Identification of Local Problem
In 2023, a collaborative survey involving surgeons and patient partners identified a gap in the availability and consistency of post-operative patient education materials across Fraser Health (FH). Respondents reported a lack of standardized resources, contributing to patient confusion and increased post-operative visits to emergency departments and clinics. This issue was observed across all 11 FH sites. When patients are not adequately informed about their surgery and recovery process, it can lead to unnecessary stress, delayed healing, and complications. Healthcare providers also face added burden from repeat visits and additional clarifications, contributing to inefficiencies and provider burnout. The strain extends to other programs such as Emergency Medicine and Primary Care, ultimately impacting system resources and increasing healthcare costs.
Context of the QI Activity
At the outset of this quality improvement initiative, a baseline assessment revealed that 0 out of 11 FH sites were actively using standardized patient education materials, such as the ACS Patient Education Toolkit. The project aimed to achieve full adoption of the toolkit across all sites by the end of 2025. Input was gathered from NSQIP patient partners, clinical nurse educators (CNEs), and other key stakeholders. Patient partners were asked to reflect on the education they received post-operatively and were given the ACS Toolkit for review. Their feedback highlighted the value of the toolkit, particularly in helping them understand what to expect during recovery. They evaluated it for clarity, content relevance, and user-friendliness. Survey participants included 299 patients, representing diverse surgical procedures and hospital sites.
Preliminary findings suggest that improved access to clear, consistent patient education could reduce unnecessary post-op visits, enhance patient confidence and recovery, and relieve pressure on acute and primary care services.
What were the interventions?
- NSQIP Leads introduced background data and ACS Patient Education Toolkit at NSQIP Collaborative meetings which are held monthly.
- Toolkit was shared at all 11 sites with the NSQIP Semi Annual Report presentation.
- Interested Surgeon champions invited NSQIP team to present to Surgical Day Care (SDC), and acute surgical Clinical Nurse Educators (CNE).
- NSQIP Leads worked with surgeons at site to customize toolkit according to site needs.
- Worked with site CNEs to integrate ACS toolkit into patient discharge teaching resources. This included creating posters and handouts for units with QR codes and links for patients and families to utilize. The posters and handouts were created by the site CNEs.
- Also provided posters to surgeons interested in displaying availability of the toolkit in their offices for patient teaching pre-op.
- Provided sites with appropriate links and QR codes to add to patient resources.
On average, for one site—from presentation of the toolkit to go-live of the patient handouts—the timeframe was about 6 months. This included time to meet with surgeons for customization and review, and also time for handouts to be printed.
Using Change Theory, this stepwise intervention allowed for early uptake of the toolkit. Implementation on a small scale allowed for potential problems to be mitigated more easily. Engagement increased once additional sites were able to visualize and receive feedback from preliminary sites. Resources were then able to be shared among sites.
Project Timeline
April 2023: Introduction of ACS toolkit to FH NSQIP Regional Team
Sept 2023: Presentation of toolkit at NSQIP Collaborative meeting
Oct 2023–Oct 2024: Presentation of toolkit at site NSQIP meetings
Spring 2024: Implementation of toolkit at 1 FH site
Oct 2023–Jan 2025: Implementation of toolkit at 10 surgeons’ offices
Ongoing: More sites and more surgeons implementing toolkit
Costs and Funding Sources
Costs included ACS patient education toolkit subscription, and individual site costs for patient resources – posters/handouts. DofBc provided funding which allowed for physician engagement.
Overall Results and Analysis
8 sites are utilizing the toolkit currently. Data is currently being analyzed via NSQIP Custom Fields to track ER visits. Results will be shared at ACS Quality and Safety Conference 2025 as well as at FH NSQIP Summit in 2025.
Limitations
Taking surgeons’ time to review the toolkit and provide feedback on customization.
This was mitigated by meeting on surgeon’s time and at location preferred by surgeon – ie. Teams or Surgeon’s office.
Lessons Learned
The team’s perspective is that the project is worthwhile as it addresses a gap in patient discharge education.
Site CNEs and Surgeons find the ACS toolkit very valuable as it fills an existing gap in available post-op education for patients.
There are plans for formal surveys of patients who have accessed the toolkit, as well as surgeons for feedback on usability.
The team notes that implementation is site specific, and the timeline is different for each site and need to adjust accordingly. They also found the more that was shared about the education (e.g. during NSQIP meetings), the more champions were involved in the project.
