Prepare Patients for

the Best Recovery

Your Name Here
Patient Education Committee
Co –Chairs
John M. Daly, MD, FACS
Ajit Sachdeva MD, FRCSC, FACS
Members
Frederick L. Greene, MD, FACS
Marlon Guerrero, MD, FACS
B.J. Hancock, MD, FACS
Mary T. Hawn, MD, FACS
Dennis H. Kraus, MD, FACS
Michael McGee, MD, FACS
Lena M. Napolitano, MD, FACS
Leigh A. Neumayer, MD, FACS
Terry Sarantou, MD, FACS
Jonah J. Stulberg, MD, FACS
Jane E. Mendez, MD, FACS
Beth Sutton, MD, FACS
Staff
Kathleen Heneghan PhD, MSN, RN, PN-C
Amanda Bruggeman
Patrice Blair, MPH
Nancy Strand RN, MPH
Patient Education Governor’s Pillar
Chair
Terry Sarantou MD, FACS
Members
Stephan Baker, MD, FACS
Brian E O’Byrne, MD, FACS
Greg Spicer Cherr, MD, FACS
Scott Grant, MD ex-officio
Gady Har-El, MD, FACS
David Lee, MD, FACS YFA representative
Vernon Walter Miller, MD, FACS
Hunter Moore, MD RAS representative
John M. Morton, MD, FACS
Edward L. Raab, MD, FACS
Marc Rubin, MD, FACS Vice-Chair
Ronald A Squires, MD, FACS
Shirin Towfigh, MD, FACS
David W. Wormuth, MD, FACS
 Objectives

Following this presentation the learner will be able to:

1.) Identify the current practices of ACS members and preference

for the development of new programs.
2.) Increase awareness of current standards and guidelines for
patient education
3.) Increase awareness of ACS resources and how to implement
within your practice setting to enhance your
patient/caregiver education program.
Survey: Patient Education in the
Surgical Community, 2014

• 36 Questions Long

• Link was placed in the Bulletin, Twitter and ACS communities

• N= 200

• Served as needs assessment for Patient Education

Workgroup and Committee

• Results show how the ACS can support and enhance patient
information and education
Results
What main sources of educational material
do you use in your practice?

50% refer patients to a website

86% use hand drawings

76% use standardized print materials

7% use computerized interactive materials

Survey results indicated it would be valuable/very valuable
for the ACS to provide the following:

85% print and electronic resources

54% iPad apps

58% online decision aids
70% ACS skills training
80% surgical specialty groups
collate materials from all the different
New Considerations Regarding
Surgical Patient Education
Value Based Purchasing 2017 Quality
Measures MIPS Performance
• All Cause Hospital Readmission
• Functional Assessment
American Board of Medical Specialties
• System based practice – coordinate
care across sites
American College of Surgeons –
Informed Consent Guidelines
• Educate on pre-op prep and home
care
Sunshine Act
• Disclosure of any items from industry
costing above $10. Resulted in many
academic hospitals refusing industry
developed patient education.
Affordable Care Act – Incentive for
Quality & Patient Education
Requirements
• Education available and delivered
electronically. 2017 – an education
evaluation plan needs to be in place.
• Pay for Performance - Satisfaction
Scored
 65% OF ALL PROCEDURES AMBULATORY
PATIENT AND FAMILY ARE NOW THE MAJOR PROVIDERS
OF POST-OPERATIVE CARE

AHRQ
H-CUP,
2015
 Creating a Better System
from Prep to Discharge
From Preop to Home Care
• Total time spent with patient is
several hours
• Majority of time is spent outside
hospital/outpatient clinic
• Great deal of mis-information
available from friends/family,
internet, television, etc.
Need to Train the Next Provider
• One in four admitted to a SNF
readmitted within 30 days.
• 30% to 67% of hospitalizations of SNF
residents could be prevented with
well-targeted interventions.
• SNF residents frequently transferred to
the ED. Estimates from the National
Nursing Home Survey (2004) identified
40% were potentially preventable.
MedPar Data 2006
ACS PATIENT EDUCATION RESOURCES

The American College of Surgeons is dedicated to improving the care

of the surgical patient and higher quality outcomes. The College has
developed an extensive collection of evidence-based patient education
resources to serve as a conduit for providers as they work to support
patients and their caregivers in successfully engaging in their own pre-
and postsurgical care.
HOME SKILLS PROGRAM

