patient satisfaction prior to implementation of eras for gynecology oncology surgery
TRANSCRIPT
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Patient Satisfaction Prior to Implementation of Enhanced
Recovery After Surgery (ERAS) for Gynecology Oncology Surgery
Jordan Lewis
Breakout E
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Disclosures
• Relationships with Commercial Interests: • None
• Potential for conflicts of interest within this presentation • None
• Steps taken to review and mitigate potential bias • N/A
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Context “Fast-track” care pathway for gynecology oncology
(ERAS on same ward for radical cystectomy)
Next step: ERAS for Gynecology Oncology
Release of ERAS® Society official gyne/onc guidelines (2015)
Successful ERAS implementation at VGH for elective colorectal and radical cystectomy
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Context
You are here!
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Aim
• To assess overall patient satisfaction with existing “fast-track” care pathway for gyne/onc surgery before formal ERAS implementation
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Methods
• Reached out to 37 eligible patients undergoing major abdominal or laparoscopic surgery between June-August 2016 • Endometrial, ovarian, or cervical malignancies
• Maximum of 5 attempts up to 3 weeks post-D/C
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Methods
• Voluntary 10 question phone survey • 7-point Likert Scale
• Additional comments
1 2 3 4 5 6 7
Excellent Very Good Good Neutral Poor Very Poor Extremely
Poor
Strongly Agree
Agree Moderately
Agree Neutral
Moderately Disagree
Disagree Strongly Disagree
• Satisfactory scores: 1-3
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Assumptions
1. Patient perspective is important
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What did we ask? Satisfaction related to:
• Pain therapy - hospital & discharge
• Treatment of PONV - hospital & discharge
• Satisfaction with care (surgery & anesthesia)
• Overall quality of care
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What did we ask? Did they feel able to ask questions?
Was their pre-admission clinic teaching from the nurses helpful in preparing for their surgery?
Did they feel sufficiently educated about their post-op recovery?
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Assumptions
2. Prepare to be hung up on!
83.8% response rate (31/37)
(1 refusal / 3 could not contact / 2 language barriers)
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Assumptions
3. Mediocre Satisfaction?
58.1
22.6 12.9
3.2 3.2 0.0 0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Excellent Very Good Good Neutral Poor Very PoorPe
rce
nt
of
Pat
ien
ts (
%)
Overall Satisfaction of Quality of Care at VGH
= 93.6%
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Satisfaction: Pain Therapy
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Excellent VeryGood
Good Neutral Poor Very PoorExtremelyPoor
Pe
rce
nt
of
Pat
ien
ts (
%)
Patient Satisfaction with Pain Therapy (%)
In Hospital Upon Dischage
In hospital: 96.8% Upon Discharge: 87.1%
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Satisfaction: PONV
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Excellent VeryGood
Good Neutral Poor Very PoorExtremelyPoor
Pe
rce
nt
of
Pat
ien
ts (
%)
Patient Satisfaction of PONV Prevention and Treatment (%)
In Hospital Upon Discharge
In hospital: 90.3% Upon Discharge: 90.3%
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0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
Excellent Very Good Good Neutral Poor Very Poor ExtremelyPoor
Pe
rce
nt
of
Pat
ien
ts (
%)
Patient Satisfaction with Service of Care (%)
Anesthesia Surgery
Satisfaction: Care Service
Anesthesia: 96.8% Surgery: 100%
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Satisfaction: Perioperative Education
Strongly Agree
Agree Moderately Agree
Felt able to ask questions
90.3% 0.0% 0.0%
ACC was helpful for surgery prep
74.1% 14.8% 11.1%
Felt educated about pre/post-op
education 63.3% 20.0% 6.7%
= 90.3%
= 100.0%
= 90.0%
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Assumptions
4. Satisfaction = less need for focused improvement
• Unsatisfactory scores increased upon discharge for pain management
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Assumptions
4. Satisfaction = less need for focused improvement
0.0
20.0
40.0
60.0
80.0
Excellent Very Good Good Neutral Poor Very Poor ExtremelyPoor
Pe
rce
nt
of
Pat
ien
ts (
%)
Patient Satisfaction with Pain Therapy (%)
In Hospital Upon Dischage
In hospital: 3.2% *Upon Discharge: 12.9%
4X↑ unsatisfactory scores
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Assumptions
4. Satisfaction = less need for focused improvement
• Dissatisfaction with pre- and post-op education
Strongly Agree
Agree Moderately Agree
Neutral Moderately Disagree
Disagree Strongly Disagree
Felt educated about pre/post-op
education 63.3% 20.0% 6.7% 3.3% 3.3% 3.3% 0%
9.9% unsatisfactory
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Assumptions
4. Satisfaction = less need for focused improvement
• Although 90.3% of patients felt comfortable asking questions prior to their surgery, many did not know which questions to ask at this stage!
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Lessons Learned
“The food was nauseating” - anonymous patient
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Lessons Learned
Satisfaction is related to patient values and expectations
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Additional Comments: Compassionate Care ““My anesthesiologist had a
graceful, compassionate, professional present. It made me feel like I could trust her.
She was absolutely lovely, and that kind of presence—for all of us—aids in quick recovery.”
“I feel that VGH needs to be a model for other hospitals.”
“I made a trip back to the hospital to send a thank you card to the
nurses. They are beacons of light.”
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“The fishbowl near the nursing station made me feel safe. You can see
everyone interact with each other. It made me feel like I was included with
what they were doing, and I felt like they weren’t hiding anything.”
“When she said ‘I’ve read your report’, it made me feel as if she
knows me as well as I know myself. I trusted her, and this made me a kinder patient.”
Additional Comments: Patient-Centered Care
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“I felt like the nurse explained nothing to me – I wanted to know what they were doing,
how they would do it.”
“I didn’t understand why some questions were being asked. I felt like my doctor should have
talked to me about some of these things.”
Additional Comments: Communication is Vital “I felt like VGH had a true sense of teamwork and
communication – I will never forget the nurses I had.”
“The pain management at home could be improved in terms of
explaining it more carefully… things like how long to take them, side
effects, and what alternatives there are.”
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Lessons Learned
• Use your strengths, identify your weaknesses
• Patient’s want to be involved in their care – let them! • “It made me feel like I was included with what they were
doing”
• Everyone has an important role • “The volunteer team was essential that day in alleviating a
lot of anxiety”
• Patient as a person • “Making people feel safe aids in quick recovery”
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Identified Area of Focus
Prioritize patient teaching and expectations
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What biggest change has taken place?
• Patient education booklet - FAQs
- Common concerns
- Address use of analgesic agents and VTE prophylaxis
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Who can they turn to after discharge? • Readmission risk
• High in person follow up (within 48hr) • Physician office, home care visit
• Moderate phone call follow up (within 48hr) • Care Management Leader (CML) on T4
• Low regular specialist appointments/blood work
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Who can they turn to after discharge?
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Thank you so much!
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Acknowledgements
• Dr. Kelly Mayson (supervisor)
• VGH ERAS Team members: Tracey Hong, Andrea Bisaillon, Dr. Mark Heywood
• BCPSQC
• Graphics made by Vizzlo
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References
• G. Nelson, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations, Gynecol. Oncol. (2015)
• G. Nelson, et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations – Part II, Gynecol. Oncol. (2015)
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Discussion
Thoughts? Questions?