Link the care continuum
Making surgery more patient-centered begins well before surgery. Each point of the care continuum should involve the patient in his or her healthcare decision-making. Often, the most important step is determining whether surgery is the best treatment approach, says Frank G. Opelka, MD, FACS, vice chancellor for clinical affairs at the Louisiana State University (LSU) Health Sciences Center, which coordinates care for the seven-hospital LSU Health System.
“Sometimes the best surgical care is making the decision when not to operate. Thinking about it in that sense, we’re no longer focused on surgery; we’re focused on the patient,” Opelka says. In a truly patient-centered system, the patient would have a clear view of the entire pathway—from diagnosis to surgery to recovery.
UPMC Presbyterian has developed what it calls “patient flight plans” to map out the surgical process, much like airline flight plans give pilots an idea of what to expect from takeoff to landing. “They know here’s what to expect, here’s how long you’ll be in the hospital, here’s the physical therapy you might need,” says Lorenz.
The flight plan also gives providers a better idea of whether a patient is on track to be discharged on time. The hospital color-codes patient doorways red, yellow, or green to indicate throughout the process whether patients are on track for a timely discharge. The preplanning and scripting has enabled patients to leave the hospital sooner, cutting two days off the average length of stay, says Lorenz.
The flight plans depend on members of a diverse team—outpatient physicians, surgeons, nurses, and office staff—all being on the same page. That type of coordination can be tricky from a leadership perspective, but Lorenz says there was virtually no resistance to the program because providers were aware of the benefits. “If the surgeons realize that their patients will always get a bed in the ortho unit because there is always a bed available, that’s a win from their standpoint,” she says.
Care is not really patient-centered if it doesn’t involve the patient’s family, says Anthony M. DiGioia, MD, an orthopedic surgeon at Magee-Womens Hospital of UPMC, a 278-bed teaching hospital in Pittsburgh. DiGioia pioneered a patient- and family-centered care methodology through a total joint replacement program.
Family members often shape the care experience more than patients, who aren’t always active participants after undergoing sedation or when recovering from surgery. “If you don’t include [family], not only are you not tapping into a tremendous resource, but you also may lose an opportunity to show that you’re providing exceptional care,” says DiGioia.
Family involvement begins with the initial office visit. Family members are included in the education process and have the option of viewing x-rays and other health information with the patient, says DiGioia. Before surgery, patients take part in an education session that prepares them for their care experience, including the rehabilitation exercises. Family members—or close friends, in some cases—are encouraged to attend as “coaches.” This helps improves compliance after the surgery, he says.
DiGioia also solicits feedback from family members after surgery. “Families are really concerned about the transitions of care—meaning going from outpatient to inpatient, but particularly coming home. They’ll be the care providers when the patient comes home. Everything we do by including the family and starting the education process weeks ahead of time sets the stage to reduce anxiety,” he says.