Patient Satisfaction: Easing Minds at the Front Door

By: Adam Taylor

Published: 9/1/2020

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The outpatient surgery team at the Hospital of the University of Pennsylvania reduced the anxiety of surgery patients and their loved ones at the start of the COVID-19 outbreak.


The news came on Monday, April 6. Due to the coronavirus, visitors were no longer allowed to escort their loved ones to the operating rooms at the Hospital of the University of Pennsylvania (HUP) in Philadelphia. Ann Marie Morris, MSN, RN, CNOR, CSSGB, an associate clinical director of perioperative quality and safety, remembers her first thought: “If I were a patient, I’d be so frightened if I had to get dropped off and come into the hospital by myself. If I were a family member, I couldn’t imagine leaving my loved one at the door to fend for themself.”

Ms. Morris immediately went to work. She devised HUP’s Patient Receiving and Escort Process, which redeployed the hospital’s outpatient surgery center staff to meet patients at the hospital’s front door in the roles of greeters, scribes and escorts. They piloted the program on Wednesday. It was up and running the next day and remained in action for six weeks.

The willingness of the entire outpatient surgery staff to step outside of their usual roles and go the extra mile for anxious patients and their loved ones make HUP the winner of the 2020 OR Excellence Award for Patient Satisfaction.

Ms. Morris and Joyce Stengel, HUP’s perioperative coordinator of quality education, worked with the hospital’s security department to get access to the vehicle lane closest to the facility’s front doors. Automated pre-op calls were replaced with personal calls, so staff could tell patients and families to look for the greeters at the front door, and to be prepared that only the patient would be allowed to enter the hospital.

Elective procedures at HUP’s outpatient surgery center were canceled. Nurses, surgical techs and clerical staff from the surgery center were redeployed into three-person teams that greeted vehicles from 5 a.m. until the last surgery patient of the day had arrived.

“The roles were interchangeable and integral to our success,” says Ms. Morris. “Nurses handled the clinical questions, those who were the most enthusiastic were tapped as greeters and staffers with the best handwriting were assigned as scribes because there was no time to get electronic tablets. The remainder served as patient escorts.”

The hospital’s entrance was a chaotic place as the valet service was canceled due to COVID-19 restrictions, so the new teams wound up doing much more than greeting surgery cases. Vehicles arrived with people looking for the ER or for non-emergency appointments. “We were triaging cars to find the surgery patients,” says Ms. Morris.

Some of the arrivals were heart or cancer patients who were scheduled for serious surgeries. “Looking at the faces of some of the families in the car, it was clear what they were thinking, ‘I might never see my loved one again. We might be saying goodbye right here,’” says Ms. Morris.

The greeter acted as the team leader who reviewed patient information, provided updates about COVID-19 protocols, collected contact numbers from family members, asked about patients’ mobility levels and helped patients don a mask, says Carolyn Grous, RN, MSN, CNOR, HUP’s director of perioperative services – compliance.

Family members often had helpful information about their loved ones’ previous surgeries or questions about whether daily medications might interact badly with the anesthesia their relative was about to receive. The scribes wrote those concerns down and got them to the OR team. The escorts guided patients to the surgery floor.

Some patients, young and old, don’t think clearly when they arrive for surgery due to nerves and anxiety. They often won’t speak up and rely on loved ones who brought them to relay important information to caregivers, as well as to navigate the hospital so they don’t get lost. That wasn’t possible with the COVID-19 restrictions in place.

Honorable Mention
BEDSIDE MANNERS The staff at AUA Surgical Center focus on the basics to improve patient care.   |  AUA Surgical Center
Personal Connections Are Better Than Gift Card

Staff at the AUA Surgical Center in Amarillo, Texas, don’t rely on trinkets or tricks to make sure patients leave healthy and happy. They educate patients, listen to their concerns and collaborate as a team to foster a culture of caring.

  • Educate. The center’s staff ensures patients fully realize what to expect during and after their surgeries. “Many patients think they’re going to feel awesome as soon as they get out of surgery, which isn’t realistic,” says Administrator Adam Johnson, RN. “We explain that they can’t expect zero pain.” Removing that surprise improves their mindset during recovery.
  • Listen. The pre-op staff explains procedures to patients and sets aside enough time to listen to their concerns and to answer their questions. Nurses relay any issues to surgeons, who listen and adjust their care plan as needed. The staff also makes sure patients clearly understand discharge instructions during follow-up phone calls.
  • Collaborate. Leadership makes it clear that meaningful pre-op conversations with patients — even if they’re lengthy — are valued more than hitting efficiency metrics. The center includes the time a patient spends in pre-op and the PACU when chronicling their case times to manage administrative tendencies that shorten lengths of stay.

“This focus on the fundamentals of care allows patients to leave as satisfied customers who will seek us out again if the need arises or recommend us to others in the community,” says Mr. Johnson. “A gift card to a restaurant can’t do that.”

— Adam Taylor

“If a family member isn’t present to advocate for their loved one, some patients don’t tell staff what they need to know,” says Ms. Morris. “The brief interviews at the cars were engaging discussions that normally would have taken place inside, and included the family members chiming in with useful information.”

Even though the three-person teams disbanded after six weeks, the personal calls that replaced the automated pre-op calls remain. “We didn’t know what we didn’t know before,” explains Ms. Morris. “Patients were telling us issues that needed addressing — things we wouldn’t have discovered until they arrived. Some were issues that caused case delays. Now we know in advance.”

The greeting team took family members’ contact information, allaying their greatest fears: Who was going to call them and how were they going to know what was going on with the surgery? They were very nervous about the prospect of dropping their loved ones off and not hearing from anyone.

“Having surgery is always frightening — imagine it taking place at the beginning of a pandemic,” says Ms. Morris. “Patients knew we were there for them and family members were very grateful to turn their loved ones over to staff members who they could connect with. They saw we really cared.” OSM

Honorable Mention
CHECKING IN Family members typically get four or five calls from different members of the Centennial Surgery Center clinical staff to keep them informed of their loved ones' progress.
COVID-19 Inspires Constant Communication

The coronavirus outbreak forced staff at Centennial Surgery Center in Nashville, Tenn., to improve how they interact with patients and their loved ones. “We decided that better communication was the best way to keep everyone informed about social distancing and other COVID-protocols,” says Lori Bates, CASC, the center’s administrator.

Patients receive a pre-op call explaining coronavirus-related protocols, which include arriving only 60 to 90 minutes before the start of the case, a change from the former two-hour advance arrival time. On the day of surgery, loved ones — whether they’re in the waiting room or staying outside in their vehicle — are updated when patients complete their pre-op assessments and anesthesia interviews.

The OR circulator then lets the family member know when the procedure will start and estimates how long it will take. The surgeon calls shortly after the procedure ends with an update. Finally, a PACU nurse calls to say the patient is recovering and close to meeting the discharge criteria — and then calls again with discharge instructions.

“It sounds like a lot of communicating — and it is,” says Ms. Bates. “However, the calls are very quick, and the basic message is ‘We’re taking good care of your loved one.’ We’ve chosen to flood our patients’ family members with messages to create a better-than-ever experience.”

The new communication chain was started to keep family members connected to patients because the coronavirus kept them from pre-op and PACU bays, but the once-temporary measures are now a fixture. “We saw how much the calls reassure patients’ families, so we’re going to keep them in place,” says Ms. Bates.

— Adam Taylor