Perioperative Patient Education Research Articles

Perioperative patient education and nursing management in intensive care patients: A systematic review

Perioperative patient education and nursing management in intensive care patients: A systematic review

Appropriateness and Comprehensiveness of Using ChatGPT for Perioperative Patient Education in Thoracic Surgery in Different Language Contexts: Survey Study.

ChatGPT, a dialogue-based artificial intelligence language model, has shown promise in assisting clinical workflows and patient-clinician communication. However, there is a lack of feasibility assessments regarding its use for perioperative patient education in thoracic surgery. This study aimed to assess the appropriateness and comprehensiveness of using ChatGPT for perioperative patient education in thoracic surgery in both English and Chinese contexts. This pilot study was conducted in February 2023. A total of 37 questions focused on perioperative patient education in thoracic surgery were created based on guidelines and clinical experience. Two sets of inquiries were made to ChatGPT for each question, one in English and the other in Chinese. The responses generated by ChatGPT were evaluated separately by experienced thoracic surgical clinicians for appropriateness and comprehensiveness based on a hypothetical draft response to a patient's question on the electronic information platform. For a response to be qualified, it required at least 80% of reviewers to deem it appropriate and 50% to deem it comprehensive. Statistical analyses were performed using the unpaired chi-square test or Fisher exact test, with a significance level set at P<.05. The set of 37 commonly asked questions covered topics such as disease information, diagnostic procedures, perioperative complications, treatment measures, disease prevention, and perioperative care considerations. In both the English and Chinese contexts, 34 (92%) out of 37 responses were qualified in terms of both appropriateness and comprehensiveness. The remaining 3 (8%) responses were unqualified in these 2 contexts. The unqualified responses primarily involved the diagnosis of disease symptoms and surgical-related complications symptoms. The reasons for determining the responses as unqualified were similar in both contexts. There was no statistically significant difference (34/37, 92% vs 34/37, 92%; P=.99) in the qualification rate between the 2 language sets. This pilot study demonstrates the potential feasibility of using ChatGPT for perioperative patient education in thoracic surgery in both English and Chinese contexts. ChatGPT is expected to enhance patient satisfaction, reduce anxiety, and improve compliance during the perioperative period. In the future, there will be remarkable potential application for using artificial intelligence, in conjunction with human review, for patient education and health consultation after patients have provided their informed consent.

ChatGPT and Generative Artificial Intelligence in Mohs Surgery: A New Frontier of Innovation

The rapid and exponential progress in generative artificial intelligence (AI) technologies has inspired many to contemplate the potential applications of such tools within medicine. With regard to the Mohs surgical workflow, AI shows promise in assisting with perioperative planning, patient education, patient communication, and clinical documentation. AI has the potential to transform modern Mohs surgical practices, but at this time, critical human review of any AI-generated content remains necessary.

Improving pain management and safe opioid use after surgery: A DMAIC-based quality intervention

BackgroundMultimodal perioperative patient education and expectation-setting can reduce post-operative opioid use while maintaining pain control and satisfaction. As part of a quality-improvement project, we developed a standardized model for perioperative education built upon the American College of Surgeons (ACS) Safe and Effective Pain Control After Surgery (SEPCAS) brochure to improve perioperative education regarding opioid use and pain control. Material and methodsOur study was designed within the Define, Measure, Analyze, Improve, Control (DMAIC) quality-improvement framework. Patients were surveyed about the adequacy of their perioperative education regarding pain control and use of prescription opioid medication. After gathering baseline data, a multimodal educational intervention based on the SEPCAS brochure was implemented. Survey responses were then compared between groups. ResultsTwenty-seven subjects were included from the pre-intervention period, and thirty-nine were included from the post-intervention period (n = 66). Those in the post-intervention period were more likely to report receiving the appropriate amount of education regarding recognizing the signs of opioid overdose and how to safely store and dispose of opioid medications. The majority of patients who received the SEPCAS brochure reported that it was useful in their post-operative recovery and that it should be given to every patient undergoing surgery. ConclusionsThe ACS SEPCAS brochure is an effective tool for improving patient preparation to safely store and dispose of their opioid medication and recognize the signs of opioid overdose. The brochure was also well received by patients and perceived as an effective educational material.

