Introduction
The patient pathway at a hospital unit is associated with multiple interactions with the healthcare team and experiences of an array of procedures, the competent and evidence-based characteristics of which predetermine the positive outcomes of the experience. Evidence basis is the pivotal element in the provision of any type of healthcare interventions since it allows for applying the latest and most effective findings for the patient’s soonest recovery. Indeed, the application of evidence-based practice in a hospital unit is essential at all levels, including admission, examination, nurse-patient interaction, care plan development, treatment, and recovery.
The most effective way to analyze how this principle works is by the direct observation of the professional’s work. In particular, the present reflective essay will provide a description of an observed case of a day surgery patient pathway. The reflection will be delivered following the model introduced by Driscoll (2007), who suggested three elements of a structural reflective narration. The elements include the description of the experience (what), its analysis (so what), and reflection with the implications for future practice (now what). Thus, the paper is aimed to describe, analyze, and reflect the day surgery patient pathway through the perspective of the importance of evidence-based practice.
What?
The observed case of the patient with acute appendicitis at a day surgery unit allowed for identifying how the perioperative team members interacted with each other and the patient to provide competent care. The patient transferred to the day surgery ward from an emergency department was a 21-year old female who had been suffering from acute abdominal pain for two days before admission to the emergency department. The patient complained about severe pain in the lower right quadrant of the abdomen that intensified with bodily movements. She reported high bodily temperature and several incidents of vomiting that urged her to call the ambulance.
The patient had not had any surgical interventions before; her health history did not show any chronic illnesses. The necessary symptomatic and health history information was collected during the nurse pre-assessment procedure. Given the severity of pain and a two-day period of the illness, the patient was subject to clinical diagnoses procedures immediately to minimize the risks of perforation. Indeed, according to Di Saverio et al. (2020), “the rate of perforation varies from 16% to 40%, with a higher frequency occurring in younger age groups” (p. 2). Since the admitted patient belonged to a younger age group, the likelihood of perforation was high.
The clinical diagnosis was based on the physical examination and clinical presentation. Commonly it is a challenging process that involves “a synthesis of clinical, laboratory, and radiological findings” (Di Saverio et al., 2020, p. 2). According to the evidence-based procedures available for scoring the indicators of acute appendicitis, the new Adult Appendicitis Score was applied. A team brief was initiated with all the members of the perioperative team present and fully included in the meeting. The case of acute appendicitis was not excluded, which in combination with the clinical diagnosis findings, served as the trigger for the perioperative team to admit the patient to an immediate operative intrusion to eliminate the risk of perforation and infection.
The patient was in much pain and wanted the treatment to be administered as soon as possible. However, once the surgery was appointed in an immediate manner, the patient demonstrated a significant level of anxiety, disturbance, and fear. The nurse provided the patient with the information on the procedure, its necessity, and its benefits by eliminating the risks of perforation. The nurse followed the rules of therapeutic communication and expressed support, empathy, and readiness to help. The informed consent was obtained from the patient; once the female was prepared for the operation, she was located in the operating room.
The perioperative team worked collaboratively, following the WHO surgical safety checklist and care plan guidelines. In the operation room, all necessary precautions and checks were made to eliminate the risks of wrongful decisions that might have endangered the patients’ health and life safety. Three-port laparoscopic appendectomy was chosen based on the latest evidence on the effectiveness of the procedure and better results in post-operative recovery in comparison with open appendectomy. All the data about the patient’s diagnosis were available to all the team members through the electronic patient record, which helped align the actions of all the involved parties.
Once the surgery was completed, the patient was transferred to the post-operative care unit for recovery. A consecutive care plan and administrated post-operative antibiotic treatment was prescribed. All necessary check-ups during the post-surgery period were accurately managed. Quality assurance procedures were undertaken according to the protocol; the patient remained satisfied with the procedure.
So What?
The described observation of the patient pathway allows for analyzing the implementation of evidence-based practices in the work of the perioperative team. To focus the analysis on one aspect of the patient’s journey, one will concentrate the discussion on the implementation of safety checks as informed by evidence. The World Health Organization’s (WHO) developed surgical safety checklist is reported to be one of the most effective tools for ensuring perioperative safety and reduced patient morbidity, mortality, and complications after surgery.
Indeed, according to the evidential data, the application of the WHO surgical safety checklist significantly reduces wound disruptions, surgical site infections, and sepsis in comparison with operations without the regular implementation of the WHO safety guidelines (Chhabra et al., 2019). Indeed, as it was observed, the utilization of a safety checklist allowed for unified actions of all the perioperative team members and the elimination of the risks of conditions that might be easily avoided when evidence-based interventions are applied in a timely manner.
