Improving Surgical Outcomes Using the Perioperative Dialogue Model
The estimated $8.5 to $17 billion lost to surgical errors in 1999 was not primarily due to individual incompetence, but to the failure of perioperative systems to operate seamlessly (reviewed by Plasters, Seagull, and Xiao, 2003). The successful management of an operating-room depends heavily on effective communications, but in the absence of a foolproof system for keeping abreast of changes in patient status or surgery schedules, miscommunication is not as rare as it should be.
An important component of the perioperative surgical team is the duties performed by the perioperative nurse (PN), who typically functions as a patient advocate before and during surgery (reviewed by Lee, Kerridge, Chui, Chiu, and Gin, 2011). In Sweden, surgical nursing care has begun to emphasize the importance of a perioperative dialogue between the patient and the PN (Reviewed by Lindwall and von Post, 2008). Under the perioperative dialogue model, the goal is to go beyond the patient advocate role to one focused on establishing a trusting relationship between the patient and a single PN. The dialogue thus created remains intact throughout the perioperative process. Everyone is expected to benefit from this dialogue, including the patient, surgical team, and healthcare administrators concerned about the bottom line.
Implications for a Perioperative Dialogue-Focused Practice
The continuum of care during perioperative procedures depends heavily on a variety of communication methods, including the surgical white board maintained by the charge nurse, patient medical records and admissions information, pagers, phones, face-to-face discussions, and paying attention to the activities taking place on the floor of the surgical department (Plasters, Seagull, and Xiao, 2003). However, the personnel responsible for preoperative care may not be the same individuals in the OR, or who administer postoperative care. The continuum of care in the United States therefore depends on various forms of communication between members of the perioperative team, forms of communication that have been shown to fail too frequently. It could be argued that failures of communications among surgical team members represent a major weakness in U.S. perioperative systems.
Should perioperative care in the U.S. revise the role of the PN to include initiating and maintaining frequent dialogue with the patient throughout the perioperative period, the PN could function as a surgical liaison...
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