Healthcare professionals' perspectives on transferring ...

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Royal Brompton and Harefield. NHS Foundation Trust. Across the UK, patients are commonly wheeled in a bed to theatre. There are some units that permit ...
Healthcare professionals’ perspectives on transferring patients to theatre at a tertiary centre for thoracic cancer surgery – The Walk or Wheeled (WoW) Project Paulo De Sousa, Monica Tavares Barbosa, Soraia Carvalho, Joao Moura, Hemangi Chavan, Arnold Susmiran, Thamara Kazantzis, Maria Elena Cufari, Eric Lim

Royal Brompton and Harefield NHS Foundation Trust

Royal Brompton and Harefield NHS Foundation Trust, London, UK Introduction Across the UK, patients are commonly wheeled in a bed to theatre. There are some units that permit selected patients to walk to theatre, especially day-surgery units. With advances in surgical techniques (as keyhole or robotic surgery), the introduction of day case cancer surgery and shorter stays in general, leads to the need to change patient perception in the gravity of the cancer surgery experience. Previously reported patient surveys have suggested that the majority of patients would be willing to walk to theatre¹. However little is known on healthcare professional’s willingness to support a new patient centred experience and their views regarding a change of paradigm, allowing patients to be on the decision front seat and if that change will have impact on their workload. Previous studies have shown this has a positive impact in patients’ perception of their care². The aim of this study is to survey healthcare professionals’ perspectives regarding methods of transfer for patients undergoing thoracic surgery.

Discussion Our survey was conducted to ascertain healthcare professionals’ willingness and support in changing current practice. It is well known that healthcare professionals are resistant to change as attested in the literature. However, our data suggests that, in our institution, there will be support for change. Shared decision making is paramount at all times and giving patients choices and options will make them feel more supported and empowered. At the same time, healthcare professionals will be able to better tailor care to the needs of the individual. As technology advances and specialisation progresses, interprofessional working has become the norm and responsibility has to be shared with patients. Decisions about all aspects of treatment and care should be taken in partnership. It will be important to pursue more research in this field, especially trying to perceive how important these changes are for patients, their views regarding preferences and their perception of improvement in patient care.

Table 1 - Demographic characteristics of the cohort and experience Mean age (SD) Male, n (%)

(n=69) 35 (9) 21 (32)

Table 2 – Cohort background and experience Background, n (%) HCA Nurse Doctor

7 (10.5) 53 (79) 7 (10.5)

Median experience at NHS (IQR) Median experience at RBH (IQR)

6 (3-12) 3 (1-7)

Table 3 – Survey results for selected questions Question, n (%)

Disagree Strongly

Disagree Slightly

Neutral

Agree Slightly

Agree Strongly

Methods We conducted a cross sectional survey of healthcare professionals (medical, nursing and healthcare assistants staff) using 24 questions on current practice, perceptions of offering patient choice on mode of transportation and impact on current workload. A 1-5 point Likert scale was used. Results are summarised in frequency (%) and medians (IQR) and comparisons of the categories were undertaken using Fisher’s exact test.

Patients should be offered options on how they would like to be transferred to theatre

4 (6)

4 (6)

8 (12)

13 (19)

39 (57)

Healthcare professionals should always be the ones deciding patients method of transfer

9 (13)

21 (31)

15 (22)

12 (18)

11 (16)

Patients should always be the ones deciding on their preferred method of transfer

14 (21)

19 (28)

12 (17)

14 (21)

9 (13)

I am comfortable with the way patients are currently transferred to theatre

3 (4)

2 (3)

15 (22)

27 (40)

21 (31)

Changing the way we currently transfer patients to theatre will be positive for them

4 (6)

7 (10)

23 (34)

19 (28)

15 (22)

21 (32)

15 (23)

20 (30)

7 (11)

3 (4)

Patients benefit from being wheeled in a bed to theatre

3 (5)

10 (15)

32 (48)

10 (15)

11(17)

Patients benefit from walking to theatre

6 (9)

8 (12)

27 (40)

19 (28)

7 (11)

Being wheeled in a bed has a positive impact on patients’ anxiety

4 (6)

12 (18)

30 (45)

14 (21)

7 (10)

Walking to theatre has a positive impact on patients’ anxiety

9 (13)

11 (16)

26 (39)

14 (21)

7 (11)

Results Of 141 questionnaires distributed, 69 were returned (response rate 49%). 53 respondents were nurses (79%), 7 doctors (11%) and 7 healthcare assistants (10%), with a median of 6 (3-12) years’ experience in the NHS. The majority of respondents (71%) strongly or slightly agreed that they feel comfortable with the current transfer method (wheeling patients in a bed). At the same time, 39 (57%) respondents strongly agreed and 13 (19%) agreed that patients should be offered options on transfer to theatre, with no differences between doctors, nurses and healthcare assistants (P=0.82). 21 (32%) respondents strongly disagreed and 15 (23%) slightly disagreed that a change in practice will be considered as a burden, with no difference between different professional roles (P=0.51).

In terms of comfort, being wheeled in a bed to theatre is the best for patients

3 (4)

13 (20)

16 (24)

19 (29)

15 (23)

In terms of comfort, walking to theatre is the best for patients

11 (16)

14 (21)

25 (37)

14 (21)

3 (5)

Being wheeled in a bed to theatre improves the communication between patients and healthcare professionals

14 (21)

9 (13)

27 (41)

9 (13)

8 (12)

Walking to theatre improves the communication between patients and healthcare professionals

10 (15)

6 (9)

31 (46)

12 (18)

8 (12)

If I was a patient going for surgery, I would like to be wheeled in a bed to theatre

14 (21)

8 (12)

9 (13)

12 (18)

24 (36)

If I was a patient going for surgery, I would like to walk to theatre

13 (19)

9 (14)

18 (27)

12 (18)

15 (22)

If our current practice changes, I will consider it to be a burden

Conclusions The results of our survey suggest that healthcare professionals are comfortable with the current transfer method of wheeling patients in bed to theatre, but are uniformly supportive of patients being offered options (walking) and do not consider change in practice as a burden. References 1. Nagraj S, Clark CI, Talbot J, Walker S (2006). Which patients would like to walk to theatre?. Ann R Coll Surg Engl; 88: 172–173. 2. Turnbull LA, Wood N, Kester G (1998). Controlled trial of the subjective patient benefits of accompanied walking to the operating theatre. Int. J. Clin. Pract. 52 (2); 81-3