EDUCATION TO IMPROVE PATIENT

SATISFACTION AND OUTCOMES IN THE

NEUROSURGICAL PATIENT

Tara Orgon Stamper CRNP DNP Conference 2017 New Orleans, LA

INTRODUCTION

 Satisfaction ­  Outside health care ­  Within health care

 Knowledge ­  Role in health care

­  Connection to outcomes

 Outcomes ­  Used in health care today

­  Relevance to satisfaction

INTRODUCTION

 Neuroscience ­  Complex system ­  Patient/family anxiety and fear

­  Limited number of studies

BACKGROUND

 Patient satisfaction indicator of care quality

 Impacts patient outcomes

 Education influences satisfaction

DEFINITIONS

 Patient satisfaction ­  satisfaction with care delivered

 Patient knowledge ­  knowledge of disease process and surgical care

 30 day readmission ­  readmitted to inpatient setting prior to thirty days from discharge

 Post-operative complications ­  presence of surgical site infection, neurological change resulting in admission

 Demographic factors ­  age, gender, ethnicity, comorbidities, past medical and social histories

STUDY OVERVIEW

PURPOSE

 Implement a neurosurgery perioperative education bundle with patients undergoing a craniotomy to improve patient knowledge, satisfaction and outcomes

PICOT

 In the cranial neurosurgery patient (P), how does a cohesive, structured perioperative neurosurgery education bundle (I) compared with the non-structured standard education (C) affect patient satisfaction, knowledge and outcomes (O) over an eight week timeframe (T)?

CLINICAL QUESTIONS

 What demographic factors are associated with improved patient knowledge and improved patient satisfaction?

 What demographic factors are associated with an improvement in post-operative complications and 30-day readmissions?

CLINICAL QUESTIONS

 What effect does a perioperative neurosurgery patient education bundle have on the level of patient satisfaction and patient knowledge of the bundle’s information?

 What effect does a perioperative neurosurgery patient education bundle have on post-operative complications and 30 day readmissions?

FEASIBILITY & NEEDS

 Need for the project ­  Limited patient education, Low HCAPHS scores

 Project expenses ­  Minimal printing expenses incurred by PI

 Implementation issues ­  PI has access to sample, no need for technology modifications, no legal concerns

 Organizational congruence ­  Project supports organizational values

SUBJECT IMPACT

 Benefit ­  Immediate – individual satisfaction and knowledge ­  Long term – departmental culture change

 Confidentiality ­  Coded master list linking study subjects to designated number, including paper surveys,

locked in cabinet ­  Study data not stored with master list ­  Study data stored in password protected database ­  Research data maintained for six years ­  Data relayed in congregate

 Risk ­  No psychological, physical, social or legal harm to participant ­  May withdraw from study at anytime

 Financial ­  Participant not billed any additional services for education bundle

REVIEW OF LITERATURE

REVIEW OF LITERATURE

 Patient Education ­  Randomized clinical trial of 66 patients receiving post-MI education, support and

counseling

­  Intervention group with higher scores on Myocardial Infarction Self Care Ability Questionnaire (p<0.0001)

­  Oral anticoagulation therapy patient and family education program

­  Nurses delivering program found information able to be tailored to individual needs ­  Insufficient knowledge jeopardizes a health care regimen4

REVIEW OF LITERATURE

 Patient Education ­  70 ankylosing spondylitis (AS) patients received structured teaching program (STP) ­  Author created knowledge questionnaire

­  Positive differences in knowledge pre and post education STP implementation

REVIEW OF LITERATURE

 Patient Satisfaction ­  Discharge class (n=53) and traditional discharge (n=51) given to postpartum mothers

when leaving hospital

­  Individualized teaching more satisfying than discharge classes as measured by the Modified Client Satisfaction Tool (p=.0312)

­  Orthopedic patients receiving structured discharge education (n=47) were more satisfied than those receiving the standard model (n=48) (p<0.0001)

­  Satisfaction with nurse-patient communication, fewer pain complaints, functional status higher in structured discharge education group

REVIEW OF LITERATURE

 Patient Satisfaction ­  122 patients equally randomly assigned to intervention group receiving education

sessional on pain education and control group receiving no specific education

­  Cancer patients receiving an educational session on pain education were more satisfied than those receiving conventional education; when second week compared to control group (p<0.001)

