1st Place Winner: Maximillian Selbst – C. Frank Webber Prize Competition

ABSTRACT

Improving the Pediatric Peri-procedural Experience: What the Family Wants Us To Know 

MAXIMILIAN SELBST

McGovern Medical School at UTHealth

Class of 2015

Sponsored by:	Akemi Kawaguchi, M.D., M.S., Department of Pediatric Surgery
Supported by:	Akemi Kawaguchi, M.D., M.S., Department of Pediatric Surgery
Key Words:	Peri-procedural, Descriptive Analysis, Patient Experience

 

Authors: Maximilian A Selbst, BS, Nutan B Hebballi, BDS, MPH, Claire Egan RN, Kuojen Tsao MD, Amy D Graham-Carlson MD, Akemi L Kawaguchi MD, MS

Purpose: Engaging parents and families can help improve their healthcare experience and patient safety.  Our Peri-procedural Parent Advisory Council (PPAC) recommended that parents/guardians provide personalized input that could improve the peri-procedural experience for their children.  We describe a program with a written pre-procedural tool that allows healthcare providers to utilize pre-procedural parent input.

Methods: A multidisciplinary team of parents, surgery, anesthesia, child life, and nursing designed a written form for parents to address previous anesthetic experience, nicknames, feelings about the procedure, things to ask about, things to do, and things to avoid.  A retrospective review of these pre-procedural forms (in English & Spanish) completed by parents/guardians of pediatric patients (<18 years) was conducted between April 2021-July 2022 at a tertiary children’s hospital. Two team members independently coded the responses for the six open-ended statements and thematic and descriptive analyses were performed.

Results: For the 1005 forms, the average age was 6.9 ± 6.5 years with 55% male patients, and 89% were completed in English. Parents/guardians reported that 26% of the patients preferred a nickname, while 48% reported that their child was scared/anxious and 24% were happy about the upcoming procedure.  A total of 54% of patients had previous anesthesia experience, which made him/her feel tired (59%), confused (29%), scared (19%), angry (16%), nauseated (16%), other (14%), silly (13%), sad (10%), and happy (8%). Themes included patient emotions, distraction/comforting techniques, things that scare/aggravate the patient, behavioral details, pain management, and additional medical and non-medical information. (Table 1)

Conclusion:  Parents/guardians can provide useful, personalized patient information that is not available in the medical record, but can help healthcare providers deliver both safer care and a better patient experience.  Parental/guardian insight into their child is valuable and should be included in patient care.

Table 1.  Statement “It may help you to know:” (n=582 responses)  Thematic Analysis

Theme	n	%	Example
Additional medical information	208	36	“She has probable Ehlers Danlos. Some anesthetics (especially local) don’t work as well. Excessive use of seizure meds can cause suicidal ideations. Be careful with bright lights and loud noises – cause seizures.”
Things that comfort the patient	191	33	“Just let her know Mommy and daddy are outside waiting to see her soon as possible. She loves Encanto, favorite characters Mirabel and Isabela. Music possible? She pretends to create flowers out of thin air.”
Behavioral information	164	28	“If she starts to get angry, just give her a minute to calm down, without touching her. She will head bang if she gets angry.”
Pain information	111	19	“She will let you know how she is feeling if she is uncomfortable, in pain, please listen to her, look at her facial expressions and sound of her cry, sometimes it will be a cry or a moan. She is nonverbal and need us all to advocate for her.”
Things that scare/aggravate the patient	90	15	“He does not deal well away from us upon awakening.”
Additional non-medical information	47	8	“2 Dads, fussy when hungry.”