Patient Satisfaction Benefits Research Articles

Abstract TP358: Implementing Post Neuroendovascular Procedure Nursing Care With Transradial Access

Neurointerventionalists (NIR) are adopting conversion from transfemoral access (TFA) to transradial access (TRA) due to the safety, cost and patient satisfaction benefits seen in cardiology. Implementation of TRA requires specific nursing knowledge, skill competency and protocols to assure positive patient outcomes. A team approach including NIR, cardiology and nursing was used to coordinate safe patient management. Preparation began with RN education regarding advantages of the TRA vs TFA including less vascular complications, a more easily compressible location, earlier ambulation, less site pain, and earlier discharge. Identifying the patient recovery area was crucial to assure proper nursing ratios necessary to provide surveillance needed for deflation of pressure device and observation for bleeding or other complications. Specific care post NIR procedure was modeled using existing cardiac protocol. The process begins with nursing in the NIR suite and proceeds to recovery area where the pressure device is progressively deflated until hemostasis is achieved and removed by the RN. The removal protocol is clearly described and mapped in the Radial Post Procedure Checklist (RPPC), which follows physician orders and includes instruction for VS, NV and neuro checks, pulse oximetry on accessed hand, and pressure band deflation after 60 minutes for diagnostics and 90 minutes after an intervention by releasing 3 cc every 15 minutes. RPPC provides reinflation directions if bleeding is observed. RN proficiency with pressure band was achieved through instruction, practice and correlation with anatomy. Patient instructions for complications and restrictions were provided to the discharging areas. Although recovering TRA NIR patients requires new knowledge and skills, we have successfully cared for 105 in the past 6 months; one pressure band placed incorrectly over the ulnar artery was readily identified. Administration has supported a safe nursing ratio during the deflation phase with patient flow identified for procedures performed off hours. Transradial access for NIR patients can be successfully implemented with nursing education, written protocols, proper patient placement flow maps, and patient teaching.

A randomized controlled trial comparing single-incision laparoscopic cholecystectomy using a novel instrument to that using a common instrument

BackgroundTo evaluate the safety and feasibility of single incision laparoscopic cholecystectomy (SILC) using a novel instrument. Materials and methodsFrom September 2011 to June 2012, eligible patients (150 cases) were divided randomly into three groups: group A, SILC using a novel instrument; group B, SILC using a conventional instrument; and group C, conventional laparoscopic cholecystectomy (LC). Operative and postoperative outcomes were analyzed. ResultsThe operative times for Group A [mean 40 min; rang 30–50 min] and Group B [mean 37.5 min; rang 25–50 min] demonstrated no significant differences (P = 0.610), but both times were longer than that in Group C [mean 25 min; rang 20–35 min] (Z = 25.165, P = 0.000; Z = 16.184, P = 0.000). There was no significant difference between the level of blood loss in Group A [mean 10.0 ml; range 5.0–20.0 ml] and Group B [mean 10.0 ml; range 5.0–20.0 ml] (P = 0.989), but the level in both groups was higher than that in Group C [mean 7.5 ml; range 5.0–10.0 ml] (Z = 12.571, P = 0.002; Z = 13.619, P = 0.001). There were no significant differences in patient satisfaction and pain scores (P = 0.519; P = 0.691) among the three groups. Complications occurred in 4 cases, including 1 case of bile injury and 3 cases of bile leakage. There were no complications in SILC with a novel instrument. ConclusionsSILC require a longer operative time and more blood loss without benefit of patient satisfaction and pain scores. However, SILC with a novel instrument has fewer complications and a tendency to safer than SILC with a conservative instrument, and it could be a possible alternative in cholecystectomy.

Improving patients' satisfaction through more effective utilization of operating rooms resources

PurposeThis paper aims to present an applied research effort aimed at re‐engineering the utilization practices of operating rooms for a public Portuguese hospital. This re‐engineering effort is motivated by the desire to enhance the patient‐orientation of the hospital. The role of information systems in facilitating such organizational change is also to be examined.Design/methodology/approachActual data are used to simulate outcomes of three different operational scenarios related to the utilization of operating rooms and surgical teams. As such, the critical constraint related to surgical capacity is relaxed under different utilization scenarios.FindingsBased on the findings of the study, it appears that there is no conflict between operational efficiency and patient satisfaction. Well‐designed operational changes can lead to both efficiency and patient satisfaction benefits. This, in turn, can translate into competitive strategic advantage for the hospital.Research limitations/implicationsThe simulation results derived from this applied research are positive. In general, they tend to point to potential operational and strategic benefits to the hospital and its patients. Although the simulation model used in this study was validated using actual data, more research is needed to test its general applicability. Such research should shed more light on the interrelationships which exist within the hospital operating system.Practical implicationsThe approach advocated in this research has operational and strategic relevance to healthcare policy makers and hospitals' administrators. In this context, the role of the information systems in providing information relevant to tracking and improving a hospital's performance is emphasized.Originality/valueThe paper presents a practical, applied, systematic approach toward enhancing operational effectiveness in healthcare organizations. It draws on bodies of knowledge pretending to system theory, simulation and operations management in order to improve the short‐term performance of hospitals.