SMS update to NOK provides timely information, helps allay their fears, and reduces disruption to MOT staff.   

It is normal to feel anxious about surgery, not only for patients but also their next-of-kin (NOK).

“The surgeon told me my father’s operation would take about 2 hours. It’s been more than 4 hours now and I haven’t heard a single thing about it. I can’t help but worry that something has gone wrong.” Sounds familiar?

Frustrated NOKs, frustrated staff

Because NOKs get frustrated when they don’t have information on what is happening, it increases the number of interruptions to reception staff at the SGH Major Operating Theatres (MOT). MOT Principal Enrolled Nurse Anny Teo explained that “many NOKs would come through the entrance and ask for a status update of their loved one throughout our shift.”

NOKs enquiring about their loved ones at the MOT reception.

“While we empathize with the immense stress they must feel while waiting for their loved ones, frequent enquiries can be disruptive to our staff’s work,” said Nurse Clinician Peng Jiping. When NOKs enquire about the status of patients, further calls have to be made to the operating theatres or recovery area. 

Leading a QI project to resolve this issue, Jiping and team spent several sessions mapping out the surgical flow process, from patient registration at Same Day Admissions Centre to arrival at the ward, and identified several gaps in the process. For example, the estimated time given to NOKs usually does not include the post-op recovery phase. This leaves them anxious as the actual waiting time would exceed the time they were briefed on.  

Also, NOKs are usually notified late after patients arrive back at the ward, leaving them needlessly waiting outside the MOT. 

Something has to change

“We couldn’t keep doing the same things day in and day out, and not address the concerns of our patients’ and their loved ones. We needed a comprehensive solution to address NOKs’ worries and at the same time help our staff focus on their daily duties”, said MOT Senior Nurse Manager Koh Seok Tiang.

Nurses from different stages of the perioperative process brainstorm using design thinking.

Many ideas were conceived during the brainstorming session.

At first, the team considered the idea of automated SMSes to update the NOKs at every stage of the surgery process, but this proved to be too resource-intensive as it would require the tagging of patients wirelessly to the operating theatre’s IT interface, said QI coach Loo Shin Yi, Assistant Manager, Process Transformation & Improvement (PTI). “What we needed were rapid but effective fixes to the gaps in the entire process while meeting the need for clear and timely communication.”

In the process of crafting solutions, it was imperative to the team that they engaged the patients and their families for their feedback. “We went down to the ground and spoke with more than 20 families to understand their concerns more intimately. Sure, it took time, but we needed to get their insights before reengineering the processes,” said PTI executive Lin Zehang. From these conversations, the team realized that most NOKs wanted to know when the patient had completed surgery, and whether it was successful.

Clear and effective communication

Patients and their families would typically begin the surgical flow at the Same Day Admissions Centre or the wards, where nurses will brief them on the perioperative process. “In the new approach, we help them manage their expectations of the duration by clearly communicating the different steps involved, including recovery time. We also let them know that an SMS would be sent to them upon the completion of the patient’s surgery”, said Nurse Clinician Irene Goh, Same Day Admissions Centre.

The SMSes are the responsibility of the nurses monitoring patients’ post-operative condition. Rather than call the NOKs, which could be time-consuming and took valuable attention away from the patient’s care, the team used an SMS platform to simplify the communication process. Each SMS sent informed the NOK that the patient had completed the surgery and was undergoing recovery. The SMS also gave NOKs the expected waiting time before they could see the patient.

Feedback from NOKs has been overwhelmingly positive. They found the information about their loved ones timely and reassuring.

Ms Goh Meh Meh, Deputy Director of Nursing, MOT, concluded: “While much of our work is concerned with improving the clinical care of our patients, we mustn’t forget about the service aspects too. By conducting an in-depth analysis of the situation and engaging our most important stakeholders, who are our patients and their families, we can put in place the most effective solutions to improve our services.” 

This is a Quality Improvement article contributed by Lin Zehang, Executive, Dept of Process Transformation and Improvement. To learn how to use QI tools to solve problems at work, you can reach out to the PTI team at QI Marketplace on Workplace. 

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