Presentation Authors: Tara Cohen, Claire S. Burton*, Sarah Francis, A. Lenore Ackerman, Karyn S. Eilber, Jennifer T. Anger, Los Angeles, CA
Introduction: Sacral neuromodulation (SNM), though minimally invasive, involves an initial testing phase that requires active patient participation. These steps are complex and, if a patient does not receive adequate pre-procedure education, can be difficult to conceptualize. Pre-procedure preparedness has been found to impact post-procedure satisfaction and perceived treatment outcomes. The goal of this study was to conduct a needs assessment of patient preparedness, education, device usability and satisfaction regarding all stages of sacral neuromodulation therapy. Using a human factors approach, we conducted a needs analysis to identify opportunities for improvement in the efficiency and quality of care delivery.
Methods: Candidates for SNM (as determined by one of three FPMRS specialists) were recruited to participate before undergoing staged SNM. Ten patients were observed and their experiences were evaluated at four phases: 1) Date of test implant (Stage I); 2) 5 days following the test implant procedure; 3) date of permanent implant (Stage 2); 4) 3 months following the permanent implant procedure. Questionnaires administered to patients throughout this process included a preoperative preparedness questionnaire, a post-operative satisfaction/usability survey (close-ended questions), and a post-operative satisfaction/usability survey (open-ended questions).
Results: With respect to pre-operative preparedness, patients generally did not understand the risks of the planned procedures, did not know what to expect postoperatively, and were not satisfied with preoperative materials. Patients were confused on how to adjust the settings for both the test and permanent implant devices. When asked if they would choose the same treatment again and if they would recommend this treatment to a friend/family member, 30% indicated they would not. Every patient reported that their symptoms were at least â€œa little betterâ€ postoperatively. The overall systems usability scale score of the test device was a 55.6 across all patients (a score of 68 is considered average for usability), while the score for the permanent device was a 50.0; both scores are considered â€œbelow averageâ€ for usability.
Conclusions: This pilot needs analysis demonstrates that there are several opportunities for improvement for patients undergoing sacral neuromodulation. These findings highlight the opportunities for a mutli-faceted intervention, including the development of an informational sheet/video, an in-service training for all PACU nurses, and updated discharge instructions.
Source of Funding: 2017 SUFU Research Foundation grant for the Study of Neuromodulation funded by Medtronic