Surgery in Clerkship

Key Communication Strategies for Preoperative and Postoperative Discussions

Effective communication before and after surgery is crucial for ensuring patients are informed, prepared, and supported. Here are key strategies for both stages:

Preoperative Communication and Support

• Clear Explanation of the Procedure: Start with a detailed yet understandable explanation of the surgery's purpose, benefits, and risks. Incorporate diagrams, videos, or other visual aids as needed, and use simple language to ensure clarity and avoid medical jargon.

• Discussing Expectations and Outcomes: Outline expected surgical outcomes, recovery timelines, and what constitutes a successful result. Be transparent about potential complications and set realistic expectations for the patient.

• Acknowledging Patient Preferences in Decision-Making: Present evidence-based treatment options, including non-surgical alternatives, and recognize the patient's preferences in the decision-making process. This approach helps ensure that care plans align with the patient's values, which can improve satisfaction and enhance adherence to the chosen treatment.

• Addressing Concerns and Anxiety: Acknowledge and address any fears or anxieties the patient may have. Provide reassurance, suggest coping strategies such as relaxation techniques, and connect them with support resources when needed.

• Informed Consent: Thoroughly explain the consent form, ensuring the patient fully understands the procedure and its risks. Encourage questions and emphasize the importance of their comfort and confidence in their decision.

Effective preoperative communication fosters trust, reduces anxiety, and ensures the patient feels informed and prepared for their surgical experience.

Postoperative Communication and Support

• Clear Recovery Instructions: Outline the entire postoperative care process, including pain management, wound care, signs of infection, and potential complications. Provide patients with a clear understanding of immediate postoperative expectations and long-term recovery timelines.

• Realistic Expectations: Set achievable recovery goals by discussing physical limitations, expected milestones, and follow-up schedules. This approach helps reduce anxiety and aligns patient expectations with clinical realities.

• Encourage Dialogue and Follow-Up: Promote open communication by encouraging patients to ask questions and voice concerns at any stage of recovery. Ensure they have access to contact information for follow-up support throughout their healing process.

• Emotional and Psychological Support: Acknowledge the emotional challenges that can arise after surgery, including anxiety or distress. Offer empathy, validate their feelings, and provide resources such as counseling or support groups as needed.

• Educational Materials for Self-Care: Supply accessible, written, or visual guides for self-care during recovery, emphasizing critical topics like wound care, mobility, and recognizing complications.

Clear, empathetic communication and a comprehensive approach to patient education can significantly enhance recovery outcomes, reduce complications, and build trust in the surgical process.

Source

Karol, D., Malik, A., Philippopoulos, E., Alibhai, K., Jones, C., & Tannenbaum, E. (2024). Interventions used to improve communication competencies in surgical residencies: A systematic review. Journal of Surgical Education, 81(12), 103284. https://doi.org/10.1016/j.jsurg.2024.08.007

Patient Handover

Accurately conveying key information to a transition team during care handoffs is critical for maintaining patient safety and ensuring continuity of care.

Effective Handover Strategies

1. Standardized Protocols and Checklists: Use structured tools like the I-PASS handoff framework, which includes elements such as Illness severity, Patient summary, Action list, Situational awareness, and Synthesis by receiver. These tools help ensure completeness and clarity while minimizing information loss.

2. Face-to-Face and Two-Way Communication: Direct interactions allow for clarification and immediate questions, reducing miscommunication. Employing closed-loop communication—where the receiver repeats key information to confirm understanding—further enhances accuracy.

3. Limiting Interruptions: Create an environment free from distractions to allow for focused information exchange. This can include timing handoffs outside of high-traffic or peak activity periods.

4. Comprehensive Information Sharing: Include critical details such as patient condition, treatment plans, potential complications, and post-operative care needs. This also involves integrating relevant documentation, like lab results or imaging data.

5. Team Member Preparation: Both giving and receiving teams should review pertinent patient data beforehand. This readiness supports efficient and thorough handoffs.

6. Training and Simulation: Regular training and the use of simulation exercises can help teams practice and refine handoff processes, aligning with best practices from other high-risk industries like aviation and nuclear power.

Sources:

Barbeito, A., Agarwala, A. V., & Lorinc, A. (2018). Handovers in perioperative care. Anesthesiology Clinics, 36(1), 87-98. https://doi.org/10.1016/j.anclin.2017.11.005

Lane-Fall, M., Pascual, J., Peifer, H., Di Taranti, L., Collard, M., Jablonski, J., Gutsche, J., Halpern, S., Barg, F., & Fleisher, L. (2020). A partially structured postoperative handoff protocol improves communication in 2 mixed surgical intensive care units. Annals of Surgery, 271(3), 484-493. https://doi.org/10.1097/SLA.0000000000003569