An Evaluation of Timing of Discharge Instruction and the Impact on Patient Satisfaction

Postoperative Instruction Retention, Written Versus Audiovisual Adjuncts: A Prospective Randomized Study

Purpose

Adherence to postoperative protocols is an integral perioperative intervention that impacts surgical outcomes. The focus of this study was to identify the baseline postoperative instruction retention of our traditional written format and compare that with the retention when using an audiovisual adjunct. We hypothesize that the addition of audiovisual adjuncts would result in greater patient retention of their postoperative instructions.

Methods

Sixty consecutive adult patients undergoing soft tissue procedures of the hand and wrist were enrolled prospectively at a single institution. Patients were randomized to receive postoperative instructions with either a written or an audiovisual adjunct format. Two days after surgery, a blinded investigator contacted the participants to administer a standardized phone questionnaire. Responses were recorded, and the data were analyzed by another blinded team member. Analysis was performed using χ 2 and Student t tests as appropriate.

Results

Fifty patients were included in the final analysis. The written group scored an average retention of 80%, whereas the audiovisual group showed a retention score of 85%. Demographic analysis of men versus women, and patients <60 versus >60 years of age did not demonstrate significant score differences. The subgroup analysis of patients receiving local anesthesia alone demonstrated significantly higher rates of percent correct and perfect recall in the audiovisual compared with the written-only group (87.5 vs 80.5 and 44% vs 7%, respectively).

Conclusions

For patients undergoing common soft tissue procedures of the hand, the addition of audiovisual supplementation to written instructions, especially in those undergoing wide awake, local anesthesia, no tourniquet procedures, is associated with higher rates of retention of a patient's postoperative instructions. The specific improvement in the local anesthesia cohort is especially relevant today due to an increased prevalence of wide awake, local anesthesia, no tourniquet style procedures, and the increasing reliance on patient engagement in postoperative care.

Type of study/level of evidence

Randomized control trial; Diagnostic Level 2b.

Patient satisfaction analysis of robot-assisted minimally invasive adrenalectomy: a single-center retrospective study

The objective of this study is to compare the satisfaction of patients undergoing robot-assisted retroperitoneal laparoscopy adrenalectomy under the ambulatory mode and conventional mode. Basic information and clinical data of patients who underwent robotic-assisted posterior laparoscopic adrenalectomy between June 2020 and June 2023 were queried from our case system. The Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems Survey (OAS CAHPS®) was used to investigate patient satisfaction with preoperative preparation, discharge counseling, postoperative instructions, postoperative pain, and satisfaction with nursing work. The stats R package was used to select the appropriate statistic for the statistics based on the characteristics of the data. A total of 311 patients who underwent robot-assisted posterior laparoscopic adrenalectomy were enrolled in our case system. There were no statistical differences between the two groups in gender, age, body mass index, ASA classification, laterality, maximum tumor diameter, type of resection, hormonal activity, disease type, pathological classification, duration of surgery, estimated intraoperative bleeding, postoperative complications and follow-up period that were compared between the two groups of patients. There were no significant differences in preoperative preparation score, discharge counseling score, postoperative guidance score and nursing care satisfaction score (P > 0.05). Postoperative hospitalization, peristalsis time, defecation time, time to first postoperative mobilization, duration of indwelling drain and hospitalization costs in patients in the ambulatory model group were significantly less than patients in the conventional model group (P < 0.001). Patients in the ambulatory model group had significantly higher postoperative pain relief scores than patients in the conventional model group. In conclusion, our data suggest that patient satisfaction is equal between the conventional and ambulatory mode of performing robotic-assisted adrenalectomy. Patient satisfaction was probably associated with shorter hospitalization days, adequate preoperative preparation and standardized, high-quality post-discharge information and guidance.

Reduced Readmission and Increased Patient Satisfaction in Post-Cardiac Arrhythmia Ablation: A Randomized Pilot Study

BACKGROUND

Hospital readmissions within 30 days post-cardiac arrhythmia ablation are typically related to postoperative complications and arrhythmia recurrence and considered mostly preventable.

PURPOSE

To evaluate the impact of a cardiac ablation patient education program on hospital readmissions and patient satisfaction.

METHODS

An education intervention was established for patients who underwent cardiac ablation based on the Project RED framework. Hospital readmissions rates 30 days postprocedure and satisfaction via a single-blinded posttest design were assessed to evaluate the program.

RESULTS

Those in the intervention group had a significantly lower rate of 30-day readmissions (7.1% vs 53.3%, P = .014). A large magnitude of effect and higher total patient satisfaction scores were also seen in the intervention group ( M = 633, SD = 78) than in the control group ( M = 508, SD = 137, P = .005).

CONCLUSIONS

Results of this study support the implementation of an enhanced cardiac arrhythmia patient education intervention with consideration of identified facilitators and barriers.

Patient Perspectives of the Hospital Discharge Process: A Qualitative Study

Care transitions after hospitalization require communication across care teams, patients, and caregivers. As part of a quality improvement initiative, we conducted qualitative interviews with a diverse group of 53 patients who were recently discharged from a hospitalization within a safety net hospital to explore how patient preferences were included in the hospital discharge process and differences in the hospital discharge experience by race/ethnicity. Four themes emerged from participants regarding desired characteristics of interactions with the discharge team: (1) to feel heard, (2) inclusion in decision-making, (3) to be adequately prepared to care for themselves at home through bedside teaching, (4) and to have a clear and updated discharge timeline. Additionally, participants identified patient-level factors the discharge planning team should consider, including the social context, family involvement, health literacy, and linguistic barriers. Lastly, participants identified provider characteristics, such as a caring and empathetic bedside manner, that they found valuable in the discharge process. Our findings highlight the need for shared decision-making in the discharge planning process to improve both patient safety and satisfaction.