Patient Satisfaction Prior to Implementation of Enhanced

Recovery After Surgery (ERAS) for Gynecology Oncology Surgery

Jordan Lewis

Breakout E

Disclosures

• Relationships with Commercial Interests: • None

• Potential for conflicts of interest within this presentation • None

• Steps taken to review and mitigate potential bias • N/A

Context “Fast-track” care pathway for gynecology oncology

(ERAS on same ward for radical cystectomy)

Next step: ERAS for Gynecology Oncology

Release of ERAS® Society official gyne/onc guidelines (2015)

Successful ERAS implementation at VGH for elective colorectal and radical cystectomy

Context

You are here!

Aim

• To assess overall patient satisfaction with existing “fast-track” care pathway for gyne/onc surgery before formal ERAS implementation

Methods

• Reached out to 37 eligible patients undergoing major abdominal or laparoscopic surgery between June-August 2016 • Endometrial, ovarian, or cervical malignancies

• Maximum of 5 attempts up to 3 weeks post-D/C

Methods

• Voluntary 10 question phone survey • 7-point Likert Scale

• Additional comments

1 2 3 4 5 6 7

Excellent Very Good Good Neutral Poor Very Poor Extremely

Poor

Strongly Agree

Agree Moderately

Agree Neutral

Moderately Disagree

Disagree Strongly Disagree

• Satisfactory scores: 1-3

Assumptions

1. Patient perspective is important

What did we ask? Satisfaction related to:

• Pain therapy - hospital & discharge

• Treatment of PONV - hospital & discharge

• Satisfaction with care (surgery & anesthesia)

• Overall quality of care

What did we ask? Did they feel able to ask questions?

Was their pre-admission clinic teaching from the nurses helpful in preparing for their surgery?

Did they feel sufficiently educated about their post-op recovery?

Assumptions

2. Prepare to be hung up on!

83.8% response rate (31/37)

(1 refusal / 3 could not contact / 2 language barriers)

Assumptions

3. Mediocre Satisfaction?

58.1

22.6 12.9

3.2 3.2 0.0 0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Excellent Very Good Good Neutral Poor Very PoorPe

rce

nt

of

Pat

ien

ts (

%)

Overall Satisfaction of Quality of Care at VGH

= 93.6%

Satisfaction: Pain Therapy

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Excellent VeryGood

Good Neutral Poor Very PoorExtremelyPoor

Pe

rce

nt

of

Pat

ien

ts (

%)

Patient Satisfaction with Pain Therapy (%)

In Hospital Upon Dischage

In hospital: 96.8% Upon Discharge: 87.1%

Satisfaction: PONV

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Excellent VeryGood

Good Neutral Poor Very PoorExtremelyPoor

Pe

rce

nt

of

Pat

ien

ts (

%)

Patient Satisfaction of PONV Prevention and Treatment (%)

In Hospital Upon Discharge

In hospital: 90.3% Upon Discharge: 90.3%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Excellent Very Good Good Neutral Poor Very Poor ExtremelyPoor

Pe

rce

nt

of

Pat

ien

ts (

%)

Patient Satisfaction with Service of Care (%)

Anesthesia Surgery

Satisfaction: Care Service

Anesthesia: 96.8% Surgery: 100%

Satisfaction: Perioperative Education

Strongly Agree

Agree Moderately Agree

Felt able to ask questions

90.3% 0.0% 0.0%

ACC was helpful for surgery prep

74.1% 14.8% 11.1%

Felt educated about pre/post-op

education 63.3% 20.0% 6.7%

= 90.3%

= 100.0%

= 90.0%

Assumptions

4. Satisfaction = less need for focused improvement

• Unsatisfactory scores increased upon discharge for pain management

Assumptions

4. Satisfaction = less need for focused improvement

0.0

20.0

40.0

60.0

80.0

Excellent Very Good Good Neutral Poor Very Poor ExtremelyPoor

Pe

rce

nt

of

Pat

ien

ts (

%)

Patient Satisfaction with Pain Therapy (%)

In Hospital Upon Dischage

In hospital: 3.2% *Upon Discharge: 12.9%

4X↑ unsatisfactory scores

Assumptions

4. Satisfaction = less need for focused improvement

• Dissatisfaction with pre- and post-op education

Strongly Agree

Agree Moderately Agree

Neutral Moderately Disagree

Disagree Strongly Disagree

Felt educated about pre/post-op

education 63.3% 20.0% 6.7% 3.3% 3.3% 3.3% 0%

9.9% unsatisfactory

Assumptions

4. Satisfaction = less need for focused improvement

• Although 90.3% of patients felt comfortable asking questions prior to their surgery, many did not know which questions to ask at this stage!

Lessons Learned

“The food was nauseating” - anonymous patient

Lessons Learned

Satisfaction is related to patient values and expectations

Additional Comments: Compassionate Care ““My anesthesiologist had a

graceful, compassionate, professional present. It made me feel like I could trust her.

She was absolutely lovely, and that kind of presence—for all of us—aids in quick recovery.”

“I feel that VGH needs to be a model for other hospitals.”

“I made a trip back to the hospital to send a thank you card to the

nurses. They are beacons of light.”

“The fishbowl near the nursing station made me feel safe. You can see

everyone interact with each other. It made me feel like I was included with

what they were doing, and I felt like they weren’t hiding anything.”

“When she said ‘I’ve read your report’, it made me feel as if she

knows me as well as I know myself. I trusted her, and this made me a kinder patient.”

Additional Comments: Patient-Centered Care

“I felt like the nurse explained nothing to me – I wanted to know what they were doing,

how they would do it.”

“I didn’t understand why some questions were being asked. I felt like my doctor should have

talked to me about some of these things.”

Additional Comments: Communication is Vital “I felt like VGH had a true sense of teamwork and

communication – I will never forget the nurses I had.”

“The pain management at home could be improved in terms of

explaining it more carefully… things like how long to take them, side

effects, and what alternatives there are.”

Lessons Learned

• Use your strengths, identify your weaknesses

• Patient’s want to be involved in their care – let them! • “It made me feel like I was included with what they were

doing”

• Everyone has an important role • “The volunteer team was essential that day in alleviating a

lot of anxiety”

• Patient as a person • “Making people feel safe aids in quick recovery”

Identified Area of Focus

Prioritize patient teaching and expectations

What biggest change has taken place?

• Patient education booklet - FAQs

- Common concerns

- Address use of analgesic agents and VTE prophylaxis

Who can they turn to after discharge? • Readmission risk

• High in person follow up (within 48hr) • Physician office, home care visit

• Moderate phone call follow up (within 48hr) • Care Management Leader (CML) on T4

• Low regular specialist appointments/blood work

Who can they turn to after discharge?

Thank you so much!

Acknowledgements

• Dr. Kelly Mayson (supervisor)

• VGH ERAS Team members: Tracey Hong, Andrea Bisaillon, Dr. Mark Heywood

• BCPSQC

• Graphics made by Vizzlo

References

• G. Nelson, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations, Gynecol. Oncol. (2015)

• G. Nelson, et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations – Part II, Gynecol. Oncol. (2015)

Discussion

Thoughts? Questions?