The Anatomy of the Waiting Room – Part jungle, Part jail cell

October, 2016

“Treadmills. Microwave ovens. And hospital waiting rooms. Time, it seems, appears to stand still in each of these places. Yet an abbreviated power walk or a cold Lean Cuisine pale in comparison to a loved one in an operating suite.” So wrote Sonja Mitrevska-Schwartzbach, BSN, RN, CCRN, a surgical ICU nurse describing her waiting room experience while her mother underwent surgery ^(1.) She continued, “The anatomy of a surgical waiting room is a complex and complicated one. Form doesn’t necessarily meet function. Although loved ones are made to feel welcomed and “at home,” everyone feels like an uninvited guest in an unfamiliar residence. Whether it’s a labor and delivery unit or an outpatient surgical center or a bustling hospital waiting suite, knowing that a family member is under the knife is a nerve-wracking experience. The element of the unknown prevails, and those soothing words from a nurse before your family enters his or her operation dissolve into clips and phrases that can’t seem to be retrieved or recalled any longer. The anatomy of a waiting room is an evolved one. Each one of us experiences a unique evolution from hope and expectation to desperate anxiety to internal anguish and then, a release. A sigh of relief. A stream tears. A burst of anger. A glimmer of hope. Each one of us is unique in our own growth during those hours in a waiting room: we progress as we process the news, good and bad, anticipated and unexpected. Part jungle. Part jail cell. Where awkward smiles cut through silence with surgical precision. A waiting room, foul and filthy; faith and family; cold and sterile like the operating suite. The hospital waiting room: where time remains suspended, and we dangle along with it.”

The challenge is to find ways to get reliable, accurate and real-time information from the operating room to families and friends in the waiting area. Institutions have attempted to address this need in numerous ways with variable results. “Uncertain waits seem longer than finite waits and anxiety makes waits seem longer” ⁽²⁾.

Baylor University studied the effectiveness of a Family Care Card provided to family members in the waiting room ⁽³⁾. The card contained contact phone numbers as well as estimated times for numerous surgeries and procedures. Although a survey of family members who participated found that the card was easy to read and accurate, only 50% agreed that it reduced their anxiety.

Surgical waiting rooms are often staffed by members of the hospital’s guest services department and they may also utilize the aid of volunteers to help families during the waiting period. In order to obtain information from the operating room, the staff need to contact the main desk or the operating room directly. This can be disruptive in a busy surgical suite and the information gained may be second-hand and inaccurate and by the time it reaches the family, delayed, only enhancing anxiety and frustration.

There is evidence in the literature that shows that face-to-face communication by a registered nurse is the best way to provide a communication link with families and to reduce their anxiety while their family members are undergoing surgical procedures ⁽⁴⁾.

This direct method of communication, although an improvement, is impractical in high-volume facilities and is labor-intensive, inconsistent and requires the family to remain in the waiting area at all times.

The use of an electronic patient tracking pad has been adopted by several facilities and utilizes public screens that display the patient’s progress through the surgical continuum, often using color-coded status updates with generic and impersonal information e.g. “in progress”, “surgery complete” etc. The accuracy and timeliness of such information is dependent on a healthcare worker imputing the data into a computer program. A recently published randomized, controlled study failed to demonstrate a reduction in anxiety in family members who utilized the electronic tracking pad when compared to those families that were updated by volunteers. ⁽⁵⁾

The use of mobile technology within healthcare is increasing. Kwan et al assessed the effectiveness of periodic pre-formed text messages sent to the parents of children undergoing posterior spinal fusion surgery. They found that the text messages were effective in reducing parental anxiety when compared to parents who did not receive text messages ⁽⁶⁾.

But we can do better. The Vocera Ease application is a mobile app that allows circulating nurses within the operating room to send HIPAA compliant texts, pictures and videos in real-time to the mobile devices of family and friends.  The Ease app has numerous built in security measures for compliance with HIPAA regulations and ensuring privacy and safety. A reminder notification every 30 minutes results in communication consistency and not only reduces family anxiety, but enhances trust and transparency.  Sending surgical updates to families has never been easier with the mobile app.

References

1. Sonja Mitrevska-Schwartzbach. The Anatomy of the Waiting Room. Huffington Post, October 2015.
2. Kevin R. Campbell. How Families Cope with the Surgical Waiting Room. Personal Blog 2012.
3. Keeton B, Vish N. Waiting Room Card Reduces Family Anxiety, AHC Media, November 1, 2015.
4. MacDonald K, Latimer M, Drisdelle N. Determining the Impact of a Surgical Liaison Nurse Role in the Pediatric Operating Room. Canadian Operating Room Nursing Journal, 2006;24:7-14.
5. Pamela M. Barberi. Reducing the Surgical Patient’s Family Member’s Anxiety Using an Electronic Patient Tracking Board. Walden University Dissertations and Doctoral Studies, 2015.
6. Kwan MK, Chiu CK, Gan CC et al. Can Intraoperative Text Messages Reduce Parental Anxiety of Children Undergoing Posterior Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis? Spine 2016;41:E25-E230.