4. Give updates to families during surgery
About 1,300 miles southwest of Boston at Orlando’s Arnold Palmer Hospital works William DeCampli, MD, a pediatric cardiovascular surgeon and director of The Heart Center at the hospital. One challenge he has experienced throughout his career is figuring out the right way to keep patients’ families updated throughout the course of his patients’ surgeries.
The problem was that surgeries could be lengthy, and long periods of time would elapse when families didn’t know whether or not surgeries were progressing well—or if there were problems, he says.
After trying for a few years to deploy either a hospital intensivist or a nurse practitioner or physician assistant to check in on the status of patients’ surgeries and then update their families in person, he determined that this wasn’t the best way to utilize his medical colleagues’ time or medical education. Their “success rate” was typically no higher than 50% because family members were often anxious and went to the hospital cafeteria or left the hospital altogether, thus making it very difficult for them to receive in-person updates on their loved ones.
For the last 18 months, DeCampli and his pediatric surgery team at Arnold Palmer Hospital have used Electronic Access to Surgical Events (EASE), to provide real-time updates to patients’ family members. They receive updates via an app, which can be downloaded at the iPhone App Store and on Google Play. Before deploying the app, DeCampli and his team determined the appropriate cadence of updates in 20-minute intervals by studying family members’ anxiety levels by direct interview.
(The EASE application is developed by an Orlando-based company of the same name, where DeCampli serves as chief clinical safety officer and co-founder.)
The app functions by having patients’ family members download it onto their smartphones. Smartphones are available to people who don’t have their own phones. Every 20 minutes or so, parents receive an update on their family members’ status in the operating room. This starts once the patient is successfully put under anesthesia and continues at other critical stages during surgical procedures. The events are highlighted for updates by a nurse on the team because they’re also the source of potential complications during surgical procedures, says DeCampli. Options for messages sent to family members include short, personal text updates, and images and video.
The process of communicating this flow of information with family members starts before the surgery when DeCampli has to explain the procedure and its associated risks—that’s when the anxiety begins, he says.
With ongoing communication, their anxiety is relieved. For example, there’s the induction of anesthesia, which is done in the operating room for babies. That’s another source of anxiety for parents because the anesthesiologist has told them about the associated risks. To help allay parents’ concerns, the operating room nurse takes a photo of the baby and sends it with a message letting them know the baby is asleep.
Another benefit of ongoing updates is, when he goes out to talk to the families after surgery, they look completely different than they would have without such updates. “After a four-hour heart operation, [family members typically] look haggard, exhausted, hungry, tearful, and with sweaty palms. It’s completely different now because they already know what I’m going to tell them.” Thus, his in-person conversations with family members can focus on recovery, he adds.
In the event that a problem occurs during surgery, DeCampli says the surgical team relies on a physician or other clinician to provide in-person updates about the patient on a similar schedule as they experienced with the app.
According to an eight-month comparison study, surgical patients who were involved in EASE-based surgical updates reported 3.9% higher Press Ganey scores.
5. Provide urgent care options
Anselmo Nuñez, MD, chief executive officer of Bon Secours Medical Group at Bon Secours St. Francis Hospital in Greenville, South Carolina, says approximately 30% of the patients served by his health system aren’t interested in having a relationship with a primary care physician. But these patients still get sick and need access to healthcare, which is why the health system now provides access to six urgent care centers where patients can go if they have a cold or need an immunization, for example.
“We’ve found that even patients who have relationships with primary care providers often prefer to walk in [to the urgent care center], get their problem solved, and walk out—and not have to deal with insurance and co-pays … it’s things like that that are pretty bureaucratic and impose on peoples’ time,” says Nuñez.
While he admits that Bon Secours St. Francis’ urgent care centers are a good fit for the needs of young people in their twenties who only want to interact with the healthcare system when they’re sick and young families in which parents are juggling work and family lives, Nuñez highlights that urgent care centers also increase access for all patients, including seniors.
“We also see older people who may have a primary care provider, but can’t get in to be seen for a problem they want solved right away,” explains Nuñez.
The reality is, many patients aren’t looking for a primary care provider. What matters most is that patients have a choice. “They may be briefly educated on the advantages of wellness, continuity [of care], and prevention, but there are a lot of 28-year-olds who are kind of invincible and don’t want to get involved with the healthcare system,” he says. “We try to respect consumers’ choices, while at the same time providing appropriate care.”