C. S. Smith3, K. Guyton1, N. Schindler1,4, A. Langerman2 1University Of Chicago,Department Of Surgery,Chicago, IL, USA 2Vanderbilt University Medical Center,Department Of Otolaryngology,Nashville, TN, USA 3University Of Chicago,Pritzker School Of Medicine,Chicago, IL, USA 4Northshore University Health System,Department Of Surgery,Evanston, IL, USA
Introduction:
With improved local and regional anesthetic techniques, increasing numbers of procedures are performed on awake patients. However, patients report mixed perspectives on undergoing such procedures. The patient experience, increasingly used as a metric for quality and reimbursement, offers a critical impetus for optimizing surgeon communication during awake surgery. Patient input in this context is crucial, particularly in academic hospitals where attending surgeons must balance coaching and instruction of trainees and reassuring dialogue with patients.
Methods:
We contacted patients who underwent awake procedures at an academic institution in Urology, Ophthalmology, and Orthopedic Surgery over a two-month period. Patients were called within 21 days post-procedure and consented to participate in audio-recorded semi-structured interviews regarding their experience with communication during the procedure. Interviews were transcribed, coded and reviewed using the constant comparative method until thematic saturation was reached.
Results:
Forty (67%) of the 60 patients contacted during the study period agreed to participate. Of these 40 patients, 32 (80%) cited some communication that made them feel good or better during their procedure. The positive communication cited by these patients fit into the themes of Perioperative Communication, Managing Expectations, Distraction, Emotional Comfort, Physical Comfort, Physician Qualities, Staff Interactions, and Prognosis. The most frequently expressed themes were Distraction (13/32 patients; 17 total comments), Managing Expectations (11/32; 11), Staff Interactions (9/32; 9), and Emotional Comfort (8/32; 9).
Conclusion:
Eighty percent of patients reported positive experiences related to communication during awake procedures. This highlights that surgeons’ communication practices in the procedure room impact the patient’s awake surgery experience. Additionally, this research points to the importance of patients’ interactions with non-surgeon personnel. The most commonly referenced themes offer a framework for further development of best practices for communication in this context. Surgeons should consider the importance of managing patients’ expectations regarding the procedure, distracting them from the procedure at hand, and ensuring comfort. In prior research (1) we found that surgeons are aware of many of aspects of communication that contribute to both positive and negative (2) patient experiences. Surgeons’ success in utilizing the communication techniques that contribute to patients’ positive experiences will be imperative in developing a curriculum for communication during awake surgical procedures.
1. Smith, Claire S et al. Surgeon-Patient Communication during Awake Procedures. The American Journal of Surgery (in press).
2. Smith, Claire S et al. Negative Patient Experiences during Awake Procedures. The AAMC Medical Education Meeting; Seattle, WA (accepted 2016).