When I began performing the laparoscopic adjustable gastric band (LAGB) procedure in 2003, we held monthly three-hour educational seminars for prospective patients in order to explain risks and benefits, to discuss qualifications, insurance, and alternatives, and to answer questions.
Screening and educating potential patients about surgical procedures is essential to ensure that those who wish to proceed are eligible and informed. Clinical practice guidelines published this year indicate that prior to bariatric surgeries, patients should receive educational materials and access to preoperative educational sessions.
But these seminars were frustrating for several reasons. Attendance at each seminar was about 80 to 100 people, so the room quickly became uncomfortably warm and crowded. We often did not have enough bariatric chairs to accommodate everyone. Some people arrived late and others left early, disrupting the presentation. Often one person would monopolize the floor with questions that others might consider too personal. Several might be too embarrassed to ask questions at all. The lack of privacy was a huge issue. Patients absorbed maybe 20% of what we told them.
The results were equally uninspiring; a mere 10% of attendees actually pursued the surgery. It was a highly inefficient process and I felt like I was spinning my wheels. I had to find a better way to educate and screen prospective patients.
I discontinued the seminars and in 2005 and implemented a Web-based patient education. Prospective patients instead were given a "prescription" access code to log onto a 30-minute Web-based multimedia program created by Emmi Solutions, which covers pre-, peri- and postoperative care, as well as risks, benefits, and alternatives to LAGB surgery.
The beauty of this interactive patient education tool is that people can view it at home, as often as desired, and they can share it with family and friends. They can pause, rewind, and type in questions for me to address with them later, in private. Patients can also print out a copy of the presentation for future reference or bring it with them to their next consultation, ensuring that they have a baseline of knowledge. In addition, my staff and I are able to track whether a prospective patient has viewed the information, as the entire patient viewing process is recorded and archived in a secure database.
The benefits of this approach are manifold. My mandatory one-on-one preoperative meeting with each patient (which ensures that he/she fully understands the surgery and risks) used to take two hours. The Web program cut that time down to one hour because they came to me with a much better understanding of the procedure than they did after attending a seminar.
Our surveys show that patients are thrilled; they appreciate how informative it is, and the convenience and privacy of watching from home. In fact, they often refer other patients to my practice in part because of this initiative. My staff is happier, too. They no longer need to answer as many clinical questions and therefore can more efficiently screen out patients who are ineligible for the surgery, either for medical reasons (10 -15%) or due to insurance coverage (30%-40%).
Best of all, virtually all eligible patients who view the Web program now elect to undergo the procedure, increasing the number of surgeries I perform each year. In 2004, prior to implementing the Web-based program, I performed 198 surgeries. In 2007 I performed 284 surgeries, a 43% increase. Thus, the program has greatly improved our bottom line.