Perioperative Education and Postoperative Discharge Medications in Gynecologic Oncology Patients: Prescribing Practices, Clinical Encounters, and Patient Satisfaction

Objectives: The effects of an algorithm for postoperative prescriptions on opioid-prescribing practices, pain-related postdischarge clinical encounters, and patient satisfaction were studied. Materials and Methods: A quality-improvement initiative was implemented at a single, tertiary-care, comprehensive cancer center. Perioperative patient education was restructured with detailed verbal and written components. An algorithm for postoperative discharge medications included prescribing nonopioid analgesics to all patients without contraindications. Opioid prescriptions were based on patients' length of stay and inpatient opioids' use. Data on opioids prescribed and postoperative encounters for pain were collected, and surveys at a postoperative visit were taken on patient satisfaction pre- and postintervention. Groups' results were compared. Results: The patients (107 preintervention and 90 postintervention) had similar demographics. The postintervention group had a 25% reduction in median number of opioids prescribed at discharge (p = 0.16), with similar patterns of postoperative encounters for pain and frequency of opioid refills. Patient satisfaction, assessed in 29 preintervention and 40 postintervention participants, had significant improvement; 95% postintervention participants answered that they were satisfied with their pain control, compared with 75% preintervention participants (p = 0.03). Conclusions: Perioperative education plus an algorithm for postoperative discharge medications in gynecologic oncology patients results in improved patient satisfaction, a trend toward fewer opioid prescriptions, and a similar pattern of postoperative pain encounters. Comprehensive perioperative education is effective for improving patient satisfaction and pairs well with an algorithmic approach to decreasing opioid prescriptions. (J GYNECOL SURG 20XX:000)

Effectiveness of Perioperative Patient Education Program on Knowledge and Satisfaction among Patients Undergoing Total Joint Arthroplasty

Effectiveness of Perioperative Patient Education Program on Knowledge and Satisfaction among Patients Undergoing Total Joint Arthroplasty

Use of a mobile health application by adult non-congenital cardiac surgery patients: A feasibility study.

Mobile Health (mHealth) technologies are becoming integral to our healthcare system. This study evaluated the feasibility (compliance, usability and user satisfaction) of a mHealth application (app) for delivering Enhanced Recovery Protocols (ERPs) information to Cardiac Surgery (CS) patients peri-operatively. This single centre, prospective cohort study involved patients undergoing CS. Patients received a mHealth app developed for the study at consent and for 6-8 weeks post-surgery. Patients completed system usability, patient satisfaction and quality of life surveys pre- and post-surgery. A total of 65 patients participated in the study (mean age of 64 years). The app achieved an overall utilization rate of 75% (68% vs 81% for <65 and ≥65 years respectively). Pre-surgery, the majority of patients found the app easy to use (94%), user-friendly (89%), and felt confident using the app (92%). The majority also found the app's educational information useful (90%) and easy to find (88%). 75% of patients reported that they would like to use the app frequently. This percentage decreased to 57% in the post-discharge survey. A lower percentage of patients ≥65 years indicated their preference for the app over printed information (51% vs 87%) and their recommendation for the app (84% vs 100% for >65 and <65 years respectively) in the post-surgery survey. MHealth technology is feasible for peri-operative CS patient education, including older adult patients. The majority of patients were satisfied with the app and would recommend using it over the use of printed materials.

Effect of Perioperative Patient Education via Animated Videos in Patients Undergoing Head and Neck Surgery

