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Patient feedback helps surgery center refine policies

Ambulatory Safety Monitor, January 13, 2005

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Evergreen Surgery Center, LLC (ESC), in Kirkland, WA, dazzled a JCAHO surveyor with the way it let patient satisfaction dictate one performance improvement project. ESC used data from patient satisfaction surveys to determine that it needed to improve postoperative pain management. Staff at ESC walked the surveyor through their subsequent steps for the project during the facility's December 2003 triennial survey.

Though ESC was one of the last facilities surveyed under the old methodology, it took away valuable lessons applicable to surveys conducted under tracer methodology as well.

"[The surveyor] liked the fact that we used our patient satisfaction survey to revise a process," says Josie Rowe, RN, CNOR, director.

Phrase questions carefully

These surveys revealed that ESC scored lower than other surgery centers on ensuring that patients receive pain medication. By talking with patients, the team realized that the problem was not facility policy or poor attention to patient needs, but semantics.

The patient satisfaction survey asked these two questions about pain management:

1. Do you think staff did everything they could to help control your pain?

2. How long did it take to receive pain medication?

Patients' responses to the first question showed that they were pleased with the way staff addressed their pain.

However, many patients gave ESC a negative mark on the second question, indicating that they never received pain medication. By talking with patients, Rowe realized that patients who did not need pain medication in the first place gave this mark, because they did not receive medication.

"If we hadn't looked into it, we wouldn't know," says Rowe. In the end, ESC didn't need to improve the policy, only the wording of the question.

Revive advance directives policies

Though impressed with the overall care for patients that ESC provides, the surveyor found room for improvement in one area that had slipped under the center's radar.

The surgical center does not honor advance directives, but did not have a policy in writing stating its position.

Although the number of patients who come to ESC with this request is low-about one per month-the policy still must be clear and in writing, said the surveyor.

ESC has since created a policy states that if a patient requests an advance directive form or has one already-either a living will or durable power of attorney document-the facility will include it in the patient's medical record. An admitting nurse or anesthesiologist will inform the patient that he or she cannot honor the request and have the patient sign a "notice of policy regarding advance directives" form.

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