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Spring 2021, Practice Management

Postoperative Discharges: Improving Owner Education

The success of a surgery may depend on postoperative care by the owner. Make sure you set your clients up for success.

Carrie ChandlerCVT, CCRP

Carrie is a CVT in the Rehabilitation Department at the University of Illinois Veterinary Teaching Hospital in Urbana, Illinois. Earning her associate of applied science degree from Parkland College in 2011 and physical rehabilitation certificate (CCRP) from the University of Tennessee (Northeast Seminars) in 2016, Carrie provides clinical casework, research assistance, and teaching to both veterinary and veterinary technician students at the university. She has additionally completed the Osteoarthritis Case Manager and Companion Animal Pain Management certificate programs through Northeast Seminars and is currently completing her bachelor’s degree at the University of Illinois. 

Postoperative Discharges: Improving Owner Education
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Client compliance is often one of our greatest obstacles as veterinary professionals. A study released by the American Animal Hospital Association (AAHA) in 2003 revealed that client compliance is as low as 17% to 35% for important veterinary care such as senior screenings, therapeutic diets, dental care, and heartworm preventives.1 Client compliance also happens to be one of the most important factors for a patient’s successful recovery following surgery.

Advanced procedures such as an orthopedic surgery or neurosurgery often require more extensive, long-term postoperative care for the owner to perform at home. Because of this, additional consideration must be taken to make sure the client is thoroughly educated on what home life may look like as their pet recovers from these procedures. As veterinary nurses, relaying and decoding much of this information such as bandage care, exercise restrictions, or rehabilitation exercises is often our responsibility. Understanding complex instruction for life at home in these situations can be challenging, not to mention intimidating, for the pet owner. Improving your clinic’s ability to provide thoughtful, detailed postoperative instruction helps to ensure a more smooth recovery for the pet, the owner, and your clinic.

Effective Communication is Key

Since many postsurgical discharges require extensive information for the owner, it may seem best to keep things simple in order to avoid confusing the owner during an already overwhelming situation. However, it is important to remember that much of the information we are asking them to absorb is not so simple or straightforward to a layperson, and the ability for us to relay this information effectively can often mean the difference between surgical success and failure. For intensive surgeries such as a limb fracture repair or a decompressive spinal cord procedure, patient recommendations can easily seem demanding, confusing, and overwhelming to take home. Major changes to the lifestyle of both the owner and pet are at play during the recovery period, which often includes expecting the owner to perform extensive daily tasks such as frequent medication administration, rehabilitation exercises, recumbency care, and bladder expression. So while we should want to communicate with the client in concise terms, spending extra time and attention to add detail and explanation will help the client feel adequately informed and empowered to carry out the recommendations at home.  

Communication is key in these situations, and becoming comfortable relaying instruction takes practice, knowledge, and understanding. Remember that the core rules of effective communication such as eye contact, slower speaking pace, and leaving space for the client to ask questions are critical to articulating information successfully. To take your communication skills a step further, consider these strategies when discussing postoperative concerns. 

Provide Adequate Preparation. Every client should know the full scope of the surgical process prior to consenting to their pet’s procedure. Providing a clear expectation of possible complications, restrictions, at-home changes, timelines, and prognosis at the outset helps the pet owner make well-informed decisions and become more prepared for the months to come. 

Similarly, you should also advise the client to expect a longer visit when it comes time for the animal to be discharged to allow the time needed to discuss instructions for at-home care thoroughly. The more information you are providing ahead of time, the more prepared the client will be when it comes time for the animal to go home. Consider offering advice that would help make their transition easier from the moment they leave the hospital, such as suggesting they bring along a crate in the car for safer transport or an additional person for help.

Set Aside the Time. It is often easy for veterinary nurses to get overloaded with tasks; we can find ourselves rushing through a discharge because we simply do not have the time, leaving opportunity for important instructions or questions to be omitted or insufficiently discussed. This does not result in good medicine and is never in the best interest of the patient. If ensuring you have adequate time to spend with the client is a tall order to fulfill in your clinic, you might consider setting aside a regular appointment time slot for these discharges where no other visits are seen, allowing for sufficient available staff and time in the schedule. These discussions are often lengthy, especially when the owner has many questions, so in order to ensure that neither party feels rushed, the clinic must first make it a priority to fit it into the schedule appropriately.  

