Gestational Diabetes Mellitus: Interventions for

Family-Centered Communication in Day Surgery

Three Quality of Care key drivers for Our Lady of the Resurrection (OLR) Medical Center’s Surgical Services department are measured quarterly. The Surgical Services Department has met or exceeded targets for two of the three key drivers. However, for the past six months, the department has not met the goal for a third key driver: explanations provided about progress following surgery. Meeting the goal for the third key driver is dependent on effective communication processes from staff and surgeons to patients and their families. A communication process exists, but by looking at areas in which the process is broken, relatively easy and effective fixes can be put into place. Comment by Carina Piccinini: Topic introduction, overview of issue, choice of topic.

The charge nurse for preoperative and recovery care has identified difficulty in adhering to the current process due to difficulty in locating family members if they leave the waiting room and due to the volume and acuity of patients that enter the recovery area. The nurse manager has also identified meeting the third key driver as a priority for the institution and supports the project. Comment by Carina Piccinini: Pertinence of issue to the unit and preceptor and unit manager buy-in

Increasing patient satisfaction—and thereby increasing the likelihood of returning to the facility for healthcare needs—can benefit the unit and the organization by increasing revenues. The profession of nursing can also benefit by increasing staff and improving technologies for patient care with additional revenues. Comment by Carina Piccinini: Benefit to the unit/organization

Literature Review of Problem

Much research on factors influencing patient satisfaction in perioperative care has been conducted. A driving factor identified is communication to patients and families during care.

Yellen (2003) surveyed ambulatory surgery patients to determine the influence of the nurse-sensitive variables of age, gender, culture, previous hospital admissions, nurse communication, pain, and satisfaction with pain management on overall patient satisfaction. Results showed that nurse communication was the most significant indicator of patient satisfaction, and satisfaction with pain management was the second most significant indicator. Furthermore, patients who were satisfied with nurse communication also reported satisfaction with pain management.

Fry and Warren (2005) conducted a qualitative study to determine the needs of family members in the waiting room of a critical care unit. Results showed that all participants sought some information about the patient’s outcomes during the stay. In addition, an element of trust was essential to a family member’s sense of well-being, especially with nurses. The study concluded that an environment that supports a nurse’s interaction with patients and families enhances trust. Conversely, a lack of information or trust of nurses can reduce a sense of well-being and, ultimately, patient satisfaction.

Literature Review of Solution

Implementing a family-centered communication process during surgery can take many forms. The approach can be as formal as a nurse liaison whose only job is to communicate with and to families during surgery or as informal as periodic phone call updates.

The Children’s Hospital of Philadelphia implemented a Family Liaison Model that utilized current staff to communicate to families during operative procedures with subsequent admission to a cardiac intensive care unit (CICU). A CICU nurse was designated family liaison during surgery. Duties included 1) meeting the patient and family in the holding area, 2) escorting the family to the waiting area, reviewing with the family what they can expect, 3) obtaining updates from OR staff every 45-60 minutes, 4) relaying progress information to the families in the waiting area, 5) admitting the child to the CICU, 6) ensuring the family could be at bedside within 35-40 minutes post-op, and 7) providing care until the end of shift. Patient satisfaction with staff and nursing support increased over a two-year period. However, 96% of nurses found time management with the additional duties challenging (Madigan, Donaghue, & Carpenter, 1999).

The University of Virginia Health System implemented phone calls to families every two hours during surgery to provide updates. A follow-up study on the program’s effectiveness revealed that 95% of families who received the calls reported a “good OR experience,” while only 84% of the families who didn’t receive phone calls rated the experience favorably (University of Virginia Health System, 2008).

The solution proposed for OLR will be a modified combination of the two solutions reviewed. These modifications are necessary because of cost limitations, OLR nurse workloads, and OLR environmental restrictions that do not allow support people to be with families in pre-op and recovery. Similarities to the solution used at Children’s Hospital of Philadelphia will be setting expectations of the patient’s family members through a new brochure, using current nursing staff, and relaying information in a timely manner. The primary mode of communication to families will be through telephone contact, similar to the solution implemented at the University of Virginia Health System. Obtaining cell phone information from families on a consistent basis is another significant modification.

Implementation

The solution to the problem involves enhancing the current process at four key communication opportunities. Comment by Carina Piccinini: Description of intervention.

During outpatient registration, obtaining the family’s cell number is inconsistent and expectations during surgery are set verbally. The enhanced process involves developing a brochure which informs families what to expect during the patient’s perioperative experience, and it offers them an opportunity to provide their contact information to the nurse in writing. The contact information would be attached to the front of the chart.

In preoperative holding, delays sometimes take place, and the current process does not include communication to families about delays. The enhanced process requires the preoperative nurse to make a phone call if delays longer than 45 minutes occur.

If the family leaves the waiting room for any reason, surgeon contact with the families following surgery may not take place. With the family-provided cell phone contact information on the front of the chart, the surgeon has the option of calling the family to update them about the patient.

During recovery, the volume and acuity of patients sometimes prevents recovery nurses from updating families. The enhanced process will enable the surgical and recovery room nurses to work collaboratively in deciding which nursing role should complete the task for each patient.

Changes to the family communication process during the perioperative period will start with development and approval of the brochure. The roll-out schedule would be contingent on completion of the brochure, but it should be done as soon as possible. The unit manager and charge nurses in all phases of care will schedule and conduct in-services about the new process for all nurses in perioperative services. In addition, the unit manager will document the new process and display reminders of it prominently at the nurses’ stations and the breakroom. Comment by Carina Piccinini: Rollout and timeline.

To measure the effectiveness of the new process, pre-intervention, baseline data for the Quality of Care key drivers will be compared to post-intervention data three months after implementation. A small standing committee of nurses will analyze data and patient comments every three months to determine if refinements to the process are needed. Comment by Carina Piccinini: Measurement of effectiveness.

Family-centered communication processes have been proven to increase patient satisfaction and will improve the explanations of progress during surgery, which is a Quality of Care key driver. This new process allows for family mobility during surgery while still maintaining contact with staff, which has been a problem in the past. Enhancing current processes is cost-effective, and it eliminates the need for retraining to entirely new processes. Also, this process ensures that no one nursing role is overburdened with communication responsibilities to families. Comment by Carina Piccinini: How the new process will improve the clinical issue