­  Intervention group (n=150) watched a video module on lung resection surgery; control group (n=150) received standard surgery preparation

­  Video module group stated better surgical preparation (p=0.006), less anxiety regarding surgery (p=0.0001) and overall satisfaction with their surgery (p=0.02)

REVIEW OF LITERATURE

 Patient Outcomes ­  Concept Care group (n=62) received preoperative education plus written materials

whereas only written materials was the control group (n=61)

­  Concept Care Method delivered to orthopedic patients two weeks preoperatively decreased significantly (p<0.001) admissions discussions (13.25 min, 33.36 min, respectively)

­  35 active patients against 115 historical control ­  Enrolled patients received pharmacy based counseling on medications and

importance; discharge medication list

­  Pharmacist initiated HF discharge education program decreased 30-day all-cause readmissions (p=0.02) and HF-related readmissions (p=.11)

SYNTHESIS OF EVIDENCE  Limitations ­  Scarce literature on postoperative neurosurgical patient ­  No mode of education delivery is supported over others

­  Education delivered at different times along the health care continuum

SYNTHESIS OF EVIDENCE  Strengths ­  Despite lack of generalizability to neurosurgery, evidence exists that shows education

impacts outcomes ­  Outcomes = satisfaction, knowledge, postoperative complications, 30-day readmissions

METHODOLOGY

METHODOLOGY

 IRB Roadblocks ­  Allegheny Health Network (AHN) approval BEFORE Georgia College and State

University approval

­  AHN Nursing Research Council input/question session/presentation prior to AHN approval

­  Informed Consent verbiage ­  Four surgeons needing to be co-investigators

­  Utilizing clinic/hospital personnel to help deliver intervention ­  Question regarding necessary study sample given average cases/month ­  Patient knowledge survey length, time to complete

­ 

METHODOLOGY

 Subjects and Recruitment ­  Purposive sampling ­  Inclusion Criteria

­  > 18 years of age

­  undergoing a cranial surgery

­  Proficient in English

­  Non-emergent

­  Exclusion Criteria ­  < 18 years of age

­  Not proficient in English

­  No POA (if cognitively impaired)

METHODOLOGY

 Subjects and Recruitment ­  Informed consent obtained by PI in person ­  Power analysis = 102 participants

­  Complete survey = bundle + $5 VISA gift card ­  No complete survey = bundle but no gift card ­  IRB approval from Georgia College and State University and Allegheny Health

Network

METHODOLOGY

 Setting ­  Academic level one trauma center ­  Four cranial neurosurgeons

­  Perioperative implementation ­  Once decision for surgery is made

­  Postoperative implementation ­  At hospital discharge

­  Postimplementation assessment ­  At first postoperative visit

METHODOLOGY

 Measurement Tools ­  Strength evaluated by validity and reliability ­ Validity ­  External ­ Content

­  Reliability ­  Test-retest ­  Interrater reliability ­  Internal consistency

­ Related to current study ­ No patient population specific tools pertaining to knowledge and satisfaction

ascertained

METHODOLOGY

 So then what is a PI to do?

METHODOLOGY

 Measurement Tools ­  Demographic Questionnaire

­  Developed by PI

­  Validity, reliability not a concern

­  General demographics

­  Age

­  Gender

­  Ethnicity

­  Current height and weight

­  Where do you live

­  Co-morbidities

METHODOLOGY

 Preoperative Teaching Interview Guide (PTIG) ­  32 item questionnaire; scored Likert scale ­ Cronbach’s alpha = 0.83 ­ Contains five distinct subscales ­  situational/procedural information related to the procedure itself

­  sensation/discomfort information related to sensations and pain the patient may feel before, during and after the procedure

­  patient role information related to the expected behavior of patients as participants in their health care goals

­  skills training related to postoperative care such as wound care and dressing changes

­  psychosocial support defined as “the interaction between patients and providers which is aimed at helping patients deal with anxiety, concerns and fears” about their upcoming surgery and care

METHODOLOGY

 Client Satisfaction Questionnaire 8 (CSQ-8) ­  Abbreviated version of Client Satisfaction Questionnaire

­  Originally implemented in mental health practice ­  8 item questionnaire (abbreviated from 18) ­  Cronbach’s alpha = 0.83 – 0.93 ­  Copyrighted

