Patient Engagement: The ‘Peaceful, Easy Feeling’ of Satisfaction

An experienced outpatient surgery reporter recalls his knee surgery.

I’ve been writing for Outpatient Surgery Magazine for several years about everything from 4K monitors to steep Trendelenburg (as you can see from the photo, I went full De Niro on that one).

But I always attacked these topics as a reporter … until now. Recently, I had a total knee replacement, and I got to experience the many things I’ve written about as an objective reporter from the highly subjective position of a patient. Here’s what I learned.

Schedule snafus

I was scheduled for the first surgery time slot of the day, at 8 a.m., with Thomas Greene, MD, of Rothman Orthopaedics at Jefferson Lansdale Hospital in suburban Philadelphia. Dr. Greene performed a total knee replacement on my right knee two years ago, and over the course of the last decade, he has treated me for carpal tunnel on both hands and for an Achilles injury.

I know him, I trust him and the other knee replacement has been a huge success. There was absolutely no need to change what’s already worked.

As we know, the less time it takes to turn a room over, the more OR time is available, which translates into a potential for increased revenue. Ideally, facilities would like to turn rooms over in 10 to 15 minutes. But you can’t turn the room over until the surgical procedure is complete. Unfortunately, my procedure ran into a snafu over the implant, and it delayed me getting from my room to the OR holding area. Once I did get to the holding area, the delay continued. When the first surgery of the day gets delayed, everything else is going to get backed up.

From a patient satisfaction standpoint, this unintended and unplanned delay actually had a silver lining. While in the holding area, various members of the surgical team stopped by to introduce themselves and chat — and not just about the medical procedure that was about to happen.

I talked with one nurse about the differences between living in a major metropolitan area and a small town in a rural area. Another nurse took the time to explain to me how the implants arrived in sterile packaging and the safety measures taken in that area. Dr. Greene himself stood at my bedside for quite a while and we talked about his latest hunting and fishing trips. This was where I learned that I had the distinction of being his first surgery of the new year. Everybody that came by wanted to know if I needed anything and everyone thanked me for being patient.

In fact, when it was time to actually enter the OR, two of the surgical team members anointed me with the totally fictitious but nonetheless prestigious MPP (Most Patient Patient) Award. I was hoping that would include a check presentation and plaque ceremony sometime after the surgery but no such luck.

Had it not been for the delays, I wouldn’t have gotten as much one-on-one time with the surgical team. I wouldn’t have gotten to know them as well as I did. The delay may not have been great for the hospital’s bottom line, but the extra time with the team members increased my confidence that I was being well taken care of and that everything was going to be all right. And I’m not sure you can put a price on that.

Anesthesiology

I had two choices for my procedure — a spinal anesthesia with sedation, meaning the patient is numb from the waist down, sleeping, but breathing on his own. The alternative was general anesthesia, where a tube that’s inserted down the patient’s throat does the breathing for them. I chose spinal, just as I did with the right-knee replacement two years ago. There are fewer risks and speedier recovery times. Knee replacement patients also receive a local nerve block used to manage postoperative pain from 12 to 18 hours after surgery.

My anesthesiologist was Patrick Shum, MD, and he administered both the anesthesia peripheral block and the anesthesia spinal block. Here’s how good this guy was: By the time we got to the “little pinch” portion of the procedure, I didn’t even feel the “little pinch.” I was out like a brick and didn’t wake up until I was in the recovery room.

Oh, and the nerve blocks that are supposed to manage post-operative pain for about 12 to 18 hours? I got 36 hours out of mine. Now 12 to 18 may be the experience for most patients who have average anesthesiologists, but Dr. Shum’s precision and effectiveness moved him right to the top of my list for Best Anesthesiologist on the Planet.

Pain management

Let’s face it, all patient satisfaction roads likely lead to pain management. The less pain there is, the better the patient’s experience is going to be.

In addition to the nerve blocks, my pain management regimen consisted of — two Tylenol; Toradol, a nonsteroidal anti-inflammatory drug that blocks production of certain natural substances that cause inflammation that helps decrease swelling, pain and fever; and Cefazolin, an antibiotic to prevent infections — every four hours.

This approach was part of a confluence of aspects that created another unanticipated benefit. They included: Being one of only four patients on my floor that evening; the bright overhead lights in my room had been turned off for the evening; and the low humming of a sequential compression device that was attached to my legs that inflated different sections of the leg sleeves, squeezing from bottom to top to help prevent blood clots.

This created one three-hour, stress-free bubble, what the Eagles were describing when they sang about a peaceful, easy feeling. I was able to clear my head of all worries and anxieties associated with the surgery as well as what was going on in the outside world, get some rest and relax. I’m sure it’s a different experience for every patient as well, but imagine if hospitals and surgery centers could bottle that vibe and offer it to their patients postoperatively.

One satisfied patient

If you haven’t figured it out by now, my patient experience was excellent. I was more anxious going in for the second knee replacement because this time around, I knew what to expect. Total knee arthroplasty is major surgery. It’s brutal, it’s messy, it hurts and if you want to get back on your feet quickly, you have to be diligent and aggressive with your physical therapy routine. Dr. Greene and the team at Jefferson Lansdale Hospital made it possible for me as the patient to have the best experience possible. OSM