Presurgical Education ProgramSamantha Arsenault, Jordan Braun, Logan Snyder-Olsen,

Kaitlyn Vaughn & Taylor Wilson

Program OutlineListed are the topics that will be

addressed in this powerpoint and

the order in which they will be

presented.

● Executive Summary

● Capstone Proposal

● Nurse Manager Interviews

● Review of Literature

● Project Recommendations

● Market Analysis and SWOT

● Organizational Management

● Financial Projections/Feasibility

● Closing

● References

“Appropriate and sufficient patient education and assessment prior to surgery can reduce avoidable costs to the patient and to the hospital…” (Pritchard, 2012)

Executive Summary● Promoting patient knowledge through the

use of a presurgical education program.

● Quality presurgical patient education

reduces postsurgical complications.

● Reduced cost to hospital.

● War Memorial Hospital has 1-6%

postsurgical complication rate, based on

surgical procedure performed.

○ Can be reduced through effective presurgical

patient education.

● Competitive Edge

○ Lack of high quality presurgical patient

education program based on our research.

Current Patient Education Program● Patient education is dependent on

the surgeon performing the

surgery

○ According to both nursing managers

interviewed, “some surgeons are better

at educating their patients than others”

● Written material is provided

○ Pamphlets

○ Packets

○ Educational materials possibly higher

than the patient’s literacy level

Flaws in the Current System

● Varied education based on

surgeon

● Disabilities that impact receiving

the information provided

○ Literacy

○ Physical

○ Mental

● Timeframe in which the

information is provided

○ Scheduled office visits

■ 15-30 minutes

“Patient education is the process in

which healthcare providers share

information with patients in order

to alter their health behaviors and

improve their overall health

status…” (O’Brien, McKeough, & Abbasi, 2013)

“ Education and preparing the patient for their surgery in advance of the surgical day will help to reduce fear, stress, and anxiety that can often be accompanied with surgical procedures…” (Guo, 2015)

Nurse Manager Interviews

Our group interviewed two nursing managers. Our first interview was with Ms. Valerie

Pfander, a perianesthesia clinical nurse specialist, at Munson Medical Center in

Traverse City. Our second interview was with Professor Carrie Perez, nurse manager,

at War Memorial Hospital in Sault Ste. Marie.

Interview with Ms. Valerie Pfander● Munson Medical Center

○ Currently implementing a new program

● Education should begin in the physician’s office

● Most common concerns of patients:

○ Postoperative restrictions

○ When they can return to work/school

“ Most often patients have concerns about what type of restrictions they will have after surgery, and when they will be able to return to work or school…” ( V. Pfander, personal communication, March 11, 2016)

Interview with Professor Carrie Perez● War Memorial Hospital’s current program

○ 5 RN’s

○ 2 CNA’s

● Bariatric patient education

● Use teach back method

● Provide ample time to ask questions

● Follow up phone calls

○ Trouble shoot quicker

○ Catch postoperative complications faster

Review of LiteratureIn order for presurgical education to be effective, a well-structured program must be

implemented. All members of the healthcare team must be actively involved, and the

reinforcement of the program must be ongoing.

Patient Education Programme (PEP)● Improved Physical &

Psychological Well-Being

● Strengths

○ Purpose of PEP

● Weaknesses

○ Young in Implementation

○ Assumptions

(White, J., & Dixon, S., 2015)

“I Can’t Read That!

Improving perioperative literacy

for ambulatory surgical patients”

(Liebner, L. T., 2015)

● Understandable to Patients

● Reading Level Among Adults

○ 6th-8th Grade

○ As low as 4th Grade

○ 12% have proficient health literacy

● Pictures with Text

● No Follow Up

Adherence to Preoperative Fasting

● Compliance and Understanding

● “it is appropriate to fast from clear fluids

for two hours or more”

● Fasting for too long

● Not a blind study

(Kyrtatos, P. G., Constandinou, N., Loizides, S., & Mumtaz, T., 2014)

Project Recommendations

According to Guo (2015), the level of patient satisfaction increased with preoperative

education while also decreasing the level of anxiety for both the patient and their family. It

also showed that patients had a decreased length of stay compared to patients who did not

receive adequate patient education.

Our Program● Education will begin in the physician’s office

○ How to prepare for surgery

○ NPO status

● Patient’s will attend the presurgical education class prior to surgery

○ Offered 6 days a week

● One-on-one sessions offered

● 2 RNs will lead each class

● Classes will be 2 hours with a 10 minute break after the first 50 minutes

○ Hand out literature will be distributed

○ Videos at the facility

○ Anatomical models

● Ample time for questions to be asked

Continuing the Education The Day of Surgery

● Review of procedure and

expected outcomes by nurses

and physicians

● Time for additional questions to

be answered

Ensuring that the patient is fully

prepared will help alleviate fear,

stress, and anxiety associated with

the procedure and promote

patient confidence with the

surgical process (Guo, 2015).