Provide Visit Summary Paperwork. Providing postoperative instruction in writing should be a standard in any clinic, as the client will use it for reference once at home. It also serves as record that the provider has properly communicated all pertinent information with the owner. Documenting anything in written form can leave much room for error, so extra care should be taken to make sure these instructions are accurate and detailed with the necessary information to decrease the risk of miscommunication. This paperwork should outline everything communicated during the postoperative visit, including but not limited to:

  • Pre- and postsurgical physical examination findings
  • Medication information and dosage
  • Pertinent diagnostic results or surgical findings
  • Restrictions
  • Potential for complications
  • Rehabilitation instructions
  • Follow-up visit schedule 
  • Contact information for who to reach with questions or concerns

It is also worth noting that the visit summary often serves as your communication to the referring veterinarian, if applicable, so being thorough and consistent with the execution of these records is important to the patient’s overall care.

Refrain from Bringing the Pet Into the Room. A pet’s surgery can be an emotional and overwhelming experience for a pet owner, and being reunited after an extended hospital stay is an exciting moment. Because it can be difficult for clients to focus with their newly reunited furry family member in the room, abstain from bringing the pet into the room until the conclusion of the discharge to limit any distraction that may occur during important conversation. Once all necessary postoperative information has been discussed, you may then bring the pet into the exam room to proceed with demonstration of at-home care if needed.

Help the Client Envision a Routine. As previously mentioned, many post-surgical patients are sent home with lots of layered instructions and recommendations. To simplify, provide the owner with an example routine for care that they can follow or help them develop one that fits with their capacity and schedule. Establishing a schedule for medication administration, rehabilitation exercises, and incision care can make the process less overwhelming and help them envision how to incorporate these changes into their daily lives at home. 

Encourage Hands-On Learning. Keep in mind that many of the things we ask owners to perform at home, such as rehabilitation exercises or medication administration, require nursing skills. By trade, we perform these skills daily and it can be easy to forget how challenging and uncomfortable some of these tasks can be for those who are not well-practiced with them. 

A 2010 human study found that effective postoperative education provided by nurses is directly correlated with positive patient outcomes.2 Demonstrating instructions for the client and asking them to perform them in front of you is a great way to help them carry out these instructions at home and may also help them spot possible complications, should they occur. 

Be Detail-Oriented. You have probably handled enough client interactions at this point to be able to anticipate some of the questions or points that may need further elaboration. Keeping common concerns in mind during client communication and including them in your instruction can help minimize questions and confusion throughout the postoperative process. Clarifying terms that could have a broad range of interpretation during these conversations will greatly decrease the likelihood that important concepts are misconstrued. A term like “exercise restriction,” for example, could mean the owner only needs to omit certain daily activities or it could mean they must completely confine the patient to a crate at all times. Lack of specification can easily lead to an unwanted outcome, so don’t be afraid to provide clear expectations to make sure as little is left for misinterpretation as possible. 

Provide Resources. In addition to the visit summary paperwork, providing the client with something comparable to an FAQ sheet can further improve the written communication process. Some examples for a postoperative FAQ sheet can include stating the length of time needed in an Elizabethan collar, describing normal stages of postoperative swelling, or listing potential side effects from prescribed or interactive medications. Additional external resources, such as videos for rehabilitation exercises, provide an immediate and helpful reference should questions arise at home. Beyond adding FAQs, videos, or other educational resources to your practice’s website, TABLE 1 lists some suggestions of different resources that can additionally be provided to the pet owner.

Follow-up. Implementing a call-back protocol is an excellent way to strengthen your clinic’s communication with clients that have a pet recovering from surgery. Allow time in your schedule for routine, periodic calls to check in on clients in an established timeframe. Calling the owner within the first 24 hours and again around the 1-week postoperative period is a good industry standard and is often the most vulnerable time, as the owners and pets are working to adjust to their new routines at home, based on the results from the previously mentioned AAHA study.1 These calls not only improve your clinic’s client service quality but also give providers an opportunity to evaluate patient progress while ensuring that the client is following recommendations.

Put Yourself in Their Shoes. Empathy is something we already practice to a fault as veterinary professionals, but we can also easily shut ourselves off from practicing patience and understanding due to the daily demands of the job. The postoperative transition for some of these more intensive procedures often means a significant change in lifestyle moving forward for some pets and owners, and we must be able to recognize and acknowledge the challenges involved in these changes in order to fully lend a helping hand. While we are animal advocates first, providing supportive and thoughtful communication to the pet owner is at the center of that intent and ensures that our patients receive the best care possible.

References

  1. American Animal Hospital Association. The Path To High-Quality Care: Practical Tips For Improving Compliance. Lakewood, CO: Am Anim Hosp Assoc Press; 2003.
  2. Fredericks S, Guruge S, Sidani S, Wan T. Postoperative patient education: a systematic review. Clin Nurs Res. 2010 May;19(2):144-64. doi: 10.1177/1054773810365994

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