Providing the Best Patient Experience: Simple Strategies for the Cardiac Catheterization Laboratory

Being involved in the daily care of patients in the cardiac catheterization laboratory is both challenging and rewarding; however, it can be easily overlooked that for the patients, the experience is likely unfamiliar and frightening, and may result in significant changes to their future and that of their families.   Regulatory agencies are increasingly recognizing the patient experience, and/or the continuum of patient satisfaction, as a factor in overall clinical outcomes. How well the organization performs can have implications across many hospital areas.  

One example is Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), as they consider responsiveness to patient needs, pain management, communication, and overall patient satisfaction in evaluating providers for various certifications. As this trend continues, and as competition is on the rise in markets across the country, it is essential for hospital leaders to consider what they can do to make the patient experience the best it can be under their particular circumstances.  

For some patients, a cath procedure may be elective, while for others, it may be the result of a life-threatening emergency. Members of the cath lab team, as well as those who schedule and provide pre- and post-care, all play a significant role in making the patient experience a positive one. Strategies to improve the patient experience can essentially be quite simple, not requiring major facility renovations, complex process changes, or expensive technological advances. In fact, it is often the “little” things that make all the difference in the patient experience. 

Communication and relationship building

When faced with a new or unexpected situation, we all want information: who, what, when, where, why, and how. Providing this to our patients in a convenient, timely, and especially an understandable manner is the first step to providing a good patient experience. For patients scheduled for elective procedures, this generally starts in the physician office. The patient’s symptoms, history, and other diagnostics have supported the need for cardiac catheterization, and, depending on the outcome of the procedure, the patient may face an interventional coronary procedure or even open heart surgery. This can be a significant amount of unwelcome information to digest in a brief office visit. Corazon recommends working with referring physician offices to ensure they have appropriate information sheets and education materials, and also that the office personnel who interact with patients understand the procedure(s) in order to adequately explain them to patients and families. 

If possible, once the procedure is scheduled, provide the patient with a contact number for a patient liaison in the cath lab whom they can call with any questions. In addition, having a member of the cath lab team call the patient prior to the procedure day to clarify any issues regarding medications or procedure directives, or answer any questions the patient may have, is also a personable way to enhance the patient experience.  

Many web-savvy organizations have added patient information materials and even videos to their hospital site or social media platforms, serving as a means for patients and their families to conveniently review materials at their leisure at home. As the internet continues to be the “go-to” setting for information, hospitals are wise to include patient materials online for ease of access — most likely, patients will expect to find such information online through your hospital website, and may be discouraged or disappointed if such things are not available.

When a patient arrives for a procedure, having staff members introduce not only themselves (and, importantly, their role in care delivery), but also the other staff members who will be participating in the procedure, helps to develop a strong patient/caregiver relationship from the outset. For example, a script for the nurse in the holding area can be something like, “Hi, I’m Mary and I’ll be getting you ready for your procedure. When we take you into the lab, Joe, Cathy, and Sandy will be in the room for your procedure and will take great care of you.” Such an approach helps to provide the sense of continuity of care, and will also begin to build the patient’s trust in those individuals involved in their care.  

We advise program leaders to encourage the cath lab staff to connect with patients on a more personal level as well, which can let the patient know they are more than a case or procedure number.  Any topic that can stimulate casual conversation will put the patient at ease and give staff the chance to show interest beyond the confines of his or her procedure. As mentioned previously, this is a rather simple approach, but, one that is often overlooked as part of day-to-day patient interaction. Corazon experience at hospitals across the country proves that the more time invested in getting to know patients, the higher patient satisfaction scores will likely be. 

One of the most common patient complaints is being left uninformed, especially regarding delays. If the procedure schedule is becoming backlogged, whether due to complex cases or emergencies, the department holding scheduled patients (inpatient nursing unit or outpatient area) should be kept informed of the delay, the reason for the delay (as much as can be shared within the constraints of confidentiality), and if at all possible, an estimate of when the case will be done. It then becomes critical that that unit staff relay that information to the patient and family. In most cases, patients and their families will be very understanding of delays, especially in an emergency situation; they mostly just want reassurance that they have not been forgotten.

Comfort and privacy

Beyond wanting to know procedure details, patients generally want to also be reassured that their comfort will be maintained before, during, and after the procedure.  Explaining that it will be, and via what means, will help to dispel fear. It is also important during the prep and drape of the patient to explain not only what is being done, but why. For example, “I’m going to cover you from neck to toes with this sterile sheet or drape. Once I have this cover on you, we don’t want you to reach up or try to touch anything on top of the cover, so we can keep the area where we are working clean and sterile to prevent infection. If you need anything, to move or scratch, just let me know and I will help you so we can do it in a way that will not disturb the clean area.”  

A patient will feel much more comfortable to know that if they have a need (even an itch to scratch!), the staff is willing and able to help them in a way to preserve the sterile set-up. If a patient feels unsure or uncomfortable about what they’re allowed to do, asking will magnify any initial feelings of discomfort, which can negatively impact the overall experience. Addressing patient comfort in any way possible will have the opposite effect, thereby increasing satisfaction scores.

