in the postoperative family waiting room. The provision of clear communication increases overall satisfaction and can improve patient outcomes. The changing healthcare environment and value-based purchasing makes it incumbent upon hospitals to improve the quality of care.

Hospital Consumer Assessment of Healthcare Providers and Systems surveys are not required by the Centers for Medicaid and Medicare Services (CMS) for the pediatric population; however, Press Ganey anticipates CMS will soon begin to expect states to gather specific satisfaction survey information in the near future.1,2 Enhanced communication methods improve the patient and family experience and, therefore, the quality of care. A nurse liaison and advanced technological text messaging systems provide real-time communication to families related to information during the episode of care in the postoperative phase of care.

 

Evidence-Based Practice
I conducted a literature search relative to best practice as it pertains to the ability to improve communication, reduce family apprehension, reduce family fears, and increase patient and family satisfaction related to a surgical or procedural experience.3,4 Research revealed the role of the nurse liaison in the postoperative surgical waiting room is a popular and effective way to help families reduce anxiety as well as help family members or caregivers cope with the stress related to surgery.3-5

I evaluated the current practice for the staffing of a volunteer in the postoperative surgical waiting room. The evaluation revealed the volunteers varied in their ability to communicate effectively with families. Their hours were unpredictable, and their level of sophistication and training relative to the ability to allay fears and provide support was also variable.

I expanded my research to include technological ways to communicate and discovered some hospitals had implemented cloud-based text messaging systems to communicate with families.6 I conducted an informal survey with families in our postop lounge to inquire as to whether they would be interested in receiving text messaging related to their family member’s surgical progress. The responses I received were very positive overall.

 

Dedicated Nurse Liaisons
Hourly nursing leadership rounding was implemented in the postoperative surgical waiting room in 2013. I conducted an analysis of the most recent two quarters of Press Ganey scores related to the patient and family experience in the Connecticut Children’s Ambulatory Surgery unit. The analysis revealed a positive correlation between the hourly nursing leadership rounding and an increase in satisfaction scores. Hourly nursing leadership rounding appears to have a positive effect on patient and family satisfaction; however, the perioperative department continues to lag behind our goal.

A nurse liaison possesses the clinical knowledge and interpersonal skills to communicate effectively with families. A nurse liaison who is a dedicated staff member in the postoperative surgical family waiting room provides the consistent and predictable coverage necessary to enhance the patient and family experience. The family experience is improved because the families who are under stress are appropriately informed and supported by a nurse who interacts with post-anesthesia care staff, surgeons and operating room personnel. Volunteers with a limited clinical knowledge base, dubious interpersonal skills, and unpredictable schedules do not add value or provide enough support to adequately bridge the gap between surgeons and family members.

SEE ALSO: Electronic Access to Surgical Events

This is an age of advanced technology where most families possess or have access to personal phones capable of receiving text messages. Major children’s hospitals have implemented cloud-based text messaging systems that are bilingual, as an adjunct to face-to-face communication.6 They have reported positive results relative to decreased anxiety levels of families who have received these messages and have demonstrated they have increased patient and family satisfaction scores.6

An informal survey indicates families at Connecticut Children’s Medical Center would respond positively to implementation of such a system. Hourly nursing leadership rounding is positively influencing patient and family satisfaction scores, but hourly rounding alone cannot be the stand-alone driver to comprehensive positive communication and quality care.

 

Postop Communication Technology
Research coupled with the analysis of Press Ganey patient family satisfaction scores, in addition to the current state of affairs for staffing and rounding in the postoperative family waiting room, provides evidence to support the need to enhance communication in the postoperative waiting room. There is opportunity to provide improvement by budgeting and filling the position for a full-time nurse liaison to staff the postop waiting room full time.

Discussions have already ensued relative to the implementation of the nurse liaison, as well as to develop and utilize a text messaging system to communicate real-time with families. Initial discussions have occurred at both the patient and family experience weekly meetings as well as with a representative from the information technology (IT) department as to the feasibility of leveraging the current IT system to provide the HIPAA compliant texting technology to families.7 The chief nursing officer and director of the patient and family experience are supportive of the development of these initiatives.

I look forward to the proposition of the continued development and possible implementation of both a nurse liaison program and a text messaging system that facilitates timely and appropriate communication to Connecticut Children’s patient and family population.

 

References for this article can be accessed online at www.advanceweb.com/nurses. Click on Resources, then References.

 

Mary McLaughlin is director of perioperative services at Connecticut Children’s Medical Center in Hartford.

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