A telephone survey of day-surgery eye patients

How Much Information is Too Much Information for Patients?

An effective pre-operative information-giving strategy is important in day surgery units, where a low pain score is essential for early discharge home. Good post-operative recovery at home is of utmost importance, as it has to be remembered that one-day surgery does not mean one-day recovery. Integrated care pathways (ICPs) have recognised and well documented benefits, and an ICP which includes a patient information strategy was thought likely to benefit staff and patients in the day surgery setting, where it is essential that patients receive timely, appropriate and evidenced-based care and information.

The benefits of giving patients pre-operative information are well documented, and a large majority of patients in this study ( n=100) received written pre-operative information prior to their admission to an orthopaedic day surgery ward. However, it was found that 49% ( n = 42) of patients would have preferred more information. The post-operative pain scores of these patients were demonstrably higher than those of patients who were satisfied with the information they received.

The use of the telephone interview for research

The increasing popularity of the telephone interview as a research method may be a reflection of broader social change and technological advances, with increased use and acceptability of telecommunications to support healthcare and service industries in general. Despite its widespread use there are few definitions of the term. Studies which directly compare telephone and face-to-face interviewing tend to conclude that telephone interviewing produces data which are at least comparable in quality to those attained by the face-to-face method. While it has been used for large survey studies, in nursing research the telephone interview is used predominantly in smaller-scale qualitative studies, where contact has already been made with the participants. The telephone interview was used in a study by one of the authors (EC) which explored the experience of postoperative pain. Issues relating to ethical considerations, reliability, validity, limitations and analysis are explored. The use of the approach for pain research is reflected upon before considering the wider applications that are available for this method of data collection in healthcare practice.

Brief report: telephone administration of the autism diagnostic interview--revised: reliability and suitability for use in research

The Autism Diagnostic Interview--revised is one of the "gold standard" diagnostic tools for autism spectrum disorders. It is traditionally administered face-to-face. Cost and geographical concerns constrain the employment of the ADI-R for large-scale research projects. The telephone interview is a reasonable alternative, but has not yet been examined for reliability with face-to-face administration. In this study, participants were interviewed both face-to-face and on the telephone using the complete ADI-R interview. Results indicate that there was no significant difference between the algorithm scores or the diagnoses arrived at for face-to-face and telephone administrations. Reliability statistics across the two modalities were very good and indicate that telephone interviews using the ADI-R are a viable option for researchers.

Patients' Perceptions of Emotional Support and Information Provided to Family Members

The purpose of this quality improvement project was to determine patients' perceptions of the emotional support and information provided to their family members by nurses in a day surgery setting. The project was conducted in a day surgery unit of a hospital in western Finland. Data were collected from 60 participants using a questionnaire designed specifically for the project. The results showed that half of the patients appreciated the presence of their family members during hospital care. The emotional support provided to family members was rated as moderate, and more than 50% of the patients believed their family members were adequately informed. The results were used to help develop tools for patient and family member education.

Reducing waiting times associated with an integrated child health service

Following an increase in average waiting times associated with a child health service in East London, an initiative to rapidly reduce the numbers of children waiting long periods following a referral was undertaken over the period May to June 1999. A multidisciplinary cooperative approach was adopted operating within the existing available resources and involved medical, nursing, managerial and administrative staff. The initiative involved a review of the accuracy of the waiting list, followed by an invitation to remaining patients to provide an option of continuing to wait to be seen or offering attendance at a rapid response clinic associated with reduced waiting and consultation times. Half-hourly appointments were routinely offered instead of hourly appointments and proformas were adopted for history taking and onward referrals to save time spent on administration. A total of 162 patients were seen over the course of a month and a satisfaction questionnaire completed by relatives indicated a preference for the new service. The mean waiting time was reduced to under a quarter of the time at the start of the initiative to a mean of less than two months. The purpose of the study was to see if the waiting list could be reduced by using existing staff. We wanted to ascertain the parents' views whether shorter waits and shorter consultation periods were acceptable, and to ascertain if the waiting list could be kept down or whether the waiting list would rapidly recur after the rapid response clinics stopped. The findings are discussed in relation to initiatives elsewhere and the need to maintain a high quality service.

