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Patient Safety Improving patient prep

An automated informed consent tool provides individualized pre-procedure patient instructions to thousands of veterans in the tri-state VA Gulf Coast Veterans Health Care System.

By Bunny Isgett-Lynn T

he failure of patients to adequately prepare for surgery is a potentially serious problem for nearly every medical institution. It commonly leads to last-minute cancellations, poor proce- dure results and unnecessary complications. Consider the bleeding risks, for instance, to patients who have not properly discontinued certain medications such as aspirin or warfarin prior to surgery.

Inadequate prep is more than just a matter of wasted time on the part of providers and patients. Patient safety risks are compounded by ineffi cient use of institutional resources – medications, equipment, time in the surgical suite. Moreover, patients who walk away from a cancelled or suboptimal procedure may not come back a second time, increasing the probability that they will decide to forego vital care entirely.

Supplying pre-operative patient education materials is one well-documented strategy for improving patient outcomes and reducing preventable cancellations.1,2,3 Aware of the potential benefi ts, some facilities with the Department of Veterans Affairs (VA) health system have begun using an automated informed consent tool to pro- vide individualized pre-procedure patient instructions.

Mired in the ineffi ciencies of paper The VA Gulf Coast Veterans Health Care System (GCVHCS) serves veterans in the Gulf Coast region of Mississippi, Alabama and Florida. In addition to its main facility in Biloxi, Miss., it also includes four community- based outpatient clinics in Mobile, Ala.; Eglin, Fla.; Panama City, Fla.; and Pensacola, Fla. Together they serve more than 50,000 veterans. Prior to 2009, the process used by GCVHCS to offer pre-procedure information was best described as “not optimal.” Nurses reviewed standardized instruction sheets with patients during pre-operative appointments, but just as in most other facilities, these paper pamphlets often had been copied so many times that they were diffi cult to read.

In addition, the signed documents then had to be scanned into GCVHCS’ electronic health record (EHR). Unfortunately, this was not always an immediate pro- cess; it sometimes took signifi cant time until the docu-

24 March 2011

mentation was available in the EHR. This step not only consumed personnel assets and resources, it prevented immediate provider access to the information.

The goal was to optimize the probability of obtaining optimal outcomes,

while reducing the rate of cancelled surgeries and treatments due to patients arriving improperly prepared for their procedures.

Perhaps most troublesome, however, was the fact that pre-printed instructions could not be tailored to each individual veteran. This inability to personalize information hampered efforts to foster a sense of ac- countability on the part of each patient for his or her own care. Furthermore, it opened the door to safety hazards. A patient on aspirin therapy reading through generic instructions, for example, might not accurately calculate the date on which to stop taking the aspirin prior to a procedure. So, when GCVHCS fi rst opened its Pensacola facility, new staff with new ideas helped spark fresh perspectives on the delivery of pre-procedure instructions. GCVHCS set about developing a series of instructions designed to better prepare patients for common procedures. The goal was to optimize the probability of obtaining optimal outcomes, while reducing the rate of cancelled surger- ies and treatments due to patients arriving improperly prepared for their procedures.

Choosing an automated solution The Joint Commission on Accreditation, national

VA and local VHA policy, nursing practice standards and many national nursing and medical organizations all specify that patients be allowed to give “informed consent” regarding procedures. An effective informed consent process is more than just a documentation requirement; it should foster communication between providers and patients. Within the VA health system, the entire informed consent process has been standardized


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