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Patient-Centered Surgery

Elyas Bakhtiari, for HealthLeaders Magazine, May 12, 2010
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The flight plan eliminates some of the mystery of the surgical process for the patient, but it also gives providers a better idea if a patient is on track to be discharged on time. The hospital color codes patient doorways—red, yellow, or green—to indicate whether they are on track for a timely discharge throughout the process. The pre-planning and scripting has enabled patients to leave the hospital sooner, cutting two days off the average length of stay, says Lorenz. Patients spend less time in the postanesthesia care unit, which speeds up the transition in and out of open beds.

That, in turn, has been a big motivator for physicians and other staff, says Lorenz. The flight plans depend on a diverse team—outpatient physicians, surgeons, nurses, office staff—being on the same page and delivering the same message. 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 what was in it for them. "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. "Everyone saw what was in it for them, as that was part of our communication plan."

Success Key 2: Involve families
Care is not really patient-centered if it doesn't involve the patient's family, says Anthony M. DiGioia, MD, an orthopedic surgeon who practices 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, and it is has since been adopted by hospitals through the UPMC system, including UPMC Presbyterian.

One lesson he learned while developing the methodology was that family members often shape the care experience more than patients, who aren't always active participants after undergoing sedation or when recovering from a painful operation. "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, because patients won't remember."

Family involvement begins with the initial office visit, says DiGioia. Family members are included in the education process and have the option of viewing x-rays and other health information with the patient. "It is rare that we have patients come in by themselves anymore," he says. Before surgery, patients are prepared to take part in an education session that prepares them for their care experience, including the rehabilitation exercises in the facility's on-site gym. Family members—or in some cases, close friends—are encouraged to attend as "coaches" who learn the exercises along with the patient. This helps patients retain the information and improves compliance after the surgery, hastening full recovery, he says. DiGioia also seeks out feedback from family members after surgery. They often have similar concerns as patients, and are worried most about "portal experiences," which are the transitions in and out of various settings in the care continuum.

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