For certain surgical procedures that

require a greater level of patient
involvement in preparation and recovery,
the ACS has developed in-depth programs
to provide the education and training
needed to ensure optimal outcomes for
patient who require the following:

 Ostomy
 Feeding Tube
 Central Line
 Wound Care
 ACS has experience in building Surgical
Patient Education Skills Training programs

• 2010: ACS Patient Education

Program launched the Ostomy
Home Skills program

• Professional guidelines, a skill

based training kit with practice
equipment, and demonstration
via DVD and an instruction
booklet

• 15,000 kits were distributed in

the 1st year – since then over
90,000 kits have been
distributed.
Ostomy Home Skills
Program
Ostomy DVD and Booklet Address:
Overview of:
 Operation
 Pouching Systems
 Home Skills & Management
 Problem Solving & Emergencies
 Additional Resources

Home Skills:
 Empty the Pouch
 Change the Pouch
Every kit includes a patient evaluation.
Over 1,000 patients have rated the
Ostomy Home Skills Kit as a great
resource.
 Ostomy Home Skills
Program

Each Program Contains:

 Practice Equipment
• pouches
• measuring guide
• body marking pen
• scissors
• stoma model
 40-page Instruction Booklet
 Video
 Skill Assessment Checklist
 Discharge Plans
 Certificate of Completion

Colostomy/Ileostomy and Urostomy kits are available in: Adult, Pediatric, & Spanish
 Ostomy Skills Kit:
Patient Outcomes & Economic Impact
Volume of Services in the ER Use First 3 Weeks Post-
First 2 weeks Post-Op Discharge
8
25%

Additional Services 20%

4.8 Home Care 15%
Calls to RN/ MD
Visits to RN/MD 10%
ER Use
5%

0%
Used Kit Did Not Use Kit Used Kit Did Not Use Kit
Central Lines Home
Skills Program
Central Lines DVD and Booklet Address:
Overview of:
 Types of CVADs
 Circulatory System
 CVAD Equipment
 Problem Solving
 Home Management
 Additional Resources
Home Skills:
 Flushing the CVAD
 Administering CVAD Medication
 Changing the Needless Connector
 Changing the Dressing
 Giving Parenteral Nutrition through
CVAD
 Implanted Port – Accessing and
Removing the Non-Coring Needle
 Central Lines Home
Skills Program

Each Program Contains:

 Practice Equipment
• gloves
• needleless connector
• alcohol wipes
• syringe
• tubing
 Instruction Booklet
 Video
 Skill Assessment Checklist
 Discharge Plans
 Certificate of Completion
 Central Line Lay Person Trial

Kit Vs. Print Only

– Greater Satisfaction (1-7 with 7 = extremely satisfied)
• Kit mean 6.3 vs Print mean 5.1 (p=0.01)
– Greater Self-Care Confidence
• Kit mean 6.0 vs print mean 5.2 (p=0.04)
– Greater Number of Tasks Completed Independently
• Kit mean 8.1/10 vs print mean 6.3/10 (p=0.05)

**Limitation: training was done over one hour lunch period so kit
not utilized as developed (with charge for repetitive practice).
 Feeding Tube Home
Skills Program
Feeding Tube DVD and Booklet Address:
Overview of:
 PEG
 Low-Profile
 Long Tube
 Jejunosotomy
 Problem Solving
 Home Management
 Additional Resources

Home Skills:
 Mouth & Skin Care
 Feeding via Gastrostomy Tube
 Giving Medication
 Replacing the Gastrostomy Tube
 Feeding Tube Home
Skills Program
Each Program Contains:
 Practice Equipment:
• Feeding tube Model
• Extension sets
• Syringe
• Medicine cups
 Instruction Booklet
 Video
 Skill Assessment
Checklist
 Discharge Plans
 Certificate of
Completion
 Feeding Tube Lay Person Trial
Respondents 36 females; 8 males; average age 46 years
N=46
Likert scale of 1-4 1= Definitely Disagree, 4=Definitely Agree

Sex Females tended to get more information about medical

and surgical care from sources other than their doctors
than men and were more likely to be nervous making
medical decision

Mean Scores: 3.7 Material was Easy to Read;

