Implementing stroke Edication

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Clinical Application Project: The use of a digital patient portal to improve patient experience in the ambulatory surgery setting

Susie Chapstick

NUR 4510: Professional Role Transition

Dr. Mary Poppins

December 1, 2023

The use of a digital patient portal to improve patient experience in the ambulatory surgery setting

The ambulatory surgery setting is a fast-paced, busy environment. The introduction of a patient portal has promising use in off-setting some of the stresses of the environment for both patients and healthcare providers. The use of a patient portal can streamline intake by allowing patients to answer questionnaires ahead of time, allowing them time to search for important information, such as recent test results or to look up their list of medications. It can minimize over-the-phone translation and interpretation errors. It can also allow patients to upload documents such as identification and insurance cards, thereby saving time on the administrative end. Studies have found that eHealth applications like patient portals can save valuable time for the ambulatory nurse, the surgeon, and the patient and thereby provide an overall better surgical experience for the patient (De Regge et al., 2022).

St Beverly Hospital’s ambulatory outpatient surgery unit is in the process of switching electronic medical record systems, which will include the uptake of a digital patient portal (DPP). The current state of the surgical unit is riddled with a slow, cumbersome electronic records system that takes away valuable time from patient care. This change is needed in order to keep up with current demand for an improved system that is more compatible with the ambulatory surgery setting and that is faster to manage on a day-to-day basis. With the support of the unit manager, Michael Jackson, and the rest of the staff to implement the proposed interventions, this clinical application project will attempt to gather information on attitudes regarding the uptake of this new technology with admitted surgical patients on the unit. A written questionnaire (in English or in Spanish) will be administered to willing participants and results will be analyzed to better predict whether or not the uptake of the new patient portal will be successful, and what factors can be addressed to make it more attractive. Furthermore, staff will be trained on the new patient portal and how to educate patients about its uses and benefits.

These interventions will specifically benefit the unit by helping to streamline the adoption of the patient portal. By reviewing the questionnaire, the staff can better understand how many patients are familiar with a digital portal in the first place and how many people are willing to use it as a communication tool. Then, efforts can be made to overcome barriers in this area through the use of promotional materials that will foster the uptake of the patient portal.

Literature Review: Topic/Issue

As technology becomes increasingly integrated into healthcare systems, patient portals are becoming ubiquitous in hospital settings. A patient portal can be described as “an electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment” (Van den Bulck et al., 2018, p. 3). Van den Bulck et al. (2018) found that “patients’ interest and ability to use a patient portal are influenced by age, health literacy, and level of education” (p. 3) and that “patients are more likely to adopt a patient portal if its features align with their information needs and with the functionalities they require” (p. 3). Similarly, Fatehi et al. (2020) found that patient portal registration was greater for English-speakers and younger patients, thereby confirming the importance of socioeconomic factors in considering the issue of how to design and promote the uptake of a patient portal.

Literature Review: Solution/Intervention

De Regge et al. (2022) use a mixed method research design to assess digital patient portal use in an ambulatory surgical care unit in terms of usability, applicability, and user-friendliness for both the patient and healthcare worker. They found that participation in the DPP allowed patients to fill out questionnaires and become educated in the surgical process, which significantly shortened the time needed to be spent with the ambulatory nurse and provided an overall better surgical experience for the patient. Ultimately, they found that interventions at the

beginning of the project like physician and nurse motivation to use the portal were of utmost importance to its successful uptake. In other words, “management support and the availability of time and resources are considered of great importance in successfully implementing a digital patient platform in ambulatory surgery” (De Regge et al., 2022, p. 697).

Hulter et al. (2020) conducted interviews to answer the ultimate question: “how can hospitals encourage patients and HCPs to adopt a patient portal?” (p. 1). They found that informing patients about the portal is the first step, which includes knowing what it is, what it does, and how it works. The next step is integrating the portal into the daily routine of HCPs and management. And, thirdly, adjusting the patient portal to optimize user-friendliness by gathering patient feedback and focusing on patients with special needs (low literacy and low digital skills).

Implementation/Intervention

The proposed intervention is a multi-pronged approach that precedes and accompanies the rolling out of the DPP that is to occur early next year at St. Beverly Hospital’s Ambulatory Surgery Unit. The first step is for myself to begin to survey patients with the proposed questionnaire[footnoteRef:1] to gain an understanding of perceptions regarding technology, communication, and the sharing of medical information. The next step is to educate the staff regarding the questionnaire so that they can continue the process of surveying patients. Then, prior to the roll out of the DPP, the staff will be educated on the portal, including its benefits and uses and how to promote it on the front end, during the appointment setting and registration process. As garnered from the literature review, “provider endorsement is one of the most influential factors of impacting patients’ adoption” (De Regge et al., 2022, p. 697). It is important for St. Beverly’s [1: See Appendix A & B]

staff to promote the use of the portal as an effective and efficient way to share pre and post-operative information securely and in a timely manner.

