Perioperative shared decision-making in the Bay of Plenty, New Zealand: Audit results from a complex decision pathway quality improvement initiative using a structured communication tool.

Patients presenting for elective surgery in the Bay of Plenty area in New Zealand are increasingly elderly with significant medical comorbidities. For these patients the risk-benefit balance of undergoing surgery can be complex. We recognised the need for a robust shared decision-making pathway within our perioperative medicine service. We describe the setup of a complex decision pathway within our district health board and report on the audit data from our first 49 patients. The complex decision pathway encourages surgeons to identify high-risk patients who will benefit from shared decision-making, manages input from multiple specialists as needed with excellent communication between those specialists, and provides a patient-centred approach to decision-making using a structured communication tool.

Patient recall after diagnostic laparoscopy for abdominal pain.

BACKGROUND: The purpose of the study was to ascertain how well patients recall their discharge diagnosis and details of their surgical procedure after a diagnostic laparoscopy at our institution. METHODS: Three hundred and forty-five patients were identified as being eligible in the study. Patient characteristics and treatment details were recorded. They were then contacted by telephone and 258 patients participated (response rate 75%). They were asked the same seven questions by an investigator who was blinded to their treatment details and their responses recorded. RESULTS: The sample consisted of 248 (96%) women and 10 (4%) men. Only seven persons (3%) were incorrect about the state of their appendix. However, 108 persons (42%) were incorrect about their discharge diagnosis. Seventy-one patients (28%) were unhappy with the information they received while in hospital. Age, whether pathology was found, dissatisfaction or type of operation was not found to significantly influence patient recall of diagnosis. CONCLUSION: We found that patients having a diagnostic laparoscopy at our institution often leave the hospital dissatisfied and with a poor understanding of their discharge diagnosis. This has important implications for future assessments of acute abdominal pain in these patients and can lead to misinformation and unnecessary surgical procedures.