From preop through postop
Surgical outcomes are optimized when the client is engaged and educated at every step, beginning with consent and ending with discharge and at-home care.
A client’s decision to approve a treatment plan and go forward with any procedure is largely dependent on the relationship and trust level she has with the hospital team. If she is not comfortable with the care and communication, your recommendations will not be accepted.
Financial resistance is often thought to be the reason that clients struggle with accepting surgical recommendations. In reality, it’s a fear of anesthesia and what happens after the surgery. As a technician, you have the responsibility for nursing care, not only while the patient is hospitalized but postoperatively as well.
I discussed the surgery experience in a previous article, but the focus then was on what should be done while the patient is hospitalized. (Read “Make Surgery an Exceptional Experience” at http://bit.ly/2ZJhRjn.) While very important, that is just the beginning of the connection we need to establish with the client.
We take too much for granted in veterinary medicine. We assume clients listen to, understand and remember everything we tell them. We assume they will anticipate and understand the pet’s needs and follow our instructions. We assume they know how to and will give prescribed medication or perform the at-home treatment and care needed. This is a common mistake in most practices and a trend we need to acknowledge and reverse.
If we can address concerns and assist clients before complications arise, we will have better surgical outcomes directly related to enhanced postoperative care and improved communication. Positive results lead to better patient care, increased compliance, higher adherence rates, greater client satisfaction and more revenue.
How do we get there? We need to create systems and resources that address every possible question and concern clients might have when deciding if and when to proceed with a surgical procedure. They need to know what to expect when providing the care the pet will need afterward.
Consider how you will address:
- Activity restrictions.
- Postoperative medications and treatments.
- Incision, bandage and wound care.
Properly addressing these concerns before the procedure will ensure that your clients know how to make an informed decision, not just whether they will proceed with surgery but when. Clients need to understand what they will face pre- and postop. Preparations might involve a change in a client’s work schedule, so the more information you can provide, the easier time for the pet owner.
Consider providing comprehensive printed information or links to videos. Informed-consent resources are not difficult to prepare and customize. These resources should be available on your website or emailed to a client.
They should cover:
- What to expect when a pet has surgery. Include information on preop preparation and drop-off details as well as preanesthetic diagnostics, transdermal pain-control application and patient admission instructions.
- How to prepare for surgery and recovery. Include the equipment and supplies that might be needed at home after surgery, such as bedding, towels, slings, ramps, crates and special diets.
- A detailed treatment plan and financial overview. Include postop visits and services, diagnostics, bandage or cast changes, and ongoing medications.
Take Your Time
Discharge instructions should be communicated verbally and in written form. This means a discharge appointment is necessary for every patient so that the interaction isn’t rushed and incomplete. Schedule a 15- to 30-minute discharge appointment when the patient is admitted for the procedure. This sets the expectation that all discharge information and instructions will be shared with the client then rather than during a post-procedure phone call. The standard postop call is intended to let the client know that the procedure is finished and that the pet is in recovery.
A lot needs to be covered during a surgical discharge appointment, so be prepared. You should:
- Do some show and tell. If radiographs were taken, share them with the client and explain what they show. Use dental and orthopedic models to illustrate.
- Show the incision, surgical site or extraction site. This will help the client identify any unusual changes once the pet is home.
- Discuss cast, bandage, incision and wound care.
- Demonstrate how to give any prescribed or dispensed medication and explain the purpose and importance of it.
- Demonstrate any mobility aids or tips for helping large dogs to ambulate. This is especially important for orthopedic patients.
- Emphasize the importance of restricting activities.
- Fit and apply the e-collar. This is an essential item, not optional, to prevent postop incision and surgery site trauma. Explain the importance of leaving the e-collar on at all times. Consider offering comfort options to the e-collar such as fitted shirts, limb sleeves or Surgi-Sox products designed to restrict access to the surgery site.
- Escort and assist the client in putting the pet in the car.
Follow-Up Is Key
Providing written discharge instructions in addition to verbal instructions will assist clients with remembering everything, and they might need to share the information with family members.
Think of yourself as the client’s surgery liaison. The more information and resources you can provide, the better. Provide your name and, if you have one, your business card. Encourage clients to call if they have any concerns once the pet is home.
Follow-up communication needs to happen the day after the patient is discharged. Make sure you have updated contact information and the desired contact method. Establishing a robust client-callback system is a must to make sure calls are not missed. The questions need to be pointed and specific rather than one broad “How is Maverick doing today?” Start with that question and then dig deeper to get a true sense of what is going on. Clients don’t often know what they don’t know. It’s our job to identify potential surgical complications before they become a concern.
Also, develop a specific set of questions based on the type of procedure. A tibial-plateau-leveling osteotomy will require different questions than an advanced dental procedure or routine neuter.
You might want to ask:
- How does the incision look this morning?
- Do you see any blood in the mouth?
- Can he get up to go outside and urinate?
- Are you able to give the medication?
- What is his pain level?
- Is he eating and drinking?
- Is the bandage clean and dry?
- How is he tolerating the e-collar?
- Does anything concern you?
- Do you have any questions?
One postop call will not be sufficient. Depending on the complexity of the procedure, daily check-ins might be needed for the first few days. Clients need reassurance, so multiple calls are time well spent. Clients who can identify normal postoperative signs — minor swelling, decreased appetite, less frequent bowel movements, some lethargy — will feel more comfortable identifying what’s abnormal.
Think of yourself as the patient advocate. Together with the client, you can help ensure a positive surgical outcome through enhanced communication and a little hand-holding.
Getting Technical columnist Sandy Walsh is a practice management consultant, speaker, writer and instructor for Patterson Veterinary University.