In an article published in the November issue of the Journal of the American College of Surgeons, researchers from the University Health Network in Toronto are trying to learn why more than half of patients referred for a bariatric operation did not ultimately have the procedure.
The researchers from the four hospitals comprising the University Health Network – Toronto Western Hospital, Toronto General Hospital, Princess Margaret Cancer Centre and Toronto Rehabilitation Institute – analyzed data from 1,644 patients. These patients were referred to the university’s bariatric surgery program between June 2008 and July 2011. Only 45 percent became bariatric surgical patients. Of the ones not having surgery, 30 percent didn’t even make it to the patient orientation session, the first step after getting the physician referral.
“The majority of attrition appears to be the result of patient self-removal,” the authors of the article theorized.
These findings seem to reiterate what Karla Tacey, the director of bariatrics at MountainView Regional Hospital in Las Cruces, N.M., has tried to emphasize. She believes connecting and staying engaged with bariatric patients is a must in order to gain positive results.
“It takes so much for a patient to pick up that phone and say I want to have bariatric surgery. It’s scary,” said Tacey, who along with Dr. Frank Felts has seen the MountainView Weight Loss Center grow to nearly 60 patients a month in a little more than two years.
Unlike a routine procedure, like gall bladder surgery, bariatric patients go through several steps. In the University Health Network’s program, patients endure several assessments, including an orientation followed by a nursing consultation, a nutrition class, a dietician assessment and an evaluation by a social worker.
The patient is evaluated by a psychologist and has a final consultation with the surgeon prior to actually undergoing the procedure. During each of these steps, clinical experts evaluate whether the patient is a candidate for the procedure.
There are so many steps in the process, it’s no wonder there is a high attrition rate of patients falling out of the program. Moving these 1,000-plus patients through the multi-stage process is comparable to herding cats. You are not sure where they are going to go and ultimately some will fall through the cracks.
Had the University Health Network used a patient tracking solution, chances are the attrition rate would have been much lower. Perhaps the LeadTracker™, an innovative, web-based tool created by MDnetSolutions, would net more positive results for the hospital network.
With the HIPAA-compliant solution, a doctor can track a patient’s progress from initial intake through every step of the patient cycle. A doctor can track a patient’s progress with a simple click of a mouse, saving time and enhancing the patient/physician experience.
“It is a partnership,” Tacey said. “Bariatric surgery is a long process and you have to stay on top of these patients. If you don’t have a tracker or a method for watching these people, you will lose them.”
University Health Network surgeon Fayez Quereshy, who was lead author of the study, has collaborated with his colleagues and they are currently testing whether a 40-question patient survey should be completed before orientation. The goal is to identify patients who are at risk for not having the operation and then have evaluation experts provide the proper support upfront to help guide the patient through the process.
“If a patient has signs and symptoms of depression for example,” Dr. Quereshy said, “we can make sure he or she sees the psychiatrist first.”
If University Health Network used The Leadtracker™, Dr. Quereshy could track the patient who is seeing the psychiatrist first and see how that patient has progressed. He also can see when a patient has been cleared by a social worker, completed a nutrition class or completed a nursing consultation and is ready for a final consultation with the surgeon.
By doing some handholding, patients feel more secure and are more likely to go through with the surgery. The LeadTracker™ can help an organization maximize its patient relationship management and increase the chances for positive patient outcomes. It also can save a weight loss center or hospital on resources lost due to patients dropping out of the program.”