UPDATED – What makes a good pre-operative education class?
Since posting this entry in August – we have been asked a number of further questions about pre-op classes. Scroll down to the bottom of this post for the updated answers. We hope they are useful.
This week the enhanced recovery blog has been contacted by three different organisations all with questions about how to run a successful pre-operative education class. We acknowledge that what works in one setting may not be ideal for all other settings but hope that the following thoughts and ideas are useful. These were learnt when we developed a successful pre-operative hip and knee replacement education session.
– Make attendance mandatory. Pre-operative sessions shape the expectations of patients in regard to length of stay and outcome. Therefore, you need every patient to attend if you are going to accelerate the in-patient recovery process. We trained our admission clerks on the importance of this, and they booked every patient into a pre-op class at the same time as scheduling their operation. It became the default and not an optional extra.
– Encourage patients to bring a partner, relative, or friend to the class. The session is not only about managing the patient’s expectation but also about educating family and friends. This is crucial, if the friends and family understand the process, they will coach and encourage the patient along the pathway. If they don’t understand, their expectations and anxieties are likely to influence the patient and potentially delay rehab.
– Think about where you hold the session and try and make it easy to get to. We held our sessions at 5:30pm in the evening once per week. Because it was after usual hospital working hours we could use a large seminar room, parking was close and free, and we found that friends and relatives could bring patients after work.
– Choreograph the whole session and don’t let it last longer than one hour. When we designed our session we thought about how we wanted our patients to feel after attending. We decided we wanted them to be upbeat and positive about their operation, with no anxiety, and reassured that they would be treated by a highly professional, friendly, and competent team. This helped us develop the program content and also style of delivery.
– In regard to content we decided to tell patients what would happen, when, and why it would happen in that way. We aimed to de-mystify the whole pathway by showing pictures and video clips of the process from admission to discharge. At every opportunity we promoted the benefits to the patient of early mobilisation and a shorter stay in hospital.
– We included details about every aspect of the pathway all the way from information about the anaesthetic and surgery, to what clothes to bring and when to stop medications. We found that it was often logistical details which patients and relatives were most anxious about, rather than clinical details about surgery.
– We encouraged interaction, questions and discussion. We found that patients enjoy asking questions and often find that one question prompts another. Keep answers general so that they apply to the whole of the group. Other ideas for interaction and participation include trying post-op exercises, getting used to crutches and walking aids, and trying on cryo-cuffs.
– Use the class to train staff. Our class is run by a physio, OT, and nurse but they are not the same individuals every week. Staff members who work on the enhanced recovery ward are expected to take turns in running the class and all new staff members are expected to watch one, do one, and teach one. This is extremely useful for ensuring that the content of the class mirrors what happens on the ward, and the patients enjoy seeing a familiar face when they come in for their operation.
Since the original posting of this blog post we have been asked the following questions – we share the answers with you below.
How many classes do you need to provide?
This will depend on the numbers of patients you operate on (i.e. your supply and demand) as well as practical issues such as the size of the facilities you have to run the course and the number of staff you have available to staff them.
At the unit in Bournemouth that we set up, we operated on 30 patients a week, and so therefore we ran one class a week for 30 patients and 30 relatives. A nurse, physiotherapist and occupational therapist run the class.
What happens if someone cannot attend – do you cancel patients’ surgery?
Patients tend to attend 2 weeks before surgery. If they can’t attend one week, we offer them the week after. If they cannot attend at all, we telephone them individually and send them the information booklet.
What are the costs of running the classes?
There are no direct costs. The room is booked in our hospital education centre and is free, and the staff run the course within their normal operating hours. The relative time lost out of their working day is not a problem. Pre-op education for 30 patients at once saves all of the professional groups time when the patients are admitted. They don’t have to give instructions individually 30 times.
What were the costs of producing materials to support the class?
Our patient booklet was produced in house by members of the multi-disciplinary team. This was done within normal working hours; all team members saw the work as part of their normal jobs. Printing is paid for by the orthopaedic department – the booklet is essential equipment for our pathway and so we pay for it just as we pay for dressings and drugs.
Do you have an anaesthetist at every session? Is it essential to have anaesthetists present at every class?
We don’t have an anaesthetist at the session. However, we do explain anaesthesia and the material and content that we provide at the session has been drawn up and guided by our anaesthetists.
Others have tried to develop interactive centres (Wrightington is one example) where the patients can touch and feel the type of prostheses they will be having. Do you do this?
Yes we do. We have prosthesis for patients to touch and feel, as well as cryocuffs and crutches for patients to try out.
Do you include tours of the wards in the education classes and do patients get the opportunity to meet other patients. This has worked well elsewhere and helped to manage pt expectations.
At Bournemouth the patients do not visit the ward. With the volumes of patient we treat this would not be practical. We do agree that helping patients to picture what it will be like in hospital is helpful, and so we include plenty of pictures in our presentations to help de-mystify the experience. Often the classes will contain patients who are having their second hip replacement, and so we utilise their experiences where appropriate to help explain to patients what the experience will be like.
As always, get in touch if you have experiences that you would like to share or follow up questions to this post.
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