Postoperative Education● Education focused on:

○ Medications

○ Limitations

○ Wound care

○ Follow up appointments

○ PT/OT

● Additional time for questions to be

answered.

Stakeholders● Patient

● Surgeons

● Hospital Facility

○ Eliminate gaps from surgeon

to surgeon

Market Analysis & SWOT

The need for patient education is essential in providing the best patient care, reducing

possible complications, as well as reducing patient anxiety prior to a surgical

procedure. Presurgical education is immensely crucial to the patient’s well being as it

promotes the best patient outcomes.

Industry Description & Size● Healthcare workers involved in a

patient’s surgery provide necessary

information to prepare a person

for what is to be expected.

○ What the surgical process involves

○ What to expect post surgically

○ How to prepare

○ Goal: Alleviate poor patient outcomes

and promote compliance!

~78.2 Million PeopleIs the estimated amount of surgical patients each year in the United States.

How this was calculated: The CDC states the average number of inpatient surgeries is

roughly 51.4 million people annually (CDC, 2015). AHRQ states that the number of

outpatient surgeries rose to 26.8 million in 2012 (AHRQ, 2015).

Target Population● All surgical patients

○ Pediatric-Geriatric population

○ The families of surgical patients

■ The role of the caregiver during the

recovery period

● Healthcare team members involved:

○ Nurses

○ Physicians

○ Surgeons

○ Anesthesiologists

○ Certified Registered Nurse Anesthetists

(CRNAs)

○ Social workers

“82% of people that have undergone surgical procedures had expressed that they would have wanted more information prior to surgery…” (Gonzales, et. al, 2014)

Individual Needs & Demographics● Gaps in the presurgical education process

○ Patients not having a full understanding of

their surgical process

● Increase patient satisfaction

● Decrease unnecessary complications

● Patients will have ample time to ask

questions regarding their procedure

Organizational Management

When implementing this program, several different aspects need to be taken into

account. Structure helps to set the foundation for the program. Having a clear mission,

vision and philosophy statement is important in conveying the benefits and the aim of

the presurgical program.

Resources Needed● Two Additional Registered Nurses

● Educational training for nurses

○ Use open-ended questions

○ Index of Learning Styles

Questionnaire

○ Teach-back method of learning

● Technology

● Reading Materials

○ Pamphlets, handouts, etc.

● Meeting Room

Organizational Structure● Begins in the Physician’s Office

● Education Classes

● RNs and CNAs

● Presurgical RNs

MissionTo provide exceptional presurgical and post-surgical education through the highest quality of care,

compassion, and attentiveness to every patient. Exceptional pre-operative and post-operative

education will ensure optimal outcomes for all patients.

VisionTo eliminate preventable post-surgical complications and improve overall patient outcomes through

an extraordinary presurgical education program.

“Becoming an effective nurse

educator, the nurse requires

formal and informal education,

elapsed time, and real world

experience.” - (Gardner, 2014)

Adaptation Model - Sister Callista Roy

● Environment, health, personal reflection, and

type of nursing

● Bio-Psycho-Social Being

● Adaptation Model & Our Program

● Program Goals

Business and Management Theory● The General Systems Theory

○ Originated in the natural sciences.

○ Takes a broad worldview

○ Looks at all factors that not only

influence the program, but also factors

that the program influences.

○ Three levels of the person:

■ The patient

■ The suprasystems*

■ Treatment of problem or

ailment

● The Transformational Leader

○ Focuses on interrelationships between

staff, organizations, and constituents.

○ Focus is on vision of the presurgical

education program.

○ Will lead by example to all staff

involved in the program.

Transformational Management & Leadership

● Facilitate Needs of Staff

● Advocate for Staff

● Staff & Self-Motivation

● Model for Success

● Professional Opportunities

● Staff Feedback

Management Style● Coaching, participative, affiliative

management style

○ Provide support to staff

○ Promotes strengths of staff*

○ Provides professional opportunities for

employees

○ Acquire feedback to improve the

presurgical education program

Resistance● No Threat

○ Rotating Educators

● Delegated Funds

● No Vision for Change

● Emphasis Importance

● Projected Revenue

● Cost v. Savings

● Motivators

Time of Implementation

● Beginning May 1, 2015

○ 1 Year Goal

● Identify Problem & Gather Data

○ 3-6 Months

● Implementing Program

○ 3-6 Months

Evaluation● Collected per Individual

○ Monthly

○ Quarterly

● Post-operative complications,

their length of stay in the

hospital, and readmissions

● Success

Financial Projections/Feasibility

Financial Trends● Improve patient outcomes by preventing

postsurgical complications

○ Reduces patient cost

● The cost to treat a patient that acquires

complications increases 54%

○ Profit margin of the reimbursements

decreases from 23% to 3.4%

● As the reimbursement rate from insurance

companies decreases, the profit margin

decreases.

