Phone call safe, efficient for post-op follow-up

Phone Call OK Instead of Visit for Routine Post-Op Follow-Up
Phone Call OK Instead of Visit for Routine Post-Op Follow-Up

HealthDay News -- A telephone visit can be safely substituted for the standard clinic visit as postoperative follow-up for certain types of ambulatory surgery, and most patients report a high degree of satisfaction, study findings suggest.

Three-fourths of patients contacted by telephone after hernia repair or laparoscopic cholecystectomy accepted the contact as the sole means of follow-up. The "telehealth" follow-up calls saved patients trips that ranged in distance from seven to 866 miles, and enabled clinics to schedule additional appointments with the time saved.

Just three of 63 (4.8%) herniorrhaphy patients had complications, and only one required additional inpatient management for an incisional hematoma, study researchers Kimberly Hwa, MMS, PA-C, and Sherry M. Wren, MD, of the Veterans Administration Health Care System in Palo Alto, Calif., reported in JAMA Surgery.

"This pilot study demonstrated that a scripted telehealth visit by an allied health professional can be safely and effectively used for the postoperative care of open herniorrhaphy and laparoscopic cholecystectomy patients," they  wrote.

The Veterans Health Care System provides care to eligible patients from a wide geographical area, which requires many patients to miss work for clinic visits that typically take only a few minutes, according to Hwa and Wren. The telehealth pilot program was developed as a quality initiative to determine the feasibility and safety of telephone follow-up as a substitute for a clinic visit.

Eligible patients were undergoing elective open hernia repair or laparoscopic cholecystectomy and had routine postoperative clinic visits scheduled for three weeks after surgery. A certified physician assistant than conducted a screening call two-weeks after the surgery, inquiring about the patient's overall well-being, pain, and analgesic use, signs and symptoms of infection, swelling, testicular pain, activity level, appetite and bowel movements.

Patients that indicated any abnormalities were advised to return for their scheduled clinic visit. All others were asked whether the telephone contact could serve as the sole form of follow-up. Those who preferred the clinic appointment could keep it.

Among the 115 patients receiving open hernia repair and 26 patients receiving laparoscopic cholecystectomy, 110 patients (78%) were successfully contacted after surgery (89 from the hernia-repair group and 21 from the cholecystectomy group). Of those, 70.8% of hernia patients and 90.5% of cholecystectomy patients agreed to telehealth as the only method of postoperative follow-up.

Just 26 of the patients in the herniorrhaphy group (29.2%) and two of 21 in the cholecystectomy group (9.5%) declined to accept telehealth as the sole postoperative follow-up. 

"The majority of these patients wanted a provider to assess and confirm that they were progressing well after surgery, had concerns about incisional swelling, or needed a return-to-work letter and mistakenly thought a physician examination was a requirement for this," the researchers wrote. 

Almost all patients were highly satisfied with telephone follow-up.

"Evolution of care needs to continue with the aim of providing outstanding outcomes, at the lowest cost, and with a high degree of patient satisfaction," the researchers concluded. "This program appears to satisfy all of these goals and is a direction that should be considered by other high-volume ambulatory practices, with care taken to select the correct mix of procedures."


References

  1. Hwa K, Wren SM. JAMA Surg 2013; DOI: 10.1001/jamasurg.2013.2672.
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