TLC for breast surgery patients wins kudos
At Fletcher Allen Health Care in Burlington, VT, surgeons and radiologists were concerned about the high levels of anxiety in women who came in for breast biopsies and mastectomies. They asked for help from the nurses at the medical center's Breast Care Center.
To get a better understanding of the issue, the center's administrative leader, Jean Harry, RN, began immediately to decode the previous year's patient satisfaction surveys. She learned that the women wanted three service augmentations:
1. A preview of what to expect on the pre-biopsy visit with the surgeon and oncology nurses.
2. Instructions on preparation for outpatient biopsy and estimates of how long it could take.
3. Post-biopsy provider calls to ask how they were feeling and answer any questions about post-surgical self-care.
Harry says it only took four to six weeks for her and her staff to analyze the patient survey data and create a patient education tool. And the results were immediate.
"We got feedback from the physicians doing the biopsies," Harry reports. "They were telling us the procedures went much smoother."
Also, prepared with background from the Breast Care Center, patients make such efficient use of their pre-biopsy visits with the surgeons that they require 30 minutes less time than before the educational program.
In the wake of the initial successes enjoyed from the patient education project, the center engineered an additional improvement for women facing inpatient breast surgeries. Patients had regularly endured 90-minute waits for their pre-op lab work and X-rays at the medical center's outpatient department. "So why not take care of that under our own roof since the women would be coming here for pre-op education?" asked Harry and her staff.
Pilot tests confirmed that consolidating lab tests and X-rays with the pre-op education was a good idea. Now it's routine practice. "It saves the patients a lot of time and an extra trip before they go in for surgery," Harry says. "They love it!"
Fine line between sound practice and change
Despite positive physician and patient response, Harry treads gingerly along political and disciplinary lines. When she wrote the protocol for the post-biopsy phone check-in, she specified that nurses would confine their discussions to pain management, wound care, and emotional concerns.
"We didn't want to want to cross the political line of telling patients whether their lab tests were all clear or whether they had malignancies. We left that to the doctors because we did not want to appear to be taking over with their patients."
Recently, Harry had to revisit the matter when primary care physicians themselves asked the nurses to go ahead and tell women their lab test results on the biopsied breast tissue. It could have been an easy way to spare the patients and doctors a fair amount of hassle. Still she declined. This time it was on patient care principles.
Concerned that a nurse might not know what follow-up an individual doctor would choose in light of a patient's overall health history, Harry though it would be better to leave that segment of care in physicians' hands. However, the nurses nudge doctors who delay in conveying biopsy results.
"If a woman tells us her doctor hasn't called after a few days, we will call that doctor and say, 'Look, you need to call this patient," she says.
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