Surgical perioperative pathways—Patient experiences of unmet needs show that a person‐centred approach is needed

Abstract

AimTo explore patients’ and healthcare professionals’ experiences of patients’ surgical pathways in a perioperative setting.BackgroundElective surgical pathways have improved over the past decades due to fast‐track programmes, but patients desire more personalised and coordinated care and treatment. There is little knowledge of how healthcare professionals’ collaboration and communication affect patients’ pathways.DesignThe overall framework was complex intervention method. A phenomenological‐hermeneutic approach was used for data analyses. COREQ checklist was used as a guideline to secure accurate and complete reporting of the study.MethodsField observations (120 hr) and semi‐structured interviews (24 patients) were undertaken during 2016–2017. Healthcare professionals involved in the pathways were interviewed: (a) 13 single interviews and (b) 13 focus group interviews (37 healthcare professionals) were conducted. The Consolidated Criteria for Reporting Qualitative Research checklist was used.ResultsPatients asked for individualised information adapted to their life and illness experiences. Furthermore, healthcare professionals need access to a quick overview of individual patients and their perioperative pathway in the electronic patient journal (EPJ). Agreements made with patients did not always reach the right receiver, there was poor interpersonal communication and the complex teamwork between many healthcare professionals made pathways incoherent and uncoordinated. Healthcare professionals who had the time to talk about other subjects than the disease with smiles and good humour gave patients a feeling of security.ConclusionPatients wanted to be treated as individuals, but often they received standard treatment. Healthcare professionals had the intention of treating patients individually, but the EPJ and information provided to patients were not easy to access.Relevance to clinical practiceVisible information about the patient's whole pathway could improve healthcare professionals’ care and treatment. In addition, systematic feedback from patients’ could make it possible to adjust information, care and treatment to achieve a more coherent pathway. Particular attention needs to be paid to how electronic healthcare systems can underpin relational coordination in pathways.

Exploring the hospital patient journey: What does the patient experience?

“…Historically, researchers and health care managers have focused on the study of how to achieve effective care through the definition of clinical pathways and by increasing patient adherence to treatment. However, reducing the patient's path to the clinical perspective may fail to reveal aspects that are relevant to patients, that influence their experience and their perception of quality of service [42, 42]. In this study on patients’ hospital journeys, some important issues emerged through the shadowing of the hospital journey of the patients, and interviews with the key players.…”

“…Patients’ experiences have become increasingly central to assess the performance of healthcare organizations and to redesign the services around the real needs of patients [20, 41, 42, 45, 49]. In this study, the analysis of the hospital journey from the patient perspective and the integration of three different standpoints, patient shadowing, healthcare professional interviews and patient interviews, highlights important areas of improvement otherwise hidden by the analysis of the clinical pathway only.…”

Congruency Between Planned and Performed Procedures and Adherence to Recommended Perioperative Practices: A Chart Audit of High‐Risk Surgical Patients

“…A lack of response to documented patient health concerns in the EHR or the surgical planning system may contribute to complications in the postoperative period. 3,20,40 In the records we reviewed, the patients who received anticoagulants as prophylaxis received the medication in line with recommendations. 16 Alternative or combinations of care measures (eg, compression stockings) may help prevent deep vein thrombosis, 17 but we did not find any documentation of using these measures.…”

“…1 Verbal information transfers (ie, hand overs) are important; 2 however, when documentation of care is missing, perioperative nurses may not be able to follow up on interventions, information, prescriptions, or agreements that have been made between other health professionals and the patient (eg, to meet the surgeon before the procedure). 3 Documentation in the electronic health record (EHR) system provides a safety net to ensure that perioperative personnel provide appropriate treatment and care to surgical patients. 3,4 Perioperative nurses described that they experienced a lack of information as a barrier to providing safe, patient-centered care in two of our previous interview studies.…”

“…3 Documentation in the electronic health record (EHR) system provides a safety net to ensure that perioperative personnel provide appropriate treatment and care to surgical patients. 3,4 Perioperative nurses described that they experienced a lack of information as a barrier to providing safe, patient-centered care in two of our previous interview studies. 5,6 According to the OR nurses, the patients' EHRs did not contain adequate information about the planned surgical intervention or the patients' health status, preoperative preparation, or care plan.…”