Patient education and engagement is a pivotal component of surgical recovery. Ensuring proper patient education involves a thorough understanding of one's diagnosis and recovery plan, while reducing language and learning barriers to help patients make informed decisions and improve their hospital experience. To assess whether using an animated surgical guide will help patients who are undergoing head and neck surgery feel more satisfied with their surgery and recovery process. A randomized clinical trial was conducted between January and August 2020 at a single tertiary care academic center in Montreal, Canada. A consecutive sample of individuals who were undergoing any of the following surgical procedures was recruited: head and neck cancer resection with or without reconstruction, parotidectomy, thyroidectomy, parathyroidectomy, laryngectomy, or transoral robotic resection. The treating team was masked to group allocation, while study participants in the nonintervention group were unaware of the multimedia platform to avoid introducing bias in their survey responses. Patients were randomly allocated to either the treatment arm, in which they obtained access to a multimedia patient education platform, or the control arm, in which they received traditional patient education methods via clinical visits. Primary analysis compared patient satisfaction scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire INFO 25, a validated questionnaire on the perceived quality of information received by patients with cancer (possible scores ranging from 20 to 80). A total of 100 patients (50 in each arm; 63 women [63%]; 6 African American [6%, 12 Hispanic/Latino [12%], 11 Middle Eastern [11%], and 78 White [78%] individuals) completed the preintervention and postintervention questionnaires. In those who received access to the patient education platform, there was an 11.3-point (Cohen d = 1.02; control group score, 61.1 of 80; treatment group score, 72.4 of 80) difference of greater postoperative satisfaction scores at 1 month. While both groups felt that they received an adequate amount of information concerning their disease process, patients in the treatment arm had significantly better satisfaction with information concerning their medical tests, treatments, and other services. This randomized clinical trial of patients undergoing head and neck cancer treatment demonstrates that multimedia patient education platforms may enhance current traditional methods, providing complementary information on patients' treatment plans and recovery process, mental health, family life, and supplementary services. Further research is currently underway to confirm whether this platform will lead to decreased hospital stay, shorter complication rates, and long-term effects. ClinicalTrials.gov Identifier: NCT04048538.

Enhanced Recovery After Surgery (ERAS) protocols: the impact of enhanced patient perioperative education on patient satisfaction and outcomes in gynecologic oncology practice

<h3>Objectives:</h3> Enhanced Recovery After Surgery (ERAS) protocols have been developed for several surgical fields based off the available evidence to improve patient surgical outcomes with shortened recovery to return of baseline function. The ERAS® Society 2019 preoperative guidelines for gynecologic oncology give a "strong" recommendation for written and verbal preoperative patient education with "moderate" data to support this; however, the recommendation remains vague as to how this should be implemented. We hypothesized patient satisfaction related to their disease state, treatment plan, and hospital course would be improved after implementation of a standardized written preoperative education protocol in addition to traditional oral education for patients undergoing laparotomy with the gynecology oncology faculty at the Medical College of Wisconsin. Secondarily, we hypothesized that enhanced patient education preoperatively could positivelyimpact patient length of stay, emergency department admissions, nursing calls, and readmission rates following surgery. <h3>Methods:</h3> Based on the ERAS Society recommendations, our practice initiated a pilot program to improve our perioperative patient education. In collaboration with our clinic nurses, providers and inpatient nursing staff we revised all of our patient perioperative instructions which address the surgical procedure, expectations prior to surgery, expectations during hospital admission and post- operative instructions including activity limitations, pain management, bowel management and issues of concern during recovery from surgery. We obtained Institutional Review Board (IRB) approval. We compared two groups of patients undergoing laparotomy. The Standard Group received the standard patient education: the current oral and written education that had been utilized in the clinic. The Enhanced Group received the enhanced patient education material after all providers and staff had undergone education regarding the changed process. The enhanced patient education process provided consistent written instructions in addition to the oral instructions communicated by the team. In addition, at the time of discharge standardized post-operative instructions were printed and provided to the patient. During July 2019-Dec 2019, 15 patients who underwent standard preoperative instructions were included in the pilot initiative and comprised the Standard Group. During Jan 2020 - June 2020, 17 patients were included in the pilot as the Enhanced Group. All patients included in the pilot completed the EORTC QLQ-INFO 25 validated survey at the time of discharge or at their post-operative visit. <h3>Results:</h3> Patient satisfaction scores, as quantified by items 31-55 of the EORTC QLQ-INFO 25 survey, showed improvement in patient satisfaction with the possible causes of their disease after protocol implementation (p=0.03). There was also a reduction in the number of patient nursing calls following surgery (p=0.035). There was no difference between groups regarding length of stay, emergency department visits or readmission rates. <h3>Conclusions:</h3> Consistent printed and oral perioperative patient education is an effective measure that can positively impact patient satisfaction as well as staff satisfaction (personal communication). Additional ERAS measures may need to be implemented to impact perioperative patient emergency room visits, length of stay and readmission rates.

