Improving Patient Satisfaction with the Preoperative
Evaluation
Our group uses the information system to increase patient satisfaction
with preoperative evaluation in several ways (Foss JF, personal communication).
For example, the most important factor in decreasing patient satisfaction was delay
in seeing a physician. Therefore, we use the system to decrease this time interval.
The University of Chicago system logs the arrival time of the
patient at the clinic. After the patient has completed his or her self-administered
questionnaire on health matters, the system uses those answers to determine the risk
status of that patient, A "triage nurse" then uses that risk status, definitions
of the three levels of surgery (minimally invasive surgery, surgery of moderate intensity,
or major surgery), and the functional age of the patient (i.e., his or her physiologic
age [RealAge], not chronologic age) to determine what level of visit with the anesthesiologist
is required. A comprehensive visit takes 20 minutes or more and assesses the patient
who has an ASA status of 2.0 or higher, or is undergoing
major surgery, or has a biologic age over 65. The
next category, the visit of intermediate intensity, takes 15 to 25 minutes. These
patients have an ASA status of 1.5 to 2, or are undergoing
type B surgery, or have a biologic age of 61 to 65.
Finally, the "expedited visit" takes 5 to 10 minutes and evaluates the patient who
has an ASA status of 2 or less, and is undergoing
minimally invasive surgery, and has a biologic age
of less than 61.
Once the appropriate level of visit has been determined, the patient
is made ready to see the anesthesiologist. He or she is placed in an examination
room and dressed to the waist in a hospital gown. Blood pressure, heart rate, height,
and weight are recorded, and a self-entered history is completed by the patient.
The patient's status is entered into the computer system, and
the times to each room are tracked on the local area networked computer system.
A red light signals when an "expedited patient" is ready to be seen. The anesthesiologist
will often excuse himself or herself from the comprehensive-visit patient and see
the expedited patient immediately. (Comprehensive-visit patients seem not to object
to the interruption, as they understand that they require, and will receive, extra
physician time.) The total time for patients is not reduced, but the delay until
the patient first sees the physician is decreased.
Another way to use an information system to improve patient satisfaction
is to ask patients to complete a self-administered questionnaire after surgery.
The questionnaire, given by phone or, if in-hospital, by computer or paper and pencil,
can assess the patient's satisfaction with the anesthesia service's performance and
pain therapy. Feedback for such results has improved performance in the University
of Chicago system by physicians in satisfying patients' pain relief requirements.
Information systems are not a replacement for good care, nor is
it likely that they will decrease the time spent with patients. However, if carefully
designed and implemented, information systems can enhance the acquisition and management
of data, so that physicians can spend more of the time they do have with patients
in attending to their care. Although such systems can decrease the risks of caring
for a patient by providing a complete working database, they are also capable of
introducing new risks regarding confidentiality of data and dependence on availability
of the system. No matter how much automation, education, or informatics you decide
to employ, the factor most important in achieving success is marshalling the resources
and consensus of department members and users (surgeons, obstetricians, radiologists,
administrators) to institute such a considerable undertaking.
