8 Ways to Enhance the Patient Experience in Perioperative

Services
By Margaret Falconio-West12-13-2013Clinical SolutionsLeave a Comment

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Although at first it might not seem that perioperative services would be affected by HCAHPS, if you
look carefully at the survey questions, most of them do apply. In addition, patients who have a good
experience in your OR are likely to return and/or refer friends. Some experts believe that this referral
piece will have more impact on a hospital’s financial future than the reimbursement penalties being
implemented by Medicare.¹ What’s more, patients say the non-clinical experience is twice as
important as the clinical excellence when choosing a hospital, as described in a 2010 New England
Journal of Medicine article, “The Emerging Importance of Patient Amenities in Hospital Care.”¹

So, how can perioperative services staff help raise HCAHPS scores? The following are ideas that
have worked in ORs across the country.

1. Provide excellent communication, especially during handoffs. Communication with the

patient and your colleagues is important every time you hand off the patient to another staff member.
For example, be sure to tell the patient what to expect when you transition him from pre-op to the
operating room. Also, provide detailed communication to the next caregiver regarding your patient
and his condition. Tools such as SBAR (Situation, Background, Assessment, Recommendation)
help staff remember everything they need to relate to the next caregiver and emphasize consistent
and detailed communication.¹,³

2. Keep families informed. Even though family members and other loved ones do not complete the
HCAHPS, how they are treated can influence how the patient answers the questions on the survey.
Many hospitals make it a point to obtain loved ones’ phone numbers so the OR circulation nurse can
contact them every hour with patient updates. Similarly, post anesthesia care unit (PACU) nurses
notify families if recovery is prolonged.¹
3. Educate patients early and often. Be sure to explain to the patient everything you and your staff
will be doing at each step, including what kind of procedure they will be undergoing, how much pain
to expect, what kinds of medication you will be giving and instructions for aftercare at home. Patients
that understand more about their care and condition feel more engaged in the process and less
nervous. Phrases such as, “my nurse explained to me…” and “the doctor sat and talked with us…”
are associated with high HCAHPS scores.²

4. Acknowledge patients’ anxiety. Many patients are nervous right before and after surgery,
especially if this is their first surgical experience. Realize that they might not be in their
most pleasant state of mind and do your best to ease their fears.³

5. Give extra attention to older patients. More and more, a greater percentage of patients are
elderly, and they may need more assistance. Speak slowly and clearly to make sure these patients
understand your instructions.³

6. Hire exceptional people. In most cases, compassion is something people are born with, and it
can be difficult to teach. When hiring staff, examine their “soft” skills as carefully as their clinical
expertise.³

7. Ask for suggestions from your staff. Try to maintain open communication among staff so
they are comfortable sharing their ideas for improving the patient experience. You can gain a wealth
of knowledge from staff who are willing to share success stories from other hospitals where they
have worked.³

8. Use patients’ feedback to improve the patient experience. Act on problem areas that come up
often on survey results or when talking with patients in person. For example, if there is a problem
with uncomfortable beds, and the issue is lack of staff training on how to adjust the beds, implement
an in-service to educate staff and see if the problem disappears from surveys. If not, take another
approach until the problem is solved.²

 Sources

1. Saver C. HCAHPS: How the OR’s scores affect your whole organization. OR Manager.
2011; 27(4). Available at: http://www.ormanager.com/wp-
content/uploads/pdf/ORMVol27No4ORandHCAHPSScores.pdf. Accessed February 12, 2013.

2. Rodak S. 4 strategies to boost hospitals’ HCAHPS scores. Becker’s Clinical Quality & Infection
Control. September 4, 2012. Available at: http://www.beckershospitalreview.com/quality/4-
strategiesto-boost-hospitals-hcahps-scores.html. Accessed February 13, 2013.

3. Page L. 8 ways to enhance patient satisfaction in surgery centers. Becker’s ASC Review. March
29, 2011. Available at: http://www.beckersasc.com/asc-turnarounds-ideas-to-improve-
performance/8-ways-to-enhance-patient-satisfaction-in-surgerycenters. html. Accessed February 13,
2013.

