Development of a patient educational resource for laparoscopic cholecystectomy: An important component of an Enhanced Recovery After Surgery Pathway

Jimmy Bejjani, MD, Debbie Watson, RN, Giovanni Capretti, MD, Pepa Kaneva, MSc, Gerald M Fried, MD, FRCSC, FACS, Melina C Vassiliou, MD, MEd, FRCSC, Franco Carli, MD, MPhil, Liane S Feldman, MD, FRCSC, FACS

Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre

Introduction: Enhanced Recovery After Surgery (ERAS) or “Fast-track” perioperative care pathways aim to improve efficiency and quality of care. Evidence-based guidelines like avoidance of fasting, early feeding, rapid discharge and encouragement of early return to physical activities may be different than traditional care and patient education is critical to align expectations. Our objective is to describe the development and patient satisfaction with a new educational resource introduced as part of a clinical care pathway for ambulatory laparoscopic cholecystectomy.

Methods: As part of a quality improvement initiative, a multidisciplinary team was created to develop and implement evidence-based, standardized perioperative care pathways for common operative procedures across the Department of Surgery. The team was led by a surgeon and included a full-time pathway coordinator, with representation from anesthesia, nursing, physiotherapy and nutrition. For each pathway, a similar approach was used, beginning with a literature review, followed by a consensus process to create standardized medical, nursing and pharmacy orders. As part of each pathway, a patient educational resource booklet was developed in alignment with daily pathway goals and consistent with institutional standards for patient learning materials. Plain language and extensive use of pictures were appropriate for a low health literacy level population. The booklet explains the disease and operative approach, and describes the perioperative care processes, expected postoperative symptoms, management at home, healthy lifestyle habits, expectations for recovery, and signs of complications. The booklet was implemented after review by surgeons and hospital committees. The preoperative clinic nurses were trained to use the booklet. A questionnaire was given to a consecutive cohort of patients at their follow-up visit to evaluate their satisfaction with the resource.

Results: Twenty-seven consecutive patients were asked to complete the questionnaire and 22 participated; 14 were female and the average age was 53 (±15) years. There was one unplanned admission overnight for pain management. All patients were satisfied (45%) or very satisfied (55%) with their episode of care; 96% reported receiving enough preoperative information; 81% agreed that the booklet was not difficult to understand; 96% felt well informed about when to resume activities and 91% kept the booklet for further reference. 76% found the booklet helpful for preparing them for surgery but only 67% considered it useful to prepare for discharge at home and 32% searched for more information on the internet or from a family member.

Conclusion: The creation of patient educational resources is an important component of any perioperative care pathway. With attention to literacy levels, the use of pictures, and alignment with the rest of the pathway, patients reported high levels of satisfaction with the resource and it represented an important reference for perioperative care. However, many patients sought additional information, and gaps in information pertaining to the post-discharge period and patients’ needs were identified.

Session: Poster Presentation

Program Number: P168

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