Surgical Navigators, a New Front for Surgery

As the surgical field progresses to new technological and strategic heights, the role of addressing patient satisfaction is increasingly important for practice development — both in and out of the operating room (OR). Along with clinical efficacy, patient satisfaction is a factor of foremost importance in the field of medical research, particularly in surgery. From a recovery perspective, patients tend to heal better and faster when they are satisfied with the procedure and their treatment throughout the episode. From the coverage standpoint, certain payers are also beginning to reimburse institutions based on patient satisfaction (e.g., Centers for Medicare and Medicare Services). Thus, particularly in complex surgical realms, patient satisfaction is essential.

Recent practice management research has introduced surgical navigators as one potential means of addressing the important issue of patient satisfaction. The concept of surgical navigators is one that can trace its roots from medieval surgery, in which barber-surgeons were guided through rudimentary procedures by assistants at their side.[1] From the olden days of surgery to modern-day highly technologically advanced procedures, navigation is a crucial piece of a surgeon and anesthesiologists’ success in the field. The ability to accurately visualize and locate essential tools can make viable differences in surgical outcomes. However, a modern approach to surgical navigation takes the patient into account alongside the physician. As a counterpart to surgical navigation, an emerging emphasis has begun to shine a light on surgical navigators, people whose single job is to serve the patient undergoing surgery by navigating the relevant healthcare personnel, institutions, and stages in the surgery process.

A recent article from the Journal of Patient Experience highlighted a study from Bellin Hospital that researched the impact of surgical navigators on improving patient satisfaction.[2] In this study, researchers were interested in focusing on how various factors throughout a surgical episode can influence patient satisfaction post-procedure. The participant pool of this study was comprised of outpatient surgical patients, who were randomly assigned to treatment or control groups. The control group was evidently only surgery, with no additional services. Whereas, the treatment group included the actual surgery, with the addition of a surgical navigator. For this study, surgical navigators were pre-medical undergraduate college students who became experts on each step of the surgery, relevant medical team members for each stage, and post-surgery recovery. Each patient in the treatment group was assigned a surgical navigator, who was briefed on that specific patient’s medical scenario as well as on Health Insurance Portability and Accountability Act (HIPAA) procedures. Patients were asked to complete a comprehensive survey at various times throughout the medical episode. After analysis, the researchers found that the presence of a surgical navigator was associated with significant quantitative improvements in patient satisfaction rates at the hospital. In line with this result, it is important to note that the surgical navigator did not lead any specific medical intervention for the treatment group patients. Rather, the surgical navigator enhanced communication between the physicians (surgeon, anesthesiologist, and affiliated primary care doctor) and the patient, leading to higher satisfaction ratings overall.

While in this specific example students served as surgical navigators, the classification is not restricted to non-medical personnel. In fact, registered nurses (RNs) can play a very powerful role in presenting information and clinical pathways to the patient. It is important to note that when nurses act in the surgical navigator role, they are often titled as “clinical navigators” so as not to confuse with nurses that literally assist a surgeon or anesthesiologist during the surgery.[3] Regardless, nurses as clinical navigators is a more novel concept that dates to the early 20th century. Because nurses have the direct professional experience with the surgeons and anesthesiologists, they can better inform the patient on what the actual surgical experience will entail. Moreover, some very specialized nurses, such as Certified Registered Nurse Anesthetists (CRNAs), are highly knowledgeable on specific aspects of the procedure that patients are often concerned about, such as general anesthesia.

In conclusion, as hospitals move towards a patient-centric and holistic approach to care, surgical navigators represent a possible avenue towards increasing patient satisfaction and medical continuity throughout a surgical episode. Further research on this topic may aim to explore the most effective forms of information delivery, specific models for interaction between navigators and anesthesiologists or surgeons, and potential mechanisms to ensure that the patient is well-informed and at ease as he or she commences the surgical journey.

[1] https://www.ncbi.nlm.nih.gov/pubmed/16921809

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513665/

[3] http://www.oncologynurseadvisor.com/oncology-nursing/patient-navigator-a-role-for-nurses-that-goes-beyond-clinical-care/article/288490/

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