This study aims to analyze the retrospective experiences of mothers of children

with down syndrome. Affective reactions of the mothers will be examined from the
standpoint of the social and cultural context. Specifically, it seeks to answer the

following questions:

1. How may the mothers of children with down syndrome be described in terms

of their profile:

1.1 age

1.2 marital status

1.3 educational qualification

1.4 employment status

1.5 monthly income?

2. How do the issues and themes on the child with down syndrome shape the

life of the mother:

2.1 diagnosis

2.2 encountering down syndrome

2.3 fruitless sacrifices

2.4 day-to-day living/stress and coping

2.5 getting adequate treatment

2.6 mother as a teacher

2.7 hopes and fears

2.8 social reactions

 2.9 the other child (sibling)

2.10 falling apart

2.11 maturation as a parent?

3. How may the mothers’ reaction of having children with down syndrome be

analyzed in the social and cultural context to clarify their situation?

4. What are the implications of the results of the study for Special Education?

This study aims to analyze the perioperative experiences of ambulatory patients.

Experiences of the surgery patients will be examined from preoperative, intraoperative and

postoperative stages of surgery. Specifically, it seeks to answer the following questions:

The quality of perioperative care: development of a tool

for the perceptions of patients
Authors
 Tuija Leinonen MNSc RN,
1.

 Helena Leino-Kilpi PhD RN,

1.

 Marja-Riitta Ståhlberg PhD MD,

1.

 Kalle Lertola MSSc Licentiate

1.
 First published: 22 July 2001Full publication history
 DOI: 10.1046/j.1365-2648.2001.01846.x View/save citation
 Cited by (CrossRef): 27 articlesCheck for updates
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
Tuija Leinonen, Tanhuankatu 3 as 2, 20540 Turku, Finland. E-mail: tuija.leinonen@tyks.fil

Abstract
The quality of perioperative care: development of a tool for the perceptions of patients
 Aim of the study. To find out how surgical hospital patients (n=874) perceived the quality of
perioperative care they received in an operating department and in the recovery room.
Background. Patients’ perceptions of the perioperative care have not been included
systematically in the improvement of the care. Accordingly, there is no standardized, valid, and
reliable instrument or system in common use that we could use for the evaluation. The nursing
care in operating departments has an important role in modern health care, and therefore more
research concerning perioperative care quality is needed urgently and the development of the
measurement tool is urgent.
Method. The data were collected using a structured questionnaire in five operating departments
in southern Finland during 1998.
Results. Physical activities (such as pain management and temperature maintenance) were rated
as excellent, as were staff characteristics and the physical and social environment. The most
critical comments were made with regard to supporting patient initiative, encouragement and
educational activities. Patients stated they would have liked more information and it was felt that
they should have been encouraged to ask more questions about unclear matters. Some of the
patients said they had only very limited influence over their own care. The patients were very
pleased with their care in the recovery room. There were only minor differences between the
views of patients from different departments.
Conclusions. Overall the quality of care was considered extremely good, but comparisons of
different quality categories did reveal some problems. Although it has already proved to be a
useful tool, the questionnaire needs to be developed and tested further.
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Article
DOI
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10.1046/j.1365-2648.2001.01846.x

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Full text: HTML | PDF

Keywords
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 perioperative quality;
 surgery;
 operating department;
 patients’ perspectives;
 recovery;
 instrument development;
 Publication History
methods

 Issue online: 20 December 2001

 Version of record online: 20 December 2001
 Nurses’ perceptions of preoperative teaching for
ambulatory surgical patients
Authors
 Kar-yee Tse,
1.

 Winnie Kwok-wei So
1.