Safe surgery as a priority of evidence-based healthcare was ensured by the team’s accurate investigation of the case, interdisciplinary diagnoses, and validation of the benefits of surgery over the risks of appendix perforation. Pre-operative preparations were implemented according to the day surgery guidelines to ensure patient’s safety. In particular, necessary communicative devices were used “to educate the patient and carers regarding day surgery pathways” (Bailey et al., 2019, p. 781).
The information about the planned procedures and post-surgical care was delivered to the patient in a timely and comprehensive manner so that the patient was able to make informed decisions. All required efforts were made to “identify medical risk factors, promote health, and optimize the patient’s condition” (Bailey et al., 2019, p. 781). The application of these precaution procedures is informed by evidence and helps to improve patient-healthcare worker interaction for better health outcomes and safer interventions.
When in the operative room, all the participants of the procedure followed the sign in, time out, and sign out guidelines of the WHO checklist. It was done to ensure that the patient’s identity is correctly documented, the anesthesia is properly administered, and that all the instrumental or procedural issues are properly addressed and documented. These steps were accurately taken by the professionals in accordance with the evidence-based practices recommended by the WHO, which demonstrates how evidence underpins the practices of the perioperative department (Chhabra et al., 2019). The surgeon, nurse, and anesthesia professional worked in a coordinated manner, which facilitated the positive outcomes and the overall success of the conducted laparoscopic appendectomy.
Evidence-based practice allows for effective and patient-centered timely risk assessment using the latest findings as guidelines for informed decision-making. Therefore, evidence-based practice plays a major role in modern health care delivery by leading the development of quality-assured interventions in clinical settings. The procedures initiated in the perioperative unit must be supported by a substantial amount of information that demonstrates the benefits of the outcomes over other alternative procedures. For the appropriate implementation of evidence-based practice, all stakeholders should be involved in research and professional development.
In particular, an operating department practitioner (ODP) is directly involved in the surgical procedures, patient care, and treatment decision-making. Therefore, it is vital for ODP to be appropriately informed and knowledgeable about the most effective research-proven procedures and tools that are capable of ensuring safe surgery and patient benefits.
Now What?
The observed patient pathway in a day surgery unit allows for retrieving multiple implications for future practice, as well as helps to determine the importance of evidence-based practice in the work of a health care worker in general and ODP in particular. The patient’s pathway elements are now clear and are perceived as logical steps for accurate decision-making and professionals’ actions depending on the case.
This experience was a valuable opportunity to observe the work of the perioperative team and identify the relevance and omnipresence of evidence-based practice in the day surgery unit. In particular, the utilization of evidence-informed safety checklists was identified as a vital tool capable of minimizing wound disruption and infection during the recovery stage. This experience helped to actualize the theoretical knowledge about evidence-based healthcare by practice observation. It will be a useful basis for future healthcare work that prioritizes effectiveness and safety in patient-related decision-making.
Conclusion
In summation, the present reflection essay introduced the observation of the patient pathway from admission to the emergency department unit to the perioperative ward of day surgery. The analyzed decision-making of the members of the team demonstrate great precision and strict following of the guidelines and choosing the interventions informed by clinical and scientific findings. In particular, the utilization of the WHO safe surgery checklist was a regularly implemented procedure in the perioperative setting, which helped the professionals address all important procedures and issues before, during, and after the actual surgery.
Evidence shows that the application of the WHO safety checklist ensures a significantly lower percentage of wound infections, disruptions, and overall harms to patients’ health and life. Therefore, the observed procedures are a valuable contribution to the knowledge and skills of the observer. The understanding of the vital importance of evidence-based practice in the contemporary healthcare delivery has been reinforced; continuous professional development and active participation in research has been encouraged.
References
Bailey, C. R., Ahuja, M., Bartholomew, K., Bew, S., Forbes, L., Lipp, A., Montgomery, J., Russon, K., Potparic, O., & Stocker, M. (2019). Guidelines for day‐case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia, 74(6), 778–792.
Chhabra, A., Singh, A., Kuka, P. S., Kaur, H., Kuka, A. S., & Chahal, H. (2019). Role of perioperative surgical safety checklist in reducing morbidity and mortality among patients: An observational study. Nigerian Journal of Surgery: Official Publication of the Nigerian Surgical Research Society, 25(2), 192–197.
Di Saverio, S., Podda, M., De Simone, B., Ceresoli, M., Augustin, G., Gori, A., Boermeester, M., Martelli, M., Coccolini, F., Tarascon, A., de’ Angelis, N., Weber, D. G., Tolonen, M., Birindelli, A., Biffl, W., Moore, E. E., Kelly, M., Soreide, K., Kashuk, J., … & Catena, F. (2020). Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery, 15, 1–42.
Driscoll, J. (2007). Practising clinical supervision: A reflective approach for healthcare professionals (2nd ed.). Baillière Tindall/Elsevier.