As a nurse and a case manager, I am aware of the post-operative needs of surgical patients. One of the main topics of interest among patients is to go back to their regular lifestyle as soon as possible. To help decrease the length of stay in the hospital, discharge preparation before an elective orthopedic surgery should be considered.
For example, if an orthopedic surgeon prefers outpatient rehabilitation, then pre-arranged outpatient therapy visits can be performed. Also, medications such as anticoagulants and pain medication can be ordered and filled before surgery. Some health plans require prior authorization of these drugs which can increase the length of stay in the hospital. Unfortunately, some insurance companies do not expedite the approval process when patients are in the hospital.
Furthermore, if there is a risk that a patient may need a skilled nursing facility upon discharge, the family can start touring nursing homes. Typically, families and patients take a long time to decide which institution they want to go. I have found that one of the significant delays in discharge is due to indecisive families.
The additional benefit of proactive discharge planning is knowing what the out of pocket expenses will be for the patient. For example, I had a patient that had to discharge with Lovenox. This patient had to pay for 1K for a one month supply. This patient refused to pay the money for this drug which meant that they doctor had to change the medication to a more affordable one. As simple as this sounds, this process took several days. The drug prescription had to be prior authorized and then medication costs were determined afterward.
In addition to all the above, what patients want the most is the availability of the physician. Sometimes something as simple as a phone call right after discharge just to check on the patient means a lot. When I had elective surgery, my doctor called me on the same night I was released and a few days afterward. Although we have nurses who perform post-discharge calls, it means much more when the doctor reaches out directly to the patient. Also, in our institution, the patients can email their physicians with a simple question such as, “Can I have a refill?” The convenience of speaking to the doctor via email has helped increase patient satisfaction in my institution.
When a patient is in the hospital, the most significant patient concern is the amount of time the surgeon sees the patient. There are many times that my patients have complained that they barely got to see or talk to their doctors. I had one patient who stated, “Can you ask if my surgeon can sit down with me for a few minutes?” As a nurse, I know that doctors are busy. However, taking the time just to say, “Before I leave, is there any questions or concerns you have?”, means a lot to patients.
I have many patients who have stated they loved their surgeon simply because they took out the films and explained what they meant. In my sixteen years as a nurse and as a patient myself, the doctors that the patients liked the most were the ones who showed that they cared. Patients want to feel like they are people and not just another patient. There are many times in the healthcare industry that we are pushed to produce and excel. Sometimes we are running so fast that we lose focus. Our patients are our livelihood. As long as everyone in healthcare remembers that important piece, we will have positive patient satisfaction.
2016 Scholarship Finalist
Chula Vista, California
The final question on the application was an essay question.
The essay question was:
How can orthopedic surgeons doing hip and knee replacement surgery improve patient satisfaction?