Anesthesia Alert


'I Thought I Was Supposed to be Asleep For This'

Most patients think they know what their surgery will be like. For example, they may expect to be put asleep for a procedure that only requires a local anesthetic and then be surprised that they're fully conscious the whole time. It's our job as anesthesia professionals to help them understand what they will or won't see, smell, hear or feel. But it seems like too often we fail at this, and our patients end up dissatisfied with their anesthesia experience as a result - something their surgeons, you, and their friends and family may hear about. Here's some advice on how to ensure that you meet your patients' expectations about anesthesia.

Quality communication means quality time
During our training, we learned that a good patient- family relationship is essential for a satisfying and successful patient anesthetic experience. But we usually have very little time to build a rapport with patients or their families. Why? Time constraints before surgery owing to the constant pressure to turn rooms over quicker. Even though we don't always realize it, we spend less time talking to our patients, answering their questions and relieving their fears than we used to. We also may unconsciously diminish the importance of patient-family relations in the name of speed and efficiency. Meanwhile, the patient is left with vague views of his anesthetic plan, and expectations take over.

The key is to have quality communication with the patient before surgery. Here are four things you can do to help ensure patients' expectations are realistic before the procedure.

  • Involve the pre-assessment nurse. The introduction to anesthesia-related topics comes from the pre-assessment nurse. She tells the patient that the provider will decide the exact anesthetic plan. It's amazing how many patients think anesthesia is "cookie cutter" or "one size fits all," so we reassure them that their anesthetic will be tailored to their needs. Keep in mind that your nurses and surgeons should be consistent when answering a patient's questions so he won't become confused about what's happening.
  • Call the patient the day or night before surgery. This call will cover the patient's medical history, explain the type of anesthesia that will be administered (including what he can expect to experience) and answer any questions the patient has. We've found this phone call to be a great way to alleviate patient anxiety about the surgery and to give realistic expectations.
  • Better to underpromise and overdeliver. We've also learned that a patient's satisfaction with the anesthetic is greater when we understate the effect of the anesthetic to the patient. For example, we don't tell the patient, "I am going to give you some medicine that will put you to sleep and you will not remember anything," if we are planning a MAC anesthetic. Instead, we give the patient realistic expectations of, "I am going to give you some medicine that will sedate you while the surgery is in progress. Sometimes patients recall events in the OR, most do not, but we will keep you comfortable." This sets them up to expect that they may recall some events and will only be sedated. If they then do go to sleep and are amnestic (as most are), you look like the hero. If they're not totally amnestic, you explained that ahead of time and still met their expectations.
  • Give patients ample time in the waiting room to read the anesthesia and surgical permit. This gives them an opportunity to think about what they want to ask before they're brought back to pre-op holding. When we meet the patient on the day of surgery, we complete our physical portion of the pre-op assessment, answer any lingering questions and explain one more time what he can expect from the anesthetic. A study published in the Canadian Journal of Anesthesia in 2004 found there was no increase in patient anesthesia satisfaction when they were given information leaflets immediately pre-op.

Bad news travels fast
This combination of events is a great way to help patients get what they expect. They'll often be satisfied with their surgical and anesthetic experiences. We've seen positive results in both our post-op surveys and in the form of oral remarks from patients to the surgeon.

However you apply these four tips to your facility, remember that we as a profession must continually strive to communicate well with our patients. We need to adapt to the demands of efficiency as well as find better ways to communicate with the patient about his anesthetic. Relieving patient anxiety and setting realistic anesthetic expectations go a long way toward obtaining patient satisfaction.

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