Fragmented and Outdated Patient Education May Influence Post-Surgery Outcomes

Partner News | Published: Wednesday, September 15, 2021 6:00 am

It’s no secret that provider burnout is at an all-time high; everyone is stretched thin. The need for cohesive, simple, patient education is more important than ever. Saving time while improving the patient experience can be a balancing act, but with the right strategy the benefits are measurable. Nationwide, patient satisfaction with discharge instructions is low[1], and a majority of caregivers did not feel prepared for the responsibility in a cardiac surgery study[2].

To make the slope even more slippery, hospitals in search of revitalized education materials and platforms are constrained by the bitter reality of budgets and difficult financial allocation. Unfortunately, the impact is felt directly at the patient level, leaving already frightened people more overwhelmed with few resources when they get home. In turn, the bottom line is directly affected through readmission penalties and patient experience scores. Nurses and hospital educators know the profound importance of the education both pre- and post-operatively, but according to studies: “Education content is fragmented. It’s hard to document what educational material is given to a patient. Usage is even harder to measure. During discharge, nurses often lose time finding the right educational materials, editing instructions, and retrieving handouts at printers.”[3] In addition, increasing costs and payor pressures have resulted in shorter inpatient lengths of stay (LOS) and earlier post-surgery discharges. With shorter stays, discharged patients are sicker, are in greater need of home care, and have a higher risk of complications.[4] 

Many hospitals and practices have stayed on track with patient-centered care built around successful and complete patient education programs, but many are left wondering where to begin with limited resources. The days of checking off boxes for “meaningful use” requirements aren’t going to be enough for today’s patient population.  Multi-media content in the form of printed patient guides supplemented with video and online access to education material is quickly becoming the norm. Patients need and want the power of information to become their own advocate and an active participant in their own care. Frontline clinicians experience pain points around process inefficiencies. Education content is fragmented. It’s hard to document what educational material is given to a patient. Usage is even harder to measure. During discharge, nurses often lose time finding the right educational materials, editing instructions, and retrieving handouts at printers.[5]

These pain points have been well documented. Researchers at the University of Utah Health Care System identified the following variations in patient education materials:

  • Inconsistent processes for accessing and documenting patient education
  • Content gaps and preferences
  • Technical search and embedding difficulties in the EHR[6]

Unfortunately, post-surgery problems are not uncommon. One study of cardiac patients in early recovery found that all but one of the eighty-two patients experienced problems during the first six months after discharge. These varied from emotional (e.g., depression, anxiety), to physical, to convalescence issues (e.g., incisions), and others, proving that a successful recovery must overcome a variety of challenges[7]. The complexities and complications of post-discharge care precipitates patients' need for additional information.

Pre-Surgery Education Influences Post-Surgery Outcomes

Better patient education adds up to better surgical outcomes. Gallup conducted a study that asked patients undergoing medical device implantation about three important aspects of pre-surgery education:

  • I knew what to expect after surgery.
  • I was prepared for my experience post-surgery.
  • I followed post-surgery instructions, such as rehabilitation or medication.

When asked to rate their agreement with three satisfaction statements, patients who strongly agreed with one, two or three statements experienced increasing outcome improvements, such as higher overall satisfaction and lower problem incidence.[8] 

Multimedia Proves the Most Effective Delivery Format

Pamphlets or photocopied handouts, along with hurried verbal instructions, are often the only information that is given to patients and families. Postoperative patients may be groggy, in pain, or too weak to focus on learning, while caregivers may feel distracted and overwhelmed. It’s not a stretch to purport patients stop hearing when told, “you’re going home.”  One study found that patients forget 80% of what clinicians tell them, and almost 50% of the remembered data is recalled incorrectly[9]. Patients and families need to be able to refer to information, review salient points repeatedly, and have a tangible, take-away product.

A collaborative study by the Process Improvement Team of the University of Pittsburgh Medical Center (UPMC)[10] examined results from providing an educational video designed for home viewing to patients discharged after coronary artery bypass surgery. Nurses, rehabilitation therapists, patient educators, and librarians partnered to select a high-quality video designed for independent, home viewing by discharged CABG patients. The authors of that study postulated that the information provided on the video helped patients feel more confident about their ability to adhere consistently to the recommended low-fat diet. At the one-month follow-up, patients with the video measured significantly lower cholesterol and saturated fat consumption compared to the control group. Because patients and caregivers watched the video at home, patients were able to gain additional knowledge on their own, without individualized instruction from nursing staff. In addition, patients and families could watch the video as many times as they wished.

The evaluation revealed that 84% felt that the video answered questions that they otherwise would have called their health care provider to ask. This time-saving feature of the program resonated with staff as well as families, and video usage was made a formal part of the discharge planning process. By utilizing a multimedia format with less technical language, the video positively affected patients' postoperative knowledge and self-care abilities. This impact is evidenced in that 88% of respondents said they either acquired new knowledge or reinforced existing knowledge after viewing the video.

When asked in what areas the video increased their knowledge, respondents reported better understanding of activity changes (76%) and increased knowledge of appropriate diet (66%) and incision care (61%). They also reported improved comprehension of appropriate medication usage and knowledge of when to call their health care providers.

As one CNO observed at a panel discussion, “The issue isn’t with delivering the education, anything that makes the process easier, more efficient would be good. Having too many resources is not necessarily better either, as collecting and delivering these to patients is very time-consuming.”[11]

The findings from these studies demonstrate that better educational information, and especially in a multimedia format, is used and appreciated by patients. It’s time to change the face of patient education and invest in the resources that can impact people’s lives and dramatically improve their experience with the providers.


Authored by Lisa Coleman,
President of RecoverRite














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