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Patient Information Provision

Patient Information Provision: Guidelines and a practical application toolkit

Christina Ann Drace, Gamal Eldin Mohamed and Carlo Castoro
Carlo Castoro, MD, Surgical Oncology, Veneto Institute of Oncology IRCCS, Via Gattamelata 64, 35100 Padova (Italy). E-mail: carlo.castoro at unipd.it


Introduction

In a day surgery environment, contact with patients is brief and intense. It does not compare with the time once taken to prepare a patient for the same procedure in in-patient surgery. Also, patients are now in charge of their pre-operative preparation and recovery takes place at home. This makes information provision a challenge for day surgery. It is generally accepted that providing the patient with information about day surgery and individual procedures is an important aspect of day surgery management 1-2. An effective information provision policy aims to improve patient satisfaction with the overall day surgery experience and aid anxiety reduction. In fact, an informed patient is likely to experience less anxiety and is thus able to better adjust to surgery. This, in turn, will increase the overall staff satisfaction, avoid delays and contribute to the smooth running of the Day Surgery Unit (DSU). Information must be provided within a formalized framework of healthcare and delivered in a structured manner; it must be consistent throughout the entire DS pathway. Moreover, the amount of information to be provided is another important aspect, as some patients require more information than others. Too little information can cause confusion and delays. The patient may not know what is expected of them or their caregiver. On the other hand, too much information may cause unnecessary anxiety for the patient. Finally, the role of each staff member in information provision should be identified and the timing of information provision co-ordinated since patients will come in contact with and receive information, at different stages, from administrative, nursing and surgical staff 1,3-5.
Ideally, people in general retain only 20% of information given verbally. So, the simplest way to make sure patients receive and remember essential information is to provide them with clearly written leaflets, which can be referred to at any time. Good verbal communication skills are still essential because information is introduced and reinforced verbally ensuring compliance with procedures. Written information should support and be supported by verbal information.

Criteria for Patient Information Provision

Organization and management of patient information provision for any DSU will vary depending on the individual characteristics of that unit, such as location, hospital policies, etc. However, general criteria for policy development can be identified. Day surgery patient contact can be divided into stages, the number of which will depend on individual characteristics. In Figure 1, 8 stages have been identified, from patient referral to post-operative examination. For each stage, the location, type of contact, contact person and information content are described. Within these 8 stages, there are two categories of information to be provided to the patient, general and procedure specific. The timing of information provision can be divided into 3 phases - before admission, on admission and on discharge.


Figure 1: STAGES IN PROVIDING INFORMATION TO PATIENTS in DAY SURGERY

Categories of Information

There are two categories of information to be provided to the patient: general and procedure specific.
General information refers to organizational aspects of the DSU and its procedures and practices. It identifies the location and gives other useful information e.g. address and telephone numbers, public transport information, parking, etc. It also includes basic procedural information general to all procedures performed in day surgery, e.g. admission times, etc. From this information the patient should understand what to generally expect and what is expected of them.
Procedure specific refers to the clinical information regarding the patient’s condition and surgical procedure.
Moreover, recent studies suggest that not all patients require the same amount of information 4, depending on their ability to cope. Anxiety can be reduced by matching the amount of information provided to the patients’ needs and preferences. Two levels of information disclosure, minimal and full, can be distinguished.

Phases of Information

The information to be provided to patients can be organized into 3 phases: before admission, on admission and on discharge. Some information will overlap thus helping the patient understand and retain the more important issues.
Phase I – before admission
The main emphasis at this phase should be on informing the patient about procedures and likely sensations as well as skill teaching (post-operative exercises, pain management). During the pre-assessment interview the patient along with the nurse can choose the correct amount of information to be provided. Also, patients may appreciate a tour of the facilities.
Phase II – on admission
The strategy to be followed in this phase is “supporting”. The patient should be, at this point, well informed as to what is going to happen. The main emphasis at this point should involve the repetition and reinforcement of key information for support and anxiety reduction. Prior to discharge, the caregiver should be present during the giving of information.
Phase III – on discharge
The first two weeks following discharge are seen as the most important since patients are striving to return to normal. The information packet should contain the information patients need to return to normal as quickly and safely as possible. Information includes post-operative pain management, pain relief, nausea, common wound care, sleep disturbance, hygiene, stretching and heavy exercise, returning to work, driving, advice on sexual matters and the contact details of who to contact in case of complications.
Caregivers should be provided with the same information.

Formalized framework

In a formalized framework of patient information provision policies within each DSU, care must be taken to assign communication roles to all staff members and an information provision schedule identified. It is important for the patient to receive the appropriate amount of information at the appropriate time from the appropriate person. Without this, a patient may receive contradictory or conflicting information, which increases confusion and lessens patient satisfaction. Roles for the day surgery staff are identified and described in Table 1. The information provision schedule can be drawn from the typical assessment process depicted in Figure 2.

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Table 1: Day Surgery Staff and their roles in information provision

Paediatric Day Surgery

Patient information in paediatric day surgery will vary slightly. For many children hospital admission can be very stressful and this is always minimised by involving parents wherever possible in their care. Anxiety must also be alleviated in the parents because relaxed, informed and happy parents help produce happy relaxed children. Parents will require all the same day surgery information, which would be provided for patients, but written with them in mind. A certificate of bravery could be awarded to the paediatric patient at discharge.
When referring to overnight fasting, an example of re-wording for parents might be: “Eating and Drinking Restrictions - The most important thing you can do for your child is to follow these feeding instructions. Your child’s surgery may be delayed or cancelled if these instructions are not followed.”