OR Manager - October 2019 - 29

AMBULATORY
SURGERY CENTERS
Superior patient-centered care crucial for complex outpatient
procedures
A
bout 2 years ago I was diagnosed
with prostate cancer. As
I researched the treatment alternatives,
I became very concerned about
the complications associated with traditional
surgical prostatectomy or radiation.
Then I learned that I might be eligible
for an outpatient procedure: highintensity
focused ultrasound (HIFU).
Although HIFU is relatively new in the
US, it has been performed in Europe
for decades. Studies show that, for the
right patients, HIFU controls cancer as
well as other interventions but with a
much lower risk of complications.
After examining all the alternatives
and speaking with several physicians, I
decided to undergo HIFU at the Louisville
Surgery Center in Louisville, Kentucky,
in 2017. As someone who has
worked with hospitals and ambulatory
surgery centers (ASCs) for the past 35
years, I was impressed by the level of
attention I received from John Jurige,
MD, and his staff. They made sure I
understood every step of the process
and had everything I needed for a safe
operation and a strong recovery, and
they continue to follow up with me
every 3 months.
My experience with this team got me
thinking about the future of outpatient
surgery. Traditionally, ambulatory surgery
has consisted of relatively simple
procedures performed on patients who
need relatively little preparation and
follow-up. However, now that more complex
procedures are being performed
in hospital outpatient departments and
ASCs, I believe healthcare providers
must rethink their patient engagement
models. They need to develop new ways
to communicate with patients, prepare
them for their procedures, track longterm
outcomes, and maintain ongoing
relationships.
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Advances in technology, surgical technique, pain control, and rehabilitation
have made it possible to perform more complex orthopedic, oncologic,
and neurologic procedures in the outpatient setting. Patients
may prefer to avoid the longer stays and higher costs associated with
inpatient surgery, but they also may be uneasy about the level of care
provided outside of a hospital. In this article, Jeffry A. Peters, chief
executive officer of Chicago-based Surgical Directions, shares his story
about undergoing a new procedure as an outpatient. He explains why
his experience was so positive, and describes patient engagement
strategies that could benefit any ambulatory surgery center.
Patient engagement pathway
Dr Jurige has been performing prostate
HIFU for more than 12 years. " In this
procedure, we use a transrectal probe
to target ultrasound energy on cancerous
tissue in the prostate, " he says.
" Although HIFU does require patients
to have a general anesthetic, the procedure
is relatively noninvasive, and the
side effects are minimal. "
Before the Food and Drug Administration
approved HIFU for prostate tissue
ablation in 2015, Dr Jurige performed
the procedure in ASCs in Canada, Mexico,
and the Caribbean. Because both
he and his patients traveled across borders,
he developed systems for coordinating
the entire patient experience.
" I learned that we needed to have systems
in place to help patients with things
such as travel, accommodations, and
transport to and from the ASC, " Dr Jurige
says. " So going beyond patient education,
we really needed to provide a concierge
level of patient communication. "
The team's communication platform
takes advantage of several different
technologies. For example, patients
may have an online consultation with
Dr Jurige via an electronic medical record
portal that complies with HIPAA
(the Health Insurance Portability and Accountability
Act of 1996).
" Patients can take part in the consult
through their laptop, tablet, or even
smartphone, " he says. " It lets them
see me, hear my voice, and listen to my
explanation of the procedure, recovery,
and potential outcomes. With the exception
of a physical examination, I can accomplish
the same thing with the online
consult that I can in a face-to-face setting,
and I think it's a very good method
for establishing, at least initially, a doctor-patient
relationship. "
Patients can also use the portal to
exchange secure emails with the care
team. In addition, all patients are given
secure business cell phone numbers
for Dr Jurige and the nursing staff. They
can call or text the team to ask questions,
clarify instructions, get laboratory
test results, or just seek reassurance.
" The ability to get a direct and prompt
interaction with me or my staff really
allays a lot of anxiety for both patients
and their families, " Dr Jurige notes.
But isn't personally responding to
patient calls and texts time-consuming
for a surgeon? According to Dr Jurige,
it's actually efficient. " The alternative
would be that the patient contacts the
office, speaks to an assistant, and
is transferred to a nurse. Eventually
the message gets to me, and then I
would use the reverse passageway to
try to communicate something back to
the patient. " Not only is that approach
lengthy, it creates many opportunities
for miscommunication.
Continued on page 30
OR Manager | October 2019 29
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OR Manager - October 2019

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