Enhancing Surgical Care in BC - British Columbia Medical Association


Enhancing Surgical Care in BC - British Columbia Medical Association

Mr. B endured eight days without food, suff ered from delirium, a fl uid imbalance, and lack of sleep (aggravated by his

delirium). These symptoms, although each minor on its own, combined to create a catastrophic consequence. Despite

Mr. B trying to be brave, replying “I’m OK” in response to his doctor’s queries, Karen’s husband died of a gastrointestinal

bleed eight days after his surgery.

Now, several years after her husband’s death, Karen is committed to supporting the BC health system to improve the quality

and coordination of whole-patient care. In Karen’s words, “The patient’s care plan needs to be carried out across the entire

medical team, regardless of who’s on shift, day or night. We need continuity and coordination of ‘full-person’ care. Many

small things can go wrong and nobody notices until it’s a disaster. What can we do to make [full-person care] consistent

throughout system?”

After listening to Karen’s account of her late husband’s experience, the patient group overwhelmingly agreed to the

following recommendations:

• The MRP (most responsible physician) shouldn’t necessarily be the surgeon as they are too specialized. Instead,

there needs to be a “most responsible clinician” who will care for the whole patient

• The “most responsible clinician” should:

o Have a very high level of medical training (e.g., nurse practitioner, hospitalist, or other physician).

o Be responsible for the “whole patient.”

o Help with medications, monitor side eff ects, etc.

o Oversee hand-off of patient to clinical medical navigator.

o Create feedback loops so that each unit or team is informed of patient outcomes/conditions. (i.e., how

did things ultimately turn out?).

• A clinical medical navigator should be available to support patients. The navigator needs to be a doctor or have a

VERY high level of medical training (e.g., nurse practitioner), not just a personal advocate or lay volunteer.

• Patients are trusting and expect they will be informed of important information by staff ; therefore the onus is on

the system to proactively inform patient of critical information.

6. Patient Feedback

The focus group strongly advocated for improved mechanisms to gather postoperative patient feedback regarding the

quality of care to help inform the system of opportunities for improvement.

Their suggestions regarding patient feedback include:

• Patients want hospitals to feedback on every patient’s outcome and experience, such as cleanliness of facilities,

whether communication was clear, whether the patient felt listened to, whether the patient was comfortable,

whether the patient felt prepared for discharge.

o Use open-ended techniques such as “Tell us about your experience.”

o Note that “satisfaction” is not the same as the patient’s “experience.”

Enhancing Surgical Care in BC – Appendix 44

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