More specifically, a step-by-step process is as follows:

1) Patient is scheduled for elective surgery at St. Beverly Hospital,

2) The ambulatory nurse completes the questionnaire in person while the patient is being prepared for surgery,

3) If the patient does not speak English but speaks Spanish, a questionnaire in Spanish will be provided instead,

4) The questionnaire will be collected and responses added to a master list for analyzation purposes,

5) The questionnaires will be given at the end of each day and kept confidentially with Michael Jackson, surgical services unit manager, to be reviewed and evaluated.

The specific timeline for implementation is to conduct the survey from November 2022 through the end of March 2023. At that stage, it is important to gather the data and analyze how many people are familiar with a patient portal, how patients like to communicate regarding their health information, whether or not patients would be willing to complete their health history online, and how patients prefer to have their discharge instructions distributed to them. If there is minimal familiarity with and willingness to engage with a patient portal, the work to promote the patient portal roll out will be greater. It will alert St. Beverly staff that more needs to be done on the front end to promote the benefits of a patient portal for better patient experience in the ambulatory surgery setting. During April 2023, the results of the survey can guide the development of promotional marketing materials for the DPP, which will roll out on May 1st.

Future follow-up and evaluation can be done once the portal is up and running with a new survey to see if patients find it to be user-friendly, beneficial, and overall a good support for their

healthcare needs. Specifically with respect to postoperative care, the portal can serve as a good communication platform between patients and providers to address any concerns and possible complications. Ultimately, the DPP can serve as an ideal communication tool for improving and streamlining the ambulatory surgery experience, from the entire process of scheduling through discharge and including postoperative care.

References

De Regge, M., Van Caelenberg, E., Van Belle, N., Eeckloo, K., & Coppens, M. (2022). Encouraging digital patient portal use in ambulatory surgery : a mixed method research of patients and health care professionals experiences and perceptions. Journal of Perianesthesia Nursing. https://doi.org/10.1016/j.jopan.2021.11.019 .

Fatehi, A. , Gonzalez, A. , Ring, D. & Queralt, M. (2020). Psychosocial factors are associated with electronic portal registration. Clinical Orthopaedics and Related Research, 478 (9), 2079-2084. https://doi.org/10.1097/CORR.0000000000001278 .

Hulter, P., Pluut, B., Leenen-Brinkhuis, C., de Mul, M., Ahaus, K., & Weggelaar-Jansen, A. M. (2020). Adopting patient portals in hospitals: Qualitative study. Journal of medical Internet research, 22(5), e16921. https://doi.org/10.2196/16921

Van den Bulck, S. A., Hermens, R., Slegers, K., Vandenberghe, B., Goderis, G., & Vankrunkelsven, P. (2018). Designing a patient portal for patient-centered care: Cross-sectional survey. Journal of medical Internet research, 20(10), e269. https://doi.org/10.2196/jmir.9497

Appendix A: CAP Questionnaire (English)

Have you ever used a digital patient portal? ___________

How do you like to communicate regarding your medical care?

Over the Phone ___________

Via Text Message ___________

In the Mail / In Writing ___________

Via Email __________

Online/Using a Digital Patient Portal _________

If you had the opportunity to fill out a health history questionnaire online before you came here, would you? ___________

Why or why not? _______________________________________________________________

Would you like to have your discharge instructions:

▢ Printed

▢ Emailed

▢ Texted

▢ Sent to a patient portal (access anytime)

Appendix B: CAP Questionnaire (Spanish)

¿Ha utilizado alguna vez un portal digital para pacientes? ___________

Por favor, clasifique del 1 al 4 cómo le gusta comunicarse con respecto a su información médica, 1 es la mejor manera y 4 de la manera que prefiere menos.

Por teléfono ________

Por mensaje de texto ________

Por correo/por escrito ________

Por correo electrónico/un portal digital para pacientes _________

Si tuviera la oportunidad de completar un cuestionario de historial de salud en línea antes de venir aquí, ¿lo haría? __________

¿Por qué sí o por qué no?

______________________________________________________________________

Le gustaría recibir sus instrucciones de alta:

▢ En versión impresa

▢ Enviado por correo electrónico

▢ Enviado por mensaje de texto

▢ Enviado a un portal para pacientes donde puede acceder a ellos en cualquier momento