­  $.55 per use ­  Questions focus on overall satisfaction, meeting patient’s needs, did services help you

with your problems, recommend services, did you get the type of services you wanted

METHODOLOGY

 Measurement Tools ­  Strengths ­  Established validity and reliability (CSQ-8) ­ Generalizability

­  Limitations ­ Not neuroscience specific ­  Little established validity and reliability

INTERVENTION TOOL

 Perioperative Implementation ­  One on one counseling session

­  Ten minutes, in a private clinic room ­  Going over written materials personalized to patient ­  Verbal and visual materials ­  Allows adequate time for questions and answers

INTERVENTION TOOL

 Discharge Implementation ­  Study material incorporated as standard of care ­ Cranial Discharge Education Instructions

­ One on one counseling session as standard of care using study materials ­  Registered nurse going over materials specific to patient’s course ­ Verbal and visual materials

DATA ANALYSIS

 What demographic factors correlate with the level of patient satisfaction and patient knowledge after implementation of a neurosurgery perioperative education bundle?

 What demographic factors correlate with the effect a perioperative neurosurgery education bundle has on 30-day readmissions and postoperative complications?

DATA ANALYSIS

 To explore these two clinical questions, demographic factors will be collected at the time of admission into the study.

 Level of patient knowledge and satisfaction will be collected at the postoperative visit.

 Data will be analyzed for correlations between demographic factors and the level of patient knowledge and satisfaction

DISCUSSION

 Expectations ­  Sufficiently answer clinical questions ­  Positive feedback

­  Patient

­  Department

­  Network-wide implementation ­  Continue to monitor for long term impact

DISCUSSION

 Lessons Learned ­  Appropriate research protocols should be vetted and vetted AGAIN! ­  Have an IRB expert/resource on speed dial!

­  Build a study team with professionals of similar interest

 Practice Implications ­  Positivity is contagious! ­  Overcoming obstacles to nursing research

REFERENCES

 Ben-Morderchai, B., Herman, A., Kerzman, H. & Irony, A. (2010). Structured discharge education improves early outcome in orthopedic patients. International Journal of Orthopaedic and Trauma Nursing 14, 66-74

 Bernier, M., Sanares, D., Owen, D. & Newhouse, P. (2003). Preoperative teaching received and valued in a day surgery setting. Association of Operating Room Nurses Journal 77(3), 563-582

 Chou, P. & Lin, C. (2011). A pain education program to improve patient satisfaction with cancer pain management: A randomized control trial. Journal of Clinical Nursing 20, 1858-1869

 Crabtree, T., Puri, V., Bell, J., Bontumasi, N., Patterson, G., Kreisel, D., Krupnick, A. & Meyers, B. (2012). Outcomes and perception of lung surgery with implementation of a patient video education module: A prospective cohort study. Journal of the American College of Surgeons 214(5), 816-821e2

REFERENCES

 Jisha, J., Suneetha, C. & Skandhan, K. (2016). The effect of structured teaching program among patients with ankylosing spondylitis. International Journal of Nursing Education 8(2), 50-54

 Johansson, K., Salantera, S. & Katajisto, J. (2006). Empowering orthopaedic patients through preadmission education: Results from a clinical study. Patient Education and Counseling 66, 84-91

 Larsen, D., Attkisson, C., Hargreaves, W., Nguyen, T. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning 2, 197-207

 Mohammadpour, A., Sharghi, N., Khosravan, S., Alami, A. & Akhond, M. (2015). The effect of a supportive educational intervention developed based on the Orem’s self-care theory on the self-care ability of patients with myocardial infarction: A randomized controlled trial. Journal of Clinical Nursing 24, 1686-1692

REFERENCES

 Shaha, M., Wiithrich, E., Stauffer, Y., Herczeg, F., Fattinger, K., Hirter, K., Papalini, M. & Herrmann, L. (2015). Implementing evidence-based patient and family education on oral anticoagulation therapy: A community-based participatory project. Journal of Clinical Nursing 24, 1534-1545

 Wagner, D. & Washington, C. (2016). Patient satisfaction with postpartum teaching methods. The Journal of Perinatal Education 25(2), 129-136

 Warden, B., Freels, J., Furuno, J. & Mackay, J. (2014). Pharmacy-managed program for providing education and discharge instructions for patients with heart failure. American Journal of Health System Pharmacy 71, 134-139