Team approach makes patients happier and lowers costs for esophageal surgery
A new program designed to increase the overall satisfaction of patients undergoing esophageal surgery has resulted in lower patient costs and reduced times on both the operating table and in the hospital.
"We wanted to perform cases more efficiently while still providing the highest levels of patient care," said lead author Farzaneh Banki, MD, director of the Esophageal Disease Center and associate professor of cardiothoracic and vascular surgery at The University of Texas Health Medical School (UTHealth) in Houston. The results of the study were published in the American Journal of Surgery (2013;206:1007-1015).
"Achieving higher patient satisfaction and decreased costs is the result of what can be accomplished with the power of a coordinated team," Banki said.
UTHealth President Giuseppe Colasurdo, MD, said the study is just one example of how the faculty and staff of UTHealth and at Memorial Hermann, located in The Woodlands, Texas, are working together to improve care and quality for patients. "Modern health care involves teams of experts working together to manage not just diseases and symptoms, but the patient's overall health," he said. "This study shows the importance of communication, education, and teamwork in delivering the very best outcomes."
To make esophageal procedures more efficient, Banki built a team comprised of leaders in nursing, physical therapy, respiratory therapy, radiology, endoscopy, nutrition services, and the operating room. The team meets each Wednesday to review surgical cases and identify special needs.
"Everybody's opinion matters in these meetings," Banki said. "From the surgeon's standpoint, everything flows so that when we get to the operating room, all we have to do is focus on the patient."
The team emphasizes staff education with monthly interactive educational sessions for hospital nurses and educational material for the operating room staff.
Fact sheets and other easy-to-understand information are provided to patients who are carefully monitored by the surgical team and nursing staff after the surgery. A nutritionist meets with patients on the day of surgery to review their diets and answer questions. Clear discharge instructions are prepared, and Banki asks each patient to read them aloud to ensure they are understood.
The study measured differences before and after the program went into effect on October 1, 2010. Banki and her team reported that the operating room time dropped from 185 minutes to 126 minutes; length of stay from 2 days to 1 day; operating room costs from $2,407 to $2,147; and hospital room costs from $937 to $556. At the same time, there were significant improvements in patients' experiences communicating with nurses, pain management, communication about medications, and discharge instructions.
"When patients know that everyone on the team truly cares for them, I believe it helps in the healing process because they feel a sense of protection and confidence in their care," said Banki.