The lived perioperative experience of ambulatory surgery patients

Understanding patients' perspectives is central to providing appropriate nursing care. The purpose of this study was to explore ambulatory surgery patients' perceptions and views of the perioperative experience. A phenomenological study was conducted that included 16 patients who underwent abdominal surgical procedures in the ambulatory surgery center of a large teaching hospital in the northeastern United States. Intensive semistructured interviews were used to collect data. Patients were interviewed one week after surgery. Data analysis was aimed at gaining understanding of the lived experience of ambulatory surgery patients. Themes identified included fear, knowing, and presence. Results indicate that patients in this study were not prepared adequately for the perioperative experience, suffered needlessly due to inadequate pain management, and did not achieve discharge readiness.

The quality of perioperative care: development of a tool for the perceptions of patients

AIM OF THE STUDY

To find out how surgical hospital patients (n=874) perceived the quality of perioperative care they received in an operating department and in the recovery room.

BACKGROUND

Patients' perceptions of the perioperative care have not been included systematically in the improvement of the care. Accordingly, there is no standardized, valid, and reliable instrument or system in common use that we could use for the evaluation. The nursing care in operating departments has an important role in modern health care, and therefore more research concerning perioperative care quality is needed urgently and the development of the measurement tool is urgent.

METHOD

The data were collected using a structured questionnaire in five operating departments in southern Finland during 1998.

RESULTS

Physical activities (such as pain management and temperature maintenance) were rated as excellent, as were staff characteristics and the physical and social environment. The most critical comments were made with regard to supporting patient initiative, encouragement and educational activities. Patients stated they would have liked more information and it was felt that they should have been encouraged to ask more questions about unclear matters. Some of the patients said they had only very limited influence over their own care. The patients were very pleased with their care in the recovery room. There were only minor differences between the views of patients from different departments.

CONCLUSIONS

Overall the quality of care was considered extremely good, but comparisons of different quality categories did reveal some problems. Although it has already proved to be a useful tool, the questionnaire needs to be developed and tested further.

Pre-operative visiting in Wales: A study of its prevalence and nature

A telephone survey was completed involving senior nurses from all NHS theatre units in Wales that carry out routine scheduled surgery (n=19).The survey examined whether these units had pre-operative visiting regimes, constraints and barriers to pre-operative visits and the nature, content, timing and staffing of any visits that were undertaken. A purposive sample of respondents from the telephone survey (n=6) was interviewed further and a content analysis of the transcribed interviews completed.

The results indicate that only a small percentage of patients undergoing surgery actually receive a pre-operative visit. When visits are carried out their content does not reflect the evidence of effectiveness in the research literature. The reasons for this apparent non-utilisation of research evidence are explored in the paper and recommendations are made as to how this situation could be altered.

A randomized trial of a Telephone Reassurance Programme for patients recently discharged from an ophthalmic unit

Patients often experience problems after discharge, for instance with housekeeping or a general lack of information. The effect of a nurse-initiated Telephone Reassurance Programme (TRP) on ophthalmic patient outcomes was investigated. Patients in the intervention group were phoned by a nurse 3-6 days after being randomized and discharged home. Patients in both intervention and control groups received a questionnaire 1 week and 1 month after discharge to assess the patient outcomes 'Informational needs', 'Uncertainty', 'Emotional complaints' and 'Functional limitations'. In an attempt to explain the lack of statistically significant results, the limitations related to the participants, intervention and outcomes are discussed.

Unplanned admissions in day-case surgery as a clinical indicator for quality assurance

BACKGROUND

Day surgery is a modern, effective and economical way to treat patients while maintaining the same level of quality of patient care. Quality improvement in day surgery units, however, continues to be an issue due to high rates of unplanned admissions. The aim of the present retrospective study was to investigate reasons for and methods of preventing unplanned postoperative admissions in a day surgical unit over a 12-month period in respect to different surgical specialties.

METHODS

The study was based on an audit from the Endoscopy and Day Surgery Unit (EDSU) at Launceston General Hospital, which provides health care to a population of more than 120000.

