Communicating Information to the Patient Clearly and at the Correct Times Throughout the Perioperative Journey is the second of a four-part series that provides more information and insight about ASA’s Enhancing Patient Communications Program.
When first meeting with patients who are about to have surgery, I’ve found many are more afraid of the anesthesia than the procedure itself. That’s understandable – they’ve built a relationship with the surgeon, but are meeting me for the first time and I literally have their life in my hands. By making a connection with the patient, I can assure them of my expertise and that my number one goal is to provide them safe and personalized care.
“As anesthesiologists, we have limited time with patients and many aren’t aware of the role we play throughout the perioperative process. The Enhancing Patient Communications Program toolkit was developed to provide you with resources to enhance your patients’ experiences and the specialty’s overall value.”
Building that level of trust and comfort is important in every step of the patient journey, starting with being upfront about what they can expect, from the logistics of the procedure to the pain they will experience.
As anesthesiologists, we have limited time with patients and many aren’t aware of the role we play throughout the perioperative process. The Enhancing Patient Communications Program toolkit was developed to provide you with resources to enhance your patients’ experiences and the specialty’s overall value. Communicating Information to the Patient Clearly and at the Correct Times Throughout the Patient Journey – the second section of the toolkit – provides recommendations for doing that effectively. While the first section focuses on establishing the physician-patient relationship, the second delves deeper into the process, providing insights and suggestions for sharing specific information at every stage of the journey.
As part of the ASA Committee on Communications subgroup that helped to develop the toolkit, I’ve found the approaches we’ve included to be a helpful reminder. Some of the following suggested guidelines and approaches may be familiar, but others might give you new ideas for connecting with your patients and establishing expectations during those critical times before and after surgery.
Preoperative patient encounter
The preoperative encounter likely is the first time you’ve met the patient, which makes it a critical step in the communication process. While your time with patients is short – often only five to 10 minutes – it’s important to put them at ease by letting them know what they can expect and will experience throughout the various phases of their perioperative care.
First, I introduce myself as the doctor in charge of their anesthesia care team by noting, “You’ll meet the nurse anesthetist, who will care for and monitor you during the surgery and call me if they have any issues.” Establish your expertise and explain what you are about to do and that you will be in control. Let them know your number one priority is to keep them safe and comfortable. If you work solo, let them know you will be in charge of their anesthesia from start to finish.
Patients feel better prepared and more comfortable when you explain in detail what they can anticipate. I take them through the process step by step. For example, I’ll say, “I am going to give you something to help you relax, and you may or may not remember going into the operating room. You’ll be connected to monitors, given oxygen, and within 10 seconds the anesthesia will take effect and you won’t feel or see anything. Once the procedure is over, you’ll hear me say ‘take deep breaths,’ and once you are awake we will take you to the recovery room.”
Also important is acknowledging their anxiety. In fact, I usually start off our conversation by asking patients how they are feeling, and if they say they are nervous, I take time to explore that. Sometimes they’re concerned about outside issues such as who is going to take care of their pet while they are at the hospital. Once they have a chance to discuss their concerns, they often are more relaxed. Then I’ll say, “Let’s bring it back and focus on you today. Hopefully you will feel less nervous once I explain the process and answer your questions.”
If patients say they remember being awake during a previous procedure, I inform them that they likely had sedation, not general anesthesia, and may recall memories from right before or after the procedure, but likely nothing from the procedure itself. I also explain the possibility of retrograde amnesia. I simplify the term by noting “You will be groggy when you wake up after the procedure and may not remember going into or leaving the operating room.”
Many patients also expect to be pain-free when the anesthesia wears off, so an important part of the preoperative visit is managing expectations about pain after the procedure. I’ll explain, “I will give you medication before the procedure for nausea and pain, but it’s important to realize that you likely will have some pain after the procedure, typically a level 3 or 4 out of 10. But don’t worry, I will check in with you after the procedure and we’ll talk about your comfort level.”
When presenting the informed consent, explain what it means – that it is a legal document explaining the risks and benefits of the procedure as well as possible side effects, complications, and alternatives for treatment. Be sure they understand what it says. Honesty builds trust. The conversation can evolve into discussing shared goals and decision-making and asking patients about their hopes for the procedure. If the patient has a choice of anesthesia, I explain what kind of anesthesia we typically use for the procedure, but also explain any alternatives and talk that through with them.
It’s important to remember that communication is a two-way street and to be open and receptive to patients’ questions. At the end of the preoperative visit, I ask the patient if they have any questions. I typically find they don’t have many once they understand that I know their medical history and have addressed what to expect regarding the procedure and postoperative pain.
Close the communication loop by checking in with the patient while they are in the PACU to ask how they are feeling and about their pain and nausea. Let them know, “It’s normal to have pain for a few days, but each day will be better, and the best way to manage the pain is by following the directions for taking the pain relievers I prescribe. And please take it easy for the rest of the day.”
I explain issues or concerns that arose during the procedure – if any – and discuss what they need to know for future surgeries. For example, if the patient had a difficult airway, I explain what I did to safely place the breathing tube and that I will give them a note of my findings for them to provide the anesthesiologist if they have a future procedure.
Patients are comforted to know they will receive support after they go home and that the anesthesia or surgical department will follow up with them, so it’s helpful to emphasize that continuity of care. I’ll tell them the hospital will know how to reach me if they have any questions about their anesthesia or pain management.
All of these communication tactics go a long way toward making patients comfortable and helping them understand and appreciate the vital role you play in their care. For more information about the Enhancing Patient Communications Program, visit the Made for This Moment member page at asahq.org/member-center/patient-communications-toolkit.
Downloadable ASA Resources to Help You Communicate with Patients
ASA offers a number of free education brochures, checklists, and tip sheets that you can download, print, and share directly with patients. Many of these resources may be particularly useful as you communicate with patients throughout the perioperative journey. For example, brochures on Outpatient Surgery and Anesthesia; Pain Management; Seniors and Anesthesia; and Sedation, Analgesia and Anesthesia are just some of the resources available on ASA’s Made for This Moment website that may enhance your communications and be helpful to patients before a procedure. Visit asahq.org/madeforthismoment/resources/ for links to all the resources.
Additionally, ASA has developed a free, validated Perioperative Surgical Home (PSH) engagement tool and CME course titled “Patient Engagement Training for Perioperative Care Teams” that guides patients through every step of their surgical experience with clear explanations of what to expect, questions to ask, and information to record. The tool and course are available at asahq.org/engagepatients. Eighty-seven percent of patients who received the tool said they felt prepared for surgery.