3.6 Felt prepared to take care of a wound;
3.7 Felt prepared to ask questions
3.9 Would recommend the booklets to family/friends
3.7 The videos are clear and well-paced

3.7 Would feel satisfied if they received this material

Patient Trial to Begin in 2018 at 4 Medical Centers and 2 Home Health Agencies
New! Wound Care Home
Skills Program

Available Now:
• Surgical Wounds
• Abrasions & Lacerations

In Production:
• Care of Pressure Ulcers
• Care of Diabetic Foot Ulcers
• Care of Venous Leg Ulcers &
Lymphodema
Filling a Gap
Lack of Wound Care Instruction
is a Cause for Re-admission
• 60% of wounds managed in the home are
surgical

• Wound infection and deterioration account

for the highest reason for admission from a
nursing home facility – equal to respiratory
and cardiovascular related issues.

• 63% of patients who did not receive wound

care information re-entered their health
care facilities after discharge due to wound
issues.

• Surgical site infections (SSIs) cause

significant morbidity and mortality
Wound Care Home
Skills Program
Book & video demonstrations:
• Caring for Abrasions &
Lacerations
• Cleaning your wound
• Packing your wound
• Dressings and Bandaging
• Care of your surgical drain
Surgical Cancer
Education:
Your Lung
Operation
The program contains:
• Instruction booklet
• DVD and web program
• Information sheets, including
lung images, medication lists,
exercise and pulmonary rehab
activity guides, quit smoking
resources and survivorship plan
• Patient Evaluation
Your Lung Operation
Lung Operation DVD and
Booklet Address:
• Your Lungs
• Lung Cancer
• Understanding your
Operation
• Preoperative Tests
• Home Preparation
• The Day of Your Operation
• After Your Operation
• Your Recovery and
Discharge
• When to Call Your Doctor
Your Lung Operation

Evaluation Results

Nearly 100% of participants:

• Satisfied
• Would recommend
• Prepared in recovery skills.

*Helpful score lower because

reviewers thought it would be
more helpful if in multiple
languages
Informed Surgical Prep Brochure Series
Informed Surgical
Prep Brochures

• Meets ACS, Joint Commission

and Patient Safety Guidelines
• Supports low literacy levels
• Contains images
• Identifies risks
• Discharge education
• Print and Electronic availability
Informed Surgical
Prep Brochures
The following titles are currently available:
• Appendectomy
• Cholecystectomy (English and Spanish)
• Colectomy (English and Spanish)
• Colonoscopy (English and Spanish)
• Inguinal/Femoral Hernia (English and Spanish)
• Inguinal/Femoral Hernia- Pediatric
• Umbilical Hernia
• Umbilical Hernia – Pediatric
• Ventral Hernia (English and Spanish)
• Medication and Surgery
• Quit Smoking Before Surgery
• Safe Pain Management: Opioid Abuse and Surgery
 Quit Smoking
Before Surgery

ACS Smoking Cessation Tools:

Patient Handout
• Counseling strategies, website and hotline support, medication options, quit plan
Professional E-Learning
• Counsel & Code; supports coding requirements for reimbursement
ACS Position Statement
• Statement on the effects of tobacco use on surgical complications and the utility of
smoking cessation counseling.
 Patient Satisfaction Scores

• The most influential factors for patient

satisfaction in surgery:
– informed consent
– home care information (Mira et al, 2009)

• Quality of home care discharge instructions –

strongly correlated with satisfaction (Press
Ganey).

• Patients reported greater satisfaction when

materials were provided (website referral,
electronic or print) prior to the consult
 Future Patient/Family Surgical
Skills Training Model

Patient Certified

Professional
Certified Skill
Centers
Future Skill Programs:
Center Certified
• Trach Skills Kit
• Urinary Catheter Skills Kit
• DVT Prevention Skills Kit
 • Continue to evaluate patient education
Patient needs

Education • Communicate with Governors and Fellows

via communities
Governors • Governors can work with local chapters to
disseminate information
Workgroup • Communication strategy with Patient
Education Committee: Young Fellows
Assoc.
Next Steps • Web interface page for pillar workgroup
 Need More Information?

Visit: www.surgicalpatienteducation.org

Contact: Amanda Bruggeman

Program Administrator, Patient Education
Email: abruggeman@facs.org
Phone: 312-202-5263