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Archive April 2020 XXI, No. 4

Staffing: Don't Let Delays Destroy Satisfaction Scores

Keep patients and their loved ones in the loop every step of the way.

Jacqueline Sciola

Jacqueline Sciola, RN, BSN, CGRN


GROUP TALK Every member of the team at Berkshire Medical Center plays a pivotal role in keeping patients and their families informed about potential delays.

From late physicians to cases going longer than expected, you can't control the many factors that lead to lengthy, frustrating surgical delays. But you can control how well you communicate these scheduling setbacks to your patients and their families. If you don't handle the communication correctly, your satisfaction scores are bound to suffer. We learned this the hard way.

After poring over our patients' satisfaction surveys in the hopes of uncovering why our scores were lower than we'd like, the issue was obvious: We weren't doing a good enough job informing patients and their families when delays happened. Once we identified the problem, our entire team worked together to overhaul our communication practices from the moment patients arrive right up until they walk out the door.

Phase 1: Admission

You set the tone for the surgical experience the moment the patient shows up at the registration desk for admission. Make sure your receptionist tells them exactly, to the best of her ability, when the nurse will arrive to take them back to the pre-op area. You also want to be upfront about potential setbacks, which is something you often have an idea about at this stage of the process. If a patient checks in, hears everything is right on schedule and then gets hit with a significant delay, they're far more likely to report a negative experience than if you say, "Hi Ms. Smith, just to let you know we're running a little behind, but we're doing everything we can to keep you as close to on schedule as possible."

Phase 2: Pre-op

We continue our communication with patients in the pre-op area. As soon as patients settle into a bay, they're updated on how long it will likely be before they're brought back to an OR. We also allow a patient's family member or significant other to keep them company. This small comfort has a major impact on patients' anxiety. It also makes it easier to relay information to everyone, including the patient's family member or significant other, associated with the case.

Phase 3: Surgery

Before overhauling our communication process, we had a situation involving a family who wound up waiting two hours beyond when the surgery was supposed to be completed because the surgeon was delayed performing an emergency procedure in another OR. When the family finally asked what was going on, they were genuinely scared something terrible had happened. This was an extreme example, but it shows how communicating with waiting family members about how surgery on their loved one is progressing can slip through the cracks without a consistent communication process in place. Phase three ensures this doesn't happen. If there is a situation that will delay the surgery, our OR clinical leader calls our PACU clinical leader, so she can make sure those waiting for a loved one are properly informed.

Make sure the patient and their family members are informed of a delay right away.

Phase 4: Recovery

The final phase of the process is critical. After the patient has been through check-in, pre-op and surgery, family members are often ready to get their loved one home as soon as possible. While we typically discharge our patients 30 to 60 minutes after surgery — a process that includes "meds to beds," the dissemination of discharge instructions and a discussion with their surgeon — there are always exceptions. In those situations, make sure the patient and their family are informed right away. Remember, the last part of the surgical experience is what they're most likely to remember about your facility.

Consistency is key

To make this collaborative four-phase communication process work, designate employees — the OR clinical lead for the surgical phase, the PACU clinical lead for the recovery phase, for example — to keep patients and their loved ones updated on their specific phase of the surgical experience and report delays to patients or family members accordingly. This approach not only reduced the negative impact of our delays, it also bolstered our patient satisfaction scores. In fact, the year before we implemented the communication protocol, our average patient satisfaction score was a respectable 85.7. This year it shot all the way up to 100.

If you're looking to roll out a similar communication policy at your facility, consistency is everything. Make sure you follow every step of the process for every patient. This can't be an approach you take occasionally. On the other hand, when you apply this policy across the board for all your patients, you're bound to find grateful family members thanking you for keeping them informed — and satisfaction scores that reflect that gratitude. OSM

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