Use of an individualized algorithm for postoperative prescriptions in gynecologic oncology patients: prescribing practices, clinical encounters, and patient satisfaction

Objectives: There are multiple studies across surgical specialties documenting the prevalence and risks of opioid over-prescribing. Nonetheless, adequate pain control remains an important priority in the postoperative setting. There is a need for a standardized approach that balances the highly individual nature of pain with the patient and societal risks of opioid overprescribing. With this in mind, we set out to evaluate the impact of an individualized algorithm for postoperative prescriptions on opioid prescribing practices, pain-related post-discharge clinical encounters, and patient satisfaction. Methods: This was designed as a prospective cohort study conducted at a single tertiary-care comprehensive cancer center. The pre-intervention cohort included post-operative discharges from the gynecologic oncology service from July 1st through September 30th 2019. A personalized algorithm was designed and implemented starting on October 7th, 2019. Allowing for a period of implementation and normalization of this algorithm, the post-intervention cohort included post-operative patients from December 7th, 2019 until March 1st, 2020. The personalized algorithm included prescribing acetaminophen and ibuprofen to all patients unless there were contraindications, and opioid prescription based on a patient's length of stay and inpatient use of opioids. Patients with a /= 24 hours were provided a 5-day opioid pain medication supply calculated from their personal opioid use in the 24 hours prior to discharge. Data on post-operative encounters for pain medication refills were also collected. In addition, this intervention included restructuring the perioperative patient education and expectations. A detailed booklet about the perioperative experience was provided to each patient and reviewed at time of preoperative visit. Patient satisfaction pre- and post-intervention was prospectively assessed via written surveys at the post-operative visit. Survey results were compared between the groups. Results: A total of 107 pre-intervention and 90 post-intervention cases were assessed. Patient demographics and characteristics between the two cohorts were similar. The post-intervention group demonstrated a 25% reduction in the median number of opioids prescribed at discharge (p=0.16), mostly accounted for in the Conclusions: An individualized algorithm for post-operative discharge medication prescribing is a feasible concept in a gynecologic oncology population. Additional research is needed to explore an optimized algorithm.

The Effect of Standardized Perioperative Patient Education on Opioid Use After Minor Soft Tissue Procedures Distal to the Wrist

Several studies have explored opioid consumption and opioid prescriber education for upper extremity procedures; however, less literature has focused on patient-centered interventions and their impact on opioid consumption after surgery. The purpose of this study was to create a standardized perioperative patient education program regarding postoperative pain management after hand surgery and to determine if it could reduce opioid use after hand surgery. Patients scheduled to undergo elective outpatient hand surgery comprising minor soft tissue procedures at and distal to the wrist were randomized to receive pain management education or standard care. Before the surgery, all patients viewed a webinar with instructions for participation, whereas the education group received an additional 10 minutes of education on postoperative pain management and a pain management reference card for review after the surgery. All patients completed a postoperative daily log documenting the number of opioids consumed, other pain management modalities used, and pain scores. The primary outcome of the number of opioid pills consumed by the patients was compared between the groups. We constructed a linear regression model to determine the risk factors for postoperative opioid use after surgery. One hundred seventy-four patients completed the study (n= 90 education group; n= 84 standard care group). Patients in the education group took significantly fewer opioid pills (median= 0, range 0-13) than those in the standard care group (median= 0.5, range 0-40). A linear regression model showed that average week-1 pain (B= 0.93; 95% confidence interval, 0.56-1.3) and the number of pills prescribed (B= 0.12; 95% confidence interval, 0.017-0.22) were predictive of greater opioid use. Perioperative patient education significantly reduced postoperative opioid use following a minor soft tissue hand surgery, with greater than 70% of the patients taking no opioids. Prognostic II.

The Utility of Preoperative Phone Calls for Endoscopic Sinus Surgery Procedures.

