August 18, 2016

More patients are awake during surgeries—and it's affecting how surgeons communicate

Daily Briefing

A growing number of patients are using local anesthesia and staying awake during surgeries, and the practice is changing the care team's behavior in the OR, according to a study published in the American Journal of Surgery.

Researchers interviewed 23 surgeons about their experiences operating on awake patients across a range of procedures, including abortion and cataract surgeries. The surgeons reported that although using local anesthesia could be safer for the patient, it presented new issues for members of the care team, who must communicate with each other while being mindful of the patient.

Senior author Alexander Langerman told Reuters that some surgeons reported using code words to communicate while operating on awake patients, such as for when they made mistakes.

Surgeons also tended to limit trainees' involvement during the procedures, Langerman added, because patients were uncomfortable having students operate on them. But that limitation could negatively affect the student's learning process, Langerman said.

Still, surgeons reported several benefits of awake surgeries, including that the surgeries could be more efficient and that patients could help with check-ins during the procedure.

Patient communication

Many patients are anxious during an awake surgery, Lashmi Venkatraghavan, a professor at the University of Toronto who was not involved in the study, told Reuters. "All the negative events will be remembered forever by the patients, and it does have a long-lasting psychological effect," he said.

Can doctors learn to communicate with patients?

To ease patient anxiety, some surveyed surgeons played music, offered patients sedatives to help them relax, or limited the number of people in the OR. Venkatraghavan also recommended communicating with patients before and during the procedure about what to expect and what the surgeon is doing (Minemyer, FierceHealthcare, 8/16; Kennedy, Reuters, 8/12).

5 myths physicians believe about patient experience

5 myths physicians believe about patient experience

Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.

Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they're all driven by the physician as the "Influencer in Chief."

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