Staff can explain that the camera is going to move around them and may come close to their face, but won’t touch them; that there will be an injection of x-ray dye to fill the main pumping chamber to get a good picture of the heart pumping; that the x-ray dye will cause them to feel a very warm, but normal, sensation, and so on. The patient may have read materials or watched videos explaining the procedure, but once on the table, anxiety is heightened. Along with sedation, the patient may forget exactly what is happening. Step-by-step explanations increase comfort levels overall, and are reassuring that all is going according to plan. For team members, such explanations can reinforce feelings of compassion. 

Further, during all phases of care, patients want their privacy respected. Drawing the curtain or closing a door when examining or prepping the patient; covering the patient’s genital area as much as possible during the clip prep or sheath removal; and providing covers as much as possible, are small but critical ways to maintain the patient’s modesty. Remember, invasive cardiac catheterization procedures involve a level of intimacy that most patients are unaware of until it is time to begin. Many departments have a relatively “open” holding area. Neglecting to provide attention to these details can create additional unnecessary anxiety for the patient. 

Our experience has also shown that the lack of private space in some cardiac catheterization labs also contributes to another issue related to the patient experience, that of confidentiality. It is imperative that any discussion related to the patient, and his or her condition and care, is done in a professional, non-public manner. Moreover, that information should not be shared outside of those who are caring for that patient. Likewise, charts and documents that refer to the patient should be kept hidden from public view.  

Indeed, maintaining patient privacy should be top of mind for every healthcare provider, despite facility layouts that may not be ideal. Trying to view the entire department solely in the context of patient confidentiality can often highlight areas needing improvement. Again, the changes can be simple adjustments, but nonetheless, ones that need to be addressed.

Procedure follow-up

Following the procedure, the family should be informed that the procedure is complete and when they can expect to see their loved one. Ideally, when they have the opportunity visit post procedure, the physician has already spoken to the patient regarding the outcome. Staff members can then reinforce the information and answer any questions. Post procedure instructions regarding basic care and activity limitations should be given verbally to both the patient and their family, and also be provided in writing to serve as a reference. Letting everyone know what to do or who to call if they have an issue or question later on is a critical part of helping the patient to feel more secure before discharge.

Most organizations provide some type of patient follow-up, whether a visit the next day to inpatients, or a phone call within 24-48 hours of discharge. While this allows for follow-up from a clinical and outcomes perspective, patients and their families view this as an added reassurance that the concern for their wellbeing extends beyond the walls of the organization. In light of payor interest in readmission rates within 30 days (and the potential for payment penalties), this follow-up can provide early identification of any care issues that can be readily addressed (whether through the physician office or as an outpatient), avoiding a potential emergency department visit or readmission. 

Concluding thoughts

While many of the points above address the elective or scheduled patient, it is also important to consider patients arriving to the lab in emergency situations. The hospital’s emergency department staff (medical and nursing) should be well informed of cath lab procedures, and have readily available written support materials to provide to family members. In an emergency, information shared with the patient should be focused on the essentials: responding quickly and efficiently to provide appropriate care (monitoring, oxygen), pain management, explanations of what is going to happen next and why, what will be done in the cardiac cath lab, and what the potential outcomes may be (intervention or surgery).  Essential information must be provided, but this is the time for quick action and information on a “need-to-know” rather than a “nice-to-know” basis.  

Printed education materials provided to the family can be reviewed while their loved one is in the lab, which will give them a better understanding of what’s happening, given the lack of pre-procedure preparation time. They can also then be prepared to ask follow-up questions when they are able to talk with the physician or the staff. In an emergency situation, communication regarding pain management, as previously mentioned, is also of utmost importance.

Attending to the needs of the family can be extremely important to the patient. Essentially, it’s impossible to separate the patient experience from the family experience. Engaging the family and keeping them informed will play into the patient’s overall perception of their care; and, in many cases, the patient’s family may be responsible in assisting their loved one as they complete their post hospital patient care survey.

Providing the best patient experience in the cardiac cath lab doesn’t require anything radically new or different.  What it does involve is appropriate support materials and a standard process to educate (and reinforce that education) across the continuum of care. Communication, relationship-building, and simple approaches that reinforce patient comfort and privacy are all that’s needed to ensure a positive experience. In fact, even the most advanced organizations focus on these most basic components of care delivery, with stellar results. Appropriately responding to patient needs, providing ongoing and consistent communication, and quality care is all that is needed to make the patient’s experience a good one. It’s HOW this is accomplished that can be a true differentiator in the marketplace, which then drives referrals, positive word-of-mouth, and overall reputation.

Marsha is an Account Manager at Corazon, Inc., offering consulting, recruitment, interim management, and physician practice & alignment services in the heart, vascular, neuro, and orthopedics specialties for clients across the country and in Canada.  To learn more, visit www.corazoninc.com or call (412) 364-8200. To reach Marsha, email mknapik@corazoninc.com.