Perioperative patient education improves patient satisfaction, surgical outcomes, and can reduce postoperative call volume. Here, we investigate whether the use of standardized preoperative phone calls elicits similar results in patients undergoing endoscopic sinus surgery (ESS). Patients undergoing ESS at a tertiary rhinology center were identified prospectively through the electronic medical record (EMR). In the intervention cohort, a standardized preoperative educational phone call was performed. A postoperative survey was utilized to collect self-assessment of satisfaction and understanding in all patients. Postoperative call rates were obtained from the EMR. Wilcoxon rank sum and chi-squared analyses were conducted to compare results. Demographics of the otology and rhinology cohorts were compared with a Mann Whitney U-test. Data from 43 cases and 58 controls were collected. Patients receiving the intervention were similar to controls with regard to patient-reported understanding (case:9.1 ± 1.1 vs control:9.0 ± 1.4, p = 0.801) and satisfaction (case:9.4 ± 1.1 vs 8.9 ± 1.4, p = 0.155). Both cases and controls called the clinic regarding surgical outcomes more often than for postoperative medications or administrative concerns. Independent of receiving the intervention, patients that did not call clinic postoperatively had significantly better understanding of their procedures (call:8.6 ± 1.6 vs no-call:9.5 ± 1.0, p < 0.015) and satisfaction with their experience (call:8.8 ± 1.4 vs no-call:9.5 ± 1.1, p < 0.028). Patient age may contribute to lack of impact in the rhinology cohort, as compared to the otology group, but socioeconomic status does not seem to differentiate the two samples. Though shown in other settings, a significant impact of educational phone calls prior to surgery was not observed in this sample. Patient education calls prior to endoscopic sinus surgery were not associated with changes in postoperative call volume to the clinic. Patient understanding and satisfaction may be related to other factors, such as patient selection or demographics. Future studies may target such patients prior to ESS.

Reducing hospital stay for colorectal surgery in ERAS setting by means of perioperative patient education of expected day of discharge

PurposeDespite the enhanced recovery after surgery (ERAS) protocol, length of stay (LOS) after colorectal surgery varies considerably. The majority of longer admissions is often not medically necessary. We aimed to investigate possible reduction of LOS by perioperative education with an expected discharge date (EDD).MethodsThis single-centre retrospective study included 578 patients who underwent surgery for colorectal cancer in 2016 with standard care (ERAS) and in 2018 with the addition of EDD education program (ERAS+). A comparison was made of a 1-year period prior to and following the implementation of EDD. The EDD was discussed at the outpatient clinic, preoperatively and during admission (with both the patient and family members daily). Standard EDD varied between 3 and 5 days depending on the resection type. Primary outcome was LOS; secondary outcomes were readmission, serious complications and 90-day mortality.ResultsPatients in ERAS+ (n = 242) had a shorter median LOS (4.0 vs. 5.0, p < 0.001) compared to patients in the regular ERAS group (n = 336). Fewer patients of ERAS+ experienced postoperative complications (71 (29.3%) vs. 198 (58.9%), p < 0.001). No difference was found in the number of readmissions (23 (9.5%) vs. 34 (10.1%), p = 0.807), reinterventions (25 (10.3%) vs. 30 (8.9%), p = 0.571) or mortality (5 (2.1%) vs. 9 (2.7%), p = 0.261) between the two groups.ConclusionIt is possible to reduce LOS within the ERAS program, by better perioperative education and expectation management of patients with use of an EDD. This program ensures better understanding, faster discharge and lower costs for the hospital without added risk of readmissions or complications.

A Social Media-Promoted Educational Community of Joint Replacement Patients Using the WeChat App: Survey Study.

BackgroundMuch effort has been made to optimize the results of total hip arthroplasty and total knee arthroplasty. With the rapid growth of social media use, mobile apps, such as WeChat, have been considered for improving outcomes and patient satisfaction after total hip arthroplasty and total knee arthroplasty.ObjectiveWe aimed to evaluate the effectiveness of a WeChat-based community as an intervention for overall patient satisfaction.MethodsThe study was conducted among discharged in-hospital patients who received hip or knee procedures in the First Affiliated Hospital of the University of Science and Technology of China from April 2019 to January 2020. An educational online social community was constructed with the WeChat app. Participants willing to join the community were enrolled in a WeChat group and received 3 months of intervention and follow-up. Those who were not willing to use the account were included in a control group and received routine publicity via telephone, mail, and brochures. The Danish Health and Medicine Authority patient satisfaction questionnaire was used to score perioperative patient education and overall satisfaction. The contents in the group chat were analyzed using natural language processing tools.ResultsA total of 3428 patients were enrolled in the study, including 2292 in the WeChat group and 1236 in the control group. Participants in the WeChat group had higher overall satisfaction scores than those in the control group (mean 8.48, SD 1.12 vs mean 6.66, SD 1.80, P<.001). The difference between the two groups was significant for primary surgery based on subgroup stratification. To control confounding factors and explore the effects of WeChat participation as a mediating variable between perioperative patient education and overall satisfaction, hierarchical regression was utilized. An interpatient interaction model was found in the community group chat, and it contributed to overall satisfaction. Patients in the group with more interpatient interactions were more likely to have better overall satisfaction.ConclusionsThe social media–promoted educational community using WeChat was effective among joint replacement patients. Provision of more perioperative education is associated with more active patient participation in the community and therefore more patient satisfaction in terms of the overall joint procedure. Community group chat could facilitate interactions among patients and contribute to overall satisfaction.