(American College of Surgeons, 2015)

Financial Projections● WMH performs ~5,600 procedures annually (Surgical

Services, 2016)

● Fixed costs would be the wages of RN’s

○ $10,000 startup cost that accounts for visual aids and

videos (Anatomical Models, 2016)

● Breakeven Analysis (Moran, 2016)

○ Fixed Expenses

○ Cost for Classes

○ Operating Expenses

○ Margin Cost

○ Breakeven Point

Fixed Expenses● RN hourly wage $25/hr

○ $25/hr x 24 hr/week x 4 weeks = $2,400

(times 2 RNs)

○ $4,800 x 12 months = $57,600 annually

■ $23,040 (fringe) + $57,600 (annual)

● =$80,640 annual cost

● 40% fringe benefits

○ $23,040 annually

● **$10,000 additional for first year

○ =$90,640 first year expense

● 100 tri-fold pamphlets for $45 (Vistaprint,

2016)

○ Ordered about four times per month

● Cost for one class is about $5

● 12 classes held per week at $5/class

○ = $60 weekly

○ = $240 monthly

○ = $2,880 annually

● Patient cost per class is $100

○ Eight patients per class = $800/class

Cost for Classes

Margin Cost● $100 per class x eight patients/class -$5 to

run the class

○ = $795 margin cost

● $80,640 (fixed cost) + $2,880 (cost for class)

○ =$83,520 (yearly operating expense)

● **$90,640 (first year fixed cost) + $2,880

(cost for class)

○ = $93,520 (first year operating expense)

Operating Expenses

Total Costs to Run Program

Costs First Year Annual Cost Subsequent Years Annual Cost

One Time Startup Fee for Supplies $10,000.00 $0.00

Supplies Cost $2,880.00 $2,880.00

Nurse 1 Wage $28,800.00 $28,800.00

Nurse 2 Wage $28,800.00 $28,800.00

40% Fringe Benefits $23,040.00 $23,040.00

Total Costs $93,520.00 $83,520.00

Breakeven Point● $83,520 (operating expense) / $795 (margin)

○ = 106 classes (breakeven amount, yearly)

● **$93,520 (first year operating expense) /

$795 (margin)

○ = 118 classes (first year breakeven amount)

● 12 classes/week x 52 weeks = 624 classes/year

○ Hit breakeven point by third month in year

one

● $800/class x 624 classes/year

○ = $499, 200 annual profit

● $499,200 annual profit - $83,520 annual cost

○ $415,680 annual profit

● **$499,200 annual profit - $93,520 first year

cost

○ =$405,680 first year profit

Profits

Financial Projections Impact on the Bottom Line● Positive Effect

● This program will continue to further the financial growth of WMH through

several different avenues

● Average patient hospital stay without complications is $10,978 (American College

of Surgeons, 2015)

● Average cost of patients that develop complications is $21,156 (American College

of Surgeons, 2015)

○ Potentially save ~ $10,178 per patient at risk for complications

Reimbursement

● Medicaid

● Private Insurance Companies

● Patients Themselves

○ Flat rate set to ensure patients

without insurance can attend

● Crucial for the physicians to

provide education on program

importance.

Cost Savings● Adequate and thorough education leads to

compliance and patient preparedness

○ Patients who are prepared and know what to expect have a

higher satisfaction rate and lower complication rate (Ellrich &

Yu, 2015)

○ Decreased readmission rates

● Patients with complications increase from an

average of $10,978 to $21,156 (American College of

Surgeons, 2015)

● Average reimbursement rate with no complications

is $14,266 compared to $21,911 for patients with

complications

○ Profit margin drops from 23%, without complications, to 3.4%

with complications

“According to Piper (2015), the average total cost for U.S. hospital readmissions within 30 days is at least $4.3 billion dollars each year for Medicare patients.”

Cost Savings (cont.)

● More revenue for the hospital

● Proper patient education can

prevent unnecessary complications

that may lead to readmissions

○ Lead to increased profit and higher

patient satisfaction

“High quality presurgical patient education improves patient outcomes while decreasing postsurgical complications (Foss, 2011).”

Role of the Nurse● The nurse’s ability to effectively educate

patients will directly impact financial success

○ Decrease in patient postsurgical complications

○ Decrease in cost to treat these patients

● Following the patient throughout the entire

process is crucial

○ Help to determine effectiveness of education

○ Help to identify the average cost of treatment without

complications, while trending costs of patients with

complications

● Nurses will help to provide evidence that the

program is effective

Closing Statements

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