For many people, surgery is an anxiety-inducing experience. Some people get so nervous about a pending surgery that they cancel. In an effort to help alleviate patients’ presurgical anxiety and decrease the rate of surgery cancellations, the Montefiore Einstein Department of Anesthesiology has implemented—together with Perioperative Medicine leadership, the Department of Psychiatry and Behavioral Sciences, and Ambulatory Surgery Nursing—two new bundle interventions to reduce patients’ preoperative anxiety.
Offering Psychological Counseling
The first bundle intervention provides patients with the opportunity to speak with a licensed therapist who can help them manage their feelings of anxiety prior to surgery. As part of the intervention, questions were added to Epic for the preoperative evaluation team to assess patients’ anxiety several weeks before surgery. Based on the questions, the providers then ask patients who had a high anxiety score if they would like a telehealth psychology visit, which is conducted by the Max and Celia Parnes Family Psychological and Psychoeducational Services Clinic—a psychology center based at Yeshiva University in the Bronx.
The intervention is led by Matthias Eikermann, MD, PhD, Chair, Anesthesiology, Montefiore Einstein, and Francis F. Foldes Professor, Anesthesiology, Albert Einstein College of Medicine; Carina P. Himes, MD, Director, Preoperative Evaluation, Montefiore Einstein, and Assistant Professor, Anesthesiology, Albert Einstein College of Medicine; Preeti M. Anand, MD, Site Director, Anesthesia Services, Hutchinson Ambulatory Surgery Center, Montefiore Einstein, and Assistant Professor, Anesthesiology (Regional Anesthesiology & Acute Pain Medicine); along with John J. Freda, MD, Vice President, Surgical Services, Montefiore Einstein, and his Surgical Services team to address patients’ anxiety prior to surgery.
“About 60% of otolaryngology (ORL) surgery cancellations within one day of surgery at the Hutch are due to patient no-shows, which is by far the most common reason for cancellation,” Dr. Himes said. “This is due to patients changing their mind about surgery, and it’s hypothesized to be related in part to anxiety regarding surgery.”
The intervention is currently in a pilot phase for patients undergoing ORL surgery at Montefiore’s Hutchinson Ambulatory Surgery Center and will expand to patients undergoing different types of ambulatory surgeries in the coming months.
Managing Anxiety in the Ambulatory Surgery Unit
For the second intervention, the anesthesia provider will conduct an anxiety assessment of the patient while the patient is in the Ambulatory Surgery Unit (ASU) and will offer the patient a low-dose benzodiazepine to mitigate anxiety. As part of this bundle intervention, the perioperative team ensures that the anesthesia provider is available for transporting the medicated patient to the operating room (OR) and for the nursing staff to ensure a stretcher is readily available.
Philipp J. Fassbender, MD, Vice Chair, Perioperative Services, Montefiore Einstein, and Associate Professor, Anesthesiology (Transplant Anesthesiology), Albert Einstein College of Medicine, explained that prior to this intervention, providing patients with preoperative anxiolysis was not common practice at Montefiore Einstein, though it is often done at many other institutions. Instead, patients would receive an anxiolysis after being brought to the operating room and already exhibiting objective signs of anxiety, including high blood pressure and an elevated heart rate.