Standardized Perioperative Patient Education Decreases Opioid Use after Hand Surgery: A Randomized Controlled Trial.

Despite the growing hand surgery literature on postoperative opioid use, there is little research focused on patient-centered interventions. The purpose of this randomized controlled trial was to create a standardized patient education program regarding postoperative pain management after hand surgery and to determine whether that education program would decrease postoperative opioid use. Patients scheduled to undergo ambulatory hand surgery were recruited and randomized to standardized pain management education or standard of care. All patients received a webinar with instructions for study participation, whereas the education group received an additional 10 minutes of education on postoperative pain management. All patients completed a postoperative daily log documenting opioid consumption. The total number of opioid pills consumed was compared between groups. The authors constructed a linear regression model to determine risk factors for postoperative opioid use after surgery. A total of 267 patients were enrolled in the study. One hundred ninety-one patients completed the study (standardized education, n = 93; control group, n = 97). Patients in the standardized education group were more likely to take no opioid medication (42 percent versus 25 percent; p = 0.01) and took significantly fewer opioid pills (median, two) than those in the control group (median, five) (p < 0.001). Standardized education predicted decreased postoperative opioid pill consumption, whereas higher number of pills prescribed and a history of psychiatric illness were risk factors for increasing opioid use. Perioperative patient education and limitation of postoperative opioid prescription sizes reduced postoperative opioid use following ambulatory hand surgery. Therapeutic, II.

Systematic review of telemedicine in spine surgery.

The use of telemedicine (TM) has long been available, but recent restrictions to hospitals due to the coronavirus disease 2019 (COVID-19) pandemic have accelerated the global implementation of TM. However, evidence on the effectiveness of this technology for the care of spine surgery patients is limited. In this systematic review the authors aimed to examine the current utilization of TM for spine surgery. Using PubMed, Scopus, and the Cochrane Library, the authors performed a systematic review of the literature focused on the themes of telemedicine and spine surgery. Included in the search were randomized controlled trials, cohort studies, and case-controlled studies. Two independent reviewers conducted the study appraisal, data abstraction, and quality assessments of the studies. Out of 1463 references from the initial search results, 12 studies met the inclusion criteria. The majority of TM interventions focused on improving perioperative patient communication and patient education by using mobile phone apps, online surveys, or online materials for consent. The studies reported the feasibility of the use of TM for perioperative care and positive user experiences from the patients. The current increase in TM adoption due to the COVID-19 crisis presents an opportunity to further develop and validate this technology. Early evidence in the literature supports the use of TM as an adjunct to traditional in-person clinical encounters for certain perioperative tasks such as supplemental patient education and postoperative surveys.

Clinician-driven model creates opportunity for perioperative patient education AIDS

Introduction Despite readily available guidelines and convincing evidence for limiting transfusions, unjustified variability in perioperative red blood cell (RBC) transfusion practice remains in cardiac surgical patients. We hypothesize that sharing the decision of when to transfuse RBC with cardiac surgical patients will limit unjustified perioperative transfusion. Herein, we present the results of a survey to better delineate the knowledge of and preference for perioperative RBC transfusion by clinician and patients. Methods The final provider participant survey contained 11 questions plus 10 demographic questions, while the final patient participant survey contained 10 questions plus 9 demographic questions. Survey content and research method was approved by the local Institutional Review Board. Clinician surveys were distributed to the Departments of Cardiology, Cardiac Surgery, Internal Medicine and Anesthesiology using Research Electronic Data Capture (REDCap). Patient surveys were distributed to consecutive patients presenting to our Preoperative Clinic for one week. Patient responses were manually entered into excel. Participant responses were summarized and compared using JMP Pro 14. Results Of the 313 surveys distributed to clinicians, and 121 to patients, 99 (32%) and 93 (77%) were returned, respectively. Of the 6 questions that tested knowledge, three differed significantly between clinicians and patients (Table): on a seven-category Likert scale, clinicians felt more knowledgeable than patients about the hemoglobin level at which red blood cells should be transfused (5.5 vs 2.1; p Discussion In a reasonably well-represented sample of participants from a large, academic tertiary care hospital, we highlight significant differences in the basic knowledge about and preferences for perioperative red blood transfusion between clinicians and patients. Our results strongly imply a clinician-driven decision model to transfuse RBCs, and supports future efforts to develop decision aids to facilitate patient involvement in the shared decision-making of when and how much to transfuse.

