Best Care Possible: Research Helps Improve Surgical Outcomes

The weeks and days before a surgery can be nerve-wracking for patients, and often challenging for surgical staff who struggle to manage waitlists and prepare every patient before and after their procedures.

Often, overworked surgical care staff struggle with the time or resources they need to stay in contact with patients during the all-important stages before and after each patient’s surgery — when close monitoring could help prevent postoperative complications such as hospital readmission or infections.

Now, a year-long pilot program has resulted in impressive findings that could inform easy changes to serve delivery that would transform the quality of care for patients undergoing surgical procedures at Langley Memorial Hospital.

Sponsored by Doctors of BC, the Surgical Patient Optimization Collaborative (SPOC) has harnessed the talents of a team from Langley Memorial, one of eight participating hospitals in the Fraser Health Authority and among 14 across the province.

Over the last year (from May 2022) each hospital team monitored a group of patients for conditions that could complicate their health care before surgery.

Under the guidance of LMH Orthopedic Surgeon Dr. Mark Chiu, and overseen by SPOC Nurse Navigator Dawn Charlebois and a multidisciplinary team, the group screened 322 patients scheduled for joint replacement surgery at Langley Memorial Hospital, measuring for potential complications.

Before the procedures, they screened and monitored patients who were susceptible to risks related to anemia, glycemic control, Vitamin D deficiencies, obesity, sleep apnea, smoking cessation and substance use.

Ninety-five per cent of those screened did indeed require optimization in pre-op care or monitoring, and 205 patients from that screened group ended up participating in the program.

In the weeks and days before the patients’ procedures, they received guidance and referrals to specialized clinics, programs and other resources.

For instance, Dawn worked with the physicians of patients with Vitamin D deficiency or sleep apnea to get them treatment or refer them to clinics, while smokers were referred to smoking cessation plans like QuitNow.

Within 30 days after their procedure, members of the National Surgical Quality Improvement Program (NSQIP), a Fraser Health regional group, followed every patient to measure their surgical experience and any postoperative health complications.

The results have been outstanding: 96 per cent of participating patients agreed their surgical experience improved, thanks to the optimization program, and 60 per cent noted that their overall health improved as a result of the pre-op care.

Importantly, no patients in the program reported post-op complications to date.

A Process of Re-Designing Care

“This has been helpful to the hospital because it's given nurses, managers and Operating Room booking a new way of doing things. It’s a process of re-design, in order to optimize patient health and outcomes and get them feeling as best as they can, before and after a surgery,” says Dawn.

The data could be exactly what Langley Memorial needs to start the conversation surrounding new ways of optimizing pre-surgical care. In a community with a booming population, a busy hospital and long health care waitlists, a program like SPOC could support recovery and greatly improve patient and provider lives at a time when patients are at their most vulnerable.

“The time between the decision for surgery and when the patient receives surgery is an opportunity to focus on optimization. As care providers, we can use the pre-operative waiting period as an opportunity to better prepare patients — both physically and mentally — for surgery as well as empower ourselves and our patients to improve surgical outcomes,” says Dawn.

Optimizing Care Cuts Costs, Complications

Without close monitoring, a patient may be more vulnerable to an infection after surgery, which could lead to re-admission, or multiple visits to LMH’s IV therapy clinic.

“The aim of the program is to decrease length of stay, morbidity, and cancellations, and increase the experience of surgical care. Essentially decreasing costs to the health care system,” says Sooky Moore-Ruiz, LMH Project Manager, who works closely with Dawn.

Fortunately, bridge funding has been approved for the SPOC program to continue to gather even more data to support the concept of optimized pre-surgical care in a way that could work at Langley Memorial and other hospitals, she adds.

Dawn, who shared her experiences at the outcomes conference in May, says she’s proud to have worked with Langley patients on a project that has such potential to improve care.

“It has been really rewarding to be a part of something so big and so impactful,” she says. “To have the opportunity to engage with SPOC patients has been a highlight of my nursing career.”