RESULTS

For the accounted period 920 outpatients had elective day surgical procedures. Overall the unplanned admission rate was 4.7%, and surgical, anaesthetic and social reasons accounted for 58.2, 37.2 and 4.6% of the unplanned admissions, respectively. The highest rate of unplanned admissions was for plastic and reconstructive surgery (12.8%) and orthopaedic surgery (7.5%) despite the relatively small number of patients who underwent such procedures in the day surgery unit. The results also showed a correlation between age group, pre-operative medical status of the patients found suitable for the day surgical procedure and unplanned admissions.

CONCLUSIONS

Strategies to reduce the unplanned admission rate which include patient selection and pre-operative assessment, patient waiting time and education, pre-operative anaesthesia, follow-up with nursing care and postoperative analgesia are discussed.

Post-operative pain, nausea and vomiting: qualitative perspectives from telephone interviews

Previous studies on post-operative pain, nausea and vomiting tend to be quantitative in method and focus on in-patient or day case surgery. The objectives of this study carried out in one specialist eye hospital in England were to consider post-operative pain, nausea and vomiting from a qualitative perspective. Fifty-five patients undergoing general anaesthetic short-stay ophthalmic surgery (orbital hydroxyapatite implantation) consented to participate in telephone interviews 8 days post-surgery. The interviews lasted between 20 and 60 minutes. Data were analysed thematically and offer insight into varying experiences of pain, nausea and vomiting in hospital, on discharge and at home. Results indicate that not all patients were discharged home in optimum condition. The needs of post-operative short-stay patients should come before financial imperatives to vacate beds. Patient education and information giving is discussed in the light of the findings.

Research in peri-operative nursing care

This review analyses 97 research reports dealing with peri-operative care which included patients. The literature review was done as the basis of a development project to measure the quality of intra-operative nursing care from the patient's perspective. The pre-operative phase provides information about the teaching, anxiety and stress of patients. Few sources dealt with the intra-operative phase; there were a small amount of reports concerning concrete nursing activities (e.g. surgical position and warming the patient). The most information was available on the post-operative phase, such as recovery, adaptation and the treatment of pain. Peri-operative research is mainly concerned with the quality of nursing care, control of life and ambulatory surgery. The main defects of analysed studies can be characterized as follows: small samples and a single hospital, lack of definition of terms, theoretical ambiguity, short follow-up times, anaesthetic or other drugs used during the care not mentioned in the report (especially in studies on pain and quality). Previously developed research tools had usually been well tested, but there was great variety in the testing of investigator-constructed tools. There were also discrepancies in the evaluation of validity and reliability. Future research should especially deal with treatment of pain and anxiety, information and guidance given to patients, and the costs of surgical care; there is also a need for studies dealing with intra-operative care from the patient's perspective. Although information is already available on the above mentioned topics, more detailed and comprehensive facts are still needed.

Talking on the telephone with people who have experienced pain in hospital: clinical audit or research?

The adequacy of postoperative pain management in British hospitals appears insufficient to improve patient care, and much of the research and clinical audit in postoperative pain has failed to seek the patient's perspective. This paper reports on the findings from a semi-structured telephone interview survey which formed part of a hospital-wide audit on postoperative pain at a district general hospital in the south of England. Of a total of 360 completed audit questionnaires, 114 patients left their telephone number and 29 were interviewed. Content analysis revealed five main themes: inadequate information, pain at home, staff attitudes, expectations of pain, and ward atmosphere. Several patients identified insightful strategies that potentially could improve pain management. The telephone interview generated a richness of data that had not been reported before in this important area. Some authors view clinical audit and research as having different characteristics but this work raises important questions for both approaches when using the semi-structured telephone interview. The ethical issues pertaining to collection of audit data using the telephone interview are discussed.

Patients' experiences of varicose vein and arthroscopy day surgery

A small-scale telephone survey of day surgery patients' (n = 30) experience of pain, nausea and vomiting, wound healing and fatigue during the 7 days following discharge and their views of the service is described. Respondents who had undergone either varicose vein stripping (n = 15) or arthroscopy (n = 15) were interviewed using a semi-structured interview schedule. The findings indicated that most respondents expressed satisfaction with their recovery despite some evidence of postoperative morbidity. The majority of the sample indicated that they had received adequate information to enable them to cope at home and qualified nurses on the day unit were identified as a primary source of information. Following discharge, GPs or the day unit were key points of contact. The findings of this study, together with previous research, highlight important areas for further action by health professionals if this service is to be delivered effectively and efficiently.