The mCare Experience: Development of a Mobile Application for Perioperative Patient Education

Holtestaul, Torbjorg MD; Morte, Kaitlin MD; Conner, Jeff MD; Brewer, Spencer L. BS; Reinhardt, Jennifer M. RN; Jones, Ian F. MD; Bingham, Jason MD, FACS; Eckert, Matthew J. MD, FACS Author Information

Developing Strategies for Targeted Improvement of Perioperative Education for Postbariatric Surgery Body-Contouring Patients.

The quality of perioperative patient education impacts surgical outcomes, patient experiences, and resources needed to address patient concerns and unplanned visits. We examined patient inquiries and education materials to assess the quality of perioperative education and identify areas of targeted improvement for postbariatric surgery body-contouring procedures. We examined 100 consecutive postbariatric procedures at an academic center. Themes of patient-generated calls, e-mails, and electronic medical record portal messages during the perioperative period were identified via qualitative analysis. Understandability and actionability of perioperative educational resources were assessed using the Patient Education Materials Assessment Tool (PEMAT). Among 212 communications identified, 167 (79%) were postoperative. Common themes were concerns regarding the surgical site (38%), medications (10%), and activity restrictions (10%). One hundred thirty inquiries were resolved through patient re-education (57%), but 36 (16%) required in-person evaluation including 4 unplanned emergency department visits and 3 readmissions for surgical-site concerns. The PEMAT scores for institutional materials were fair for understandability (69%) and actionability (60%). American Society of Plastic Surgeons materials were more understandable (84%) but less actionable (40%). Patient queries can be leveraged as a source of qualitative data to identify gaps in perioperative education. High-yield topics, such as education regarding the surgical site and medications, can be targeted for quality improvement through better communication and potentially reduce the number of unnecessary visits. Using the PEMAT, we also identified how directly the education materials can be revised. Improving perioperative education can promote mutual understanding between patients and surgeons, better outcomes, and efficient resource utilization.

Ambulatory Surgery Protocol for Endoscopic Endonasal Resection of Pituitary Adenomas: A Prospective Single-arm Trial with Initial Implementation Experience

Endoscopic endonasal transsphenoidal resection has been accepted as a routine therapy for pituitary adenoma, but the postoperative hospital stay is typically several days long. With the advantages of reduced cost and improved patient satisfaction, the application of ambulatory surgery (AS) has developed rapidly. However, AS was still rarely adopted in neurosurgery. Here we designed an AS treatment protocol for pituitary adenoma with the endoscopic endonasal approach (EEA), and reported our initial experiences regarding the safety and efficacy of the AS protocol. 63 patients who presented with pituitary adenoma were screened at the Department of Neurosurgery, Tangdu Hospital from July to September, 2017. A total of 20 pituitary adenoma patients who met the inclusion criteria underwent EEA surgery using this evidence-based AS protocol, which emphasized adequate assessment for eligibility, full preparation to minimize invasiveness, enhanced recovery, and active perioperative patient education. Of the 20 patients enrolled, 18 were discharged on the afternoon of the operation day with a median total length of stay (LOS) of 31 hours (range, 29–32) hours. The median LOS after surgery was 6.5 (range, 5–8) hours. Two patients were transferred from the AS protocol to conventional care due to intraoperative cerebrospinal fluid leakage (one case) and an unsatisfying post-anesthetic discharge score (one case). Complications included transient and reversible mild postoperative nausea and vomiting [visual analog scale (VAS) score <3], headache (VAS score <3) after the operation or early after discharge. No patient was readmitted. Our results supported the safety and efficacy of the AS protocol for pituitary adenoma patients undergoing EEA resection among eligible patients, and further evaluation of this protocol in controlled studies with a larger sample size is warranted.