 First published: 4 September 2008Full publication history

 DOI: 10.1111/j.1365-2648.2008.04744.x View/save citation
 Cited by (CrossRef): 17 articlesCheck for updates
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
W.K.-W. So: e-mail: wkwso@hku.hk

Abstract
Title. Nurses’ perceptions of preoperative teaching for ambulatory surgical patients.
Aim. This paper is a report of a study to examine nurses’ perceptions of the importance of
providing preoperative information to ambulatory surgical patients, and factors that might
influence their provision of such teaching.
Background. Ambulatory surgery is now widespread and creates a challenge for nurses to
provide preoperative teaching in the limited contact time they have with patients. Although
nurses act as key educators in patient teaching, little is known about their perceptions of the
importance of preoperative teaching, or about current practice in the provision of such teaching
for ambulatory surgical patients.
Methods. A self-administered questionnaire including demographics and the Preoperative
Teaching Questionnaire was completed by 91 of the 169 eligible nurses (response rate 53·8%)
working in day-surgery units, operating theatres or outpatient clinics providing ambulatory
surgery services in two public hospitals in Hong Kong in 2005.
Results. A discrepancy between nurses’ perceptions and practice in relation to the provision of
preoperative information was found. Limited teaching aids, tight operation schedules and
language barriers affected the delivery of preoperative information to ambulatory surgical
patients.
Conclusion. The results highlight the importance of reviewing current preoperative teaching
methods and improving the effectiveness of such teaching to enhance the quality of care for
ambulatory surgical patients.
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© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd

Keywords
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 ambulatory surgery;
 day surgery;
 empirical research report;
 nurses’ perceptions;
 preoperative teaching;
 Publication History
questionnaire

 Issue online: 4 September 2008

 Version of record online: 4 September 2008
 Accepted for publication 19 May 2008

Preoperative patient teaching: the practice and

perceptions among surgical ward nurses.
Lee CK1, Lee IF.

Author information
Abstract
AIMS AND OBJECTIVES:
To explore the consistency between the perceptions and actual practice of preoperative patient
teaching and also the factors affecting the provision of teaching from the perspective of nurses
working in surgical wards.

BACKGROUND:
Preoperative teaching is beneficial to surgical patients in alleviating their anxiety and promoting their
postoperative recovery. Despite the leading role in patient teaching by nurses, sparse studies have
been addressed the consistency between nurses' perceptions and their actual practice of
preoperative teaching in surgical wards.
DESIGN:
A cross-sectional survey.

METHOD:
Data were collected by using self-reported preoperative teaching questionnaires together with nurse
demographic data sheets. Sampling setting was an acute public hospital and all nurses working in
surgical wards (n = 100) were approached in the study.

RESULTS:
A total of 86 nurses returned the questionnaires. 'Details of anaesthesia' was the most prominent
preoperative teaching component rated by nurses although their major teaching was pertained to
'preoperative preparation'. In addition, oral explanation was reported as the most prevalent way of
information delivery and internet was the least preferred method. Discrepancies between nurses'
perceptions and actual practice were found in this study. Moreover, nurses' time availability,
language barriers and tight operation schedules were perceived as top factors affecting the provision
of preoperative teaching. Furthermore, nurses' satisfaction with such patient teaching was
significantly associated with their professional training and their daily workload in the clinical setting.

CONCLUSIONS:
Preoperative patient teaching was not fully achieved by nurses in this study, and the results
highlighted the conflicting issues related to the implementation process that could be resolved by
means of proper planning and management in clinical practice.

RELEVANCE TO CLINICAL PRACTICE:

Healthcare organisations and nurse managers should periodically review the existing clinical
resources so that sufficient preoperative teaching strategies can be provided. Nurses' perceptions
and satisfaction towards preoperative teaching can be compared with those of the patients in further
studies so that the insights for developing an effective preoperative teaching programme can be
more comprehensive.

© 2012 Blackwell Publishing Ltd.

KEYWORDS:
nurse perceptions; nurse perspective; operative patients; preoperative education; preoperative
teaching; surgical patients

PMID:

23216818
 DOI:

10.1111/j.1365-2702.2012.04345.x

[Indexed for MEDLINE]

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