Toronto Western Hospital, Bariatric Surgery Program, Toronto, Ontario, Canada.
Health Quality Ontario, Toronto, Ontario, Canada.
Can J Diabetes. 2019 Feb;43(1):59-66. doi: 10.1016/j.jcjd.2018.05.003. Epub 2018 May 8.
Bariatric surgery is recognized as a durable treatment for severe obesity; however, high rates of nonattendance and patient engagement during the postoperative period remain challenges. This pre/post study evaluates a quality-improvement initiative to improve attendance at bariatric surgery program appointments and to heighten program efficiency, as measured by appointment attendance, cancellations and new assessments.
Patients and staff were consulted in order to identify causes for patient attrition after surgery. The ideas for change that were implemented were advance care-planning calls and e-mails in order to tailor appointments to patients' needs and an online application of follow-up care information. Online surveys were used to assess patient satisfaction. After several plan-do-study-act cycles, appointment attendance rates for 5,676 appointments between April 1, 2014, and May 29, 2015, were compared pre- and post-quality improvement intervention. For the intervention, 1,294 patients were called, representing 4,124 appointments. Both preoperative and postoperative attendance rates and costs were examined.
Although postoperative attendance and no-show rates changed by only 1.8% postintervention, advance cancellations increased by 6%; indications of special-cause variation were attributable to the intervention. With advance cancellations increasing, time was available for preoperative and nonroutine postoperative appointments, refilling 6.6 appointments per week. As a result, cost savings were $21,251 based on unused clinician time. The contact rate of patients was 45%, and patient satisfaction was high.
In summary, this quality-improvement intervention was able to improve patient-centred care and clinic efficiency through the use of advance-care planning as evaluated by appointment attendance data and patient satisfaction surveys.
减重手术被认为是治疗重度肥胖的一种持久疗法；然而，患者在术后阶段的高不参与率和参与度仍然是挑战。本研究采用前后对照的方法，评估了一项质量改进计划，以提高减重手术计划预约的参与度，并提高预约出席率、取消率和新评估率，从而提高计划效率。
为了确定手术后患者流失的原因，对患者和工作人员进行了咨询。实施的改变想法包括进行术前护理计划的电话和电子邮件，以满足患者的需求并安排预约，并在线应用随访护理信息。使用在线调查评估患者满意度。经过几个计划-执行-研究-行动循环，比较了 2014 年 4 月 1 日至 2015 年 5 月 29 日期间 5676 次预约的术前和术后预约出席率。对于干预措施，有 1294 名患者被呼叫，代表 4124 次预约。同时检查了术前和术后的出勤率和成本。
虽然术后出勤率和未到率仅在干预后改变了 1.8%，但提前取消率增加了 6%；特殊原因变化的迹象归因于干预措施。随着提前取消率的增加，为术前和非常规术后预约留出了时间，每周可填补 6.6 次预约。因此，基于未使用的临床医生时间，节省了 21251 美元的成本。患者的联系率为 45%，患者满意度很高。
总之，这项质量改进干预措施通过使用术前护理计划，能够提高以患者为中心的护理和诊所效率，这可以通过预约出席率数据和患者满意度调查来评估。
