Standardized communication and workflow redesign in hemorrhoid surgery: A quality improvement initiative

Hemorrhoidal disease is highly prevalent, yet patient reluctance to undergo surgery often stems from inadequate preoperative communication, fear of postoperative pain, and unclear recovery expectations. This quality improvement initiative evaluated whether standardized patient communication combined with workflow redesign could improve surgical decision-making, care continuity, and operational efficiency in hemorrhoid surgery.

A single-center, retrospective before-after study was conducted at a tertiary medical center in Taiwan. We included adults with grade III-IV hemorrhoidal disease who were referred for surgical evaluation during the study period. The intervention, implemented in June 2025, comprised a standardized patient communication framework-including structured explanations of disease severity, surgical indications, expected postoperative course, and visualized education materials-alongside clinical workflow redesign. Patients evaluated January-May 2025 formed the pre-intervention group (n = 312), and those evaluated July-December 2025 formed the post-intervention group (n = 309). Process measures included consultation-to-scheduling time and no-show rate. Outcome measures included surgical acceptance rate and procedure completion rate. Balancing measures included postoperative complications and unplanned emergency department visits.

Following the intervention, surgical acceptance rate increased from 74.4% to 89.3% (P < 0.001), median consultation-to-scheduling time decreased from 12 to 5 days (P < 0.001), no-show rate declined from 12.5% to 5.1% (P = 0.003), and completion rate among patients who accepted surgery improved from 87.1% to 94.9% (P = 0.002). The overall consultation-to-procedure-completion rate improved from 64.7% to 84.8%, representing an absolute increase of 20.1 %age points. Postoperative complication rates (6.4% vs. 5.7%, P = 0.738) and unplanned emergency department visits (4.0% vs. 3.4%, P = 0.757) remained comparable.

Standardized patient communication, including structured preoperative education and visualized materials, combined with workflow redesign, significantly improved surgical decision-making and care continuity in hemorrhoid surgery without compromising patient safety.

A low-cost, replicable standardization of communication and workflow-requiring no additional staffing or financial resources-can reduce patient attrition along the surgical care pathway. The approach is readily transferable to other high-volume ambulatory surgical settings seeking to improve informed decision-making and operational efficiency.