To the Editor
Anesthesiologists and members of the anesthesia care team have always been critical members of surgical teams, but largely worked “behind the drapes” and out of the surgeon’s and patient’s view. Now, as a result of health care reform and a new focus on patient satisfaction, anesthesiologists are playing a more visible role since their work can make the difference in how patients feel during the perioperative process.
Still, most patients don’t know much about their anesthesia care or anesthesia care team. It is one of the more nerve-racking elements of a surgical procedure for many patients, in large part because it isn’t well understood. There is a need to better educate patients about the role of anesthesia and the different options available; and the effort is certainly worthwhile since it impacts patient satisfaction and, most importantly, patient safety.
Anesthesia Care Team Role in Patient Education
It is often difficult to determine specifically who is responsible for patient education when care is provided by surgical teams; but the general lack of understanding around anesthesiology places anesthesiologists and members of the anesthesia care team in a pivotal role in terms of education, and ultimately satisfaction. Informed patients, who know what to expect throughout their surgery and recovery, and who understand exactly what will go on while they are “under,” feel more in control and at ease. When patients feel like they know and trust their anesthesiologist and members of their anesthesia care team, and see them as a resource for their questions and concerns, anxiety levels diminish. Education is a simple way that an anesthesiologist and anesthesia care team members can make surgery a less stressful and scary prospect for a patient. Lower stress and anxiety positively affects a patient’s perception of the quality of care he or she received. Outlining a patient’s options for anesthesia and how each might affect his or her pain and recovery helps ensure the patient’s expectations are met.
Additionally, anesthesiologists’ role as perioperative physicians places them in the unique position to better educate patients about the complete process—from booking to discharge. Anesthesia professionals are visible throughout the entire lifecycle of a surgery, so they have more touch points with the patients and more opportunities to educate them on their procedures. They, therefore, have the opportunity to become the “face” of a patient’s surgery, so the more a patient sees that face as a resource for questions, concerns and feedback, the better.
Informed Patients Are Safer Patients
Most importantly, better patient education leads to better patient safety. When a preoperative consultation is a true dialogue—with patients and anesthesia care team members asking and answering questions—we learn even more about the patients and, as a result, can further tailor their care in the most effective way.
With the rise of consumerism in health care, patients are increasingly more involved in their medical decisions. They are demanding transparency, and want to better understand their options and the reasons behind physicians’ decisions. And they should—patients should feel that they have a voice in their care. Arming patients with knowledge and giving them greater control over their care leads to better outcomes.
For instance, certain medical errors can be avoided through the input patients give and the questions they ask. Laterality specification is of the utmost importance in a surgery. If a patient is educated on the pre-operative site marking and draping procedures to expect, and the types and sites of the anesthesia they will receive (e.g., an extremity block), they provide an extra set of eyes and ears to ensure the surgery is performed on the correct part of their body.
And before patients even enter the operating room, in the planning stages of a surgery, patient education regarding their medical history is critical. Patients who have a deeper understanding of their past procedures, drug reactions, and allergies can provide crucial information to their surgical team. For example, when planning a surgery, an anesthesiologist might enter an order for a penicillin-derived medication. If the patient is documented as having a past allergic reaction to a penicillin, the EHR will likely display a warning and encourage the doctor to select an alternative. However, if the patient understands the details of their past reaction, and can share that the drug reaction was a known side effect as opposed to a true allergic reaction, the anesthesiologist can prescribe the best medication for the patient instead of a second or third line option. We should encourage patients to learn about their medical history in the planning phase of a surgery, and can guide them with the appropriate questions to ask.
Seeing an anesthesiologist and anesthesia care team members as a resource for information is critical. They should make it clear that they are available to answer questions and address patients’ concerns. Providing resource material, like the anesthesia Patient Education Portal developed by Sheridan Healthcare, can be hugely helpful for patients preparing for surgery. Sheridan’s portal provides definitions of the different types of anesthesia, including general, regional, and MAC. It outlines the roles of anesthesiologists, nurse anesthetists, and anesthesiologist assistants. It also provides a clear overview of what to expect. The site helps educate patients before they even meet with their anesthesiologist and care team, to help guide the conversation and provide patients with the questions they may want to ask before surgery.
Key Topics to Address
To ensure that your patients are well-informed about their anesthesia care and surgery in general, here is a checklist of key topics anesthesia care team members should aim to address:
- Anesthesia Options – If patients have options for their anesthesia, be sure that they know what their options are and how each will affect their surgery and recovery experience.
- Surgical Team – Detail which caregivers will be part of the patient’s surgery and the roles that each play.
- Pre-Op Testing – Define a clear preoperative plan for your patients. Make sure they consult with their primary care provider or any other necessary specialist, and that they receive all necessary tests while avoiding unnecessary preop testing. False positives from unnecessary preop testing is one of the most common causes for day-of cancellations, losing money for the hospital and, most importantly, creating a very frustrating situation for the patient and surgeon.
- NPO Guidelines – Make sure your patient understands when he or she must begin fasting from food and liquids.
- Vital Signs – Educate the patient on the physical effects of anesthesia and the vital signs doctors will be monitoring throughout the surgery.
- Immediate Side Effects – Postop nausea and vomiting is one of the biggest patient dissatisfiers. Explain that nausea is a likely side effect, and work together to address and avoid it.
- Recovery – Set real expectations for the time it will take for full recovery and explain how the patient’s pain will be managed. Let your patient know when he or she can expect to go home and when he or she will be able to start physical therapy, if necessary. Be sure to communicate these expectations to the patient’s family or other caregivers, as well. Lastly, provide a contact that the patient can call with any questions after the procedure.
The Future of OR Communication
In the last 10 years, efforts to improve OR teamwork and communication have been on the rise. These efforts have optimized surgical workflows, preventing errors and improving patient safety. Educating patients and involving them in surgical communication is a natural extension of the current practices, especially now with the Affordable Care Act’s increased focus on patient satisfaction. Many hospitals and surgical centers have devoted significant resources to OR communication and procedural training. But while progress has been tremendous, our work is not yet done. We believe patient safety can further improve with more effective training, as well as better processes for patient communication. Structuring and standardizing communication throughout the perioperative process will provide a roadmap and encourage increased dialogue that will insure critical information is shared and confirmed, ultimately making surgical procedures safer for patients.
Dr. Adam Blomberg is the National Education Director for the Anesthesiology Division at Sheridan Healthcare.