Benefit of a nurse-led telephone-based intervention prior to the first urogynecology outpatient visit: a randomized-controlled trial

Telephone completion of patient self-reporting health history documents by registered nurses: a survey to evaluate its effectiveness and strategies for improvement

AIM

Prior to the COVID-19 pandemic, cancer patients would complete their self-reporting health history documentation at their initial consultation visit. With the increase in virtual care, a program was established; whereby, a registered nurse (RN) would complete the self-reporting history with the patient by telephone prior to the initial consultation. A survey of RNs and oncologists evaluating the effectiveness of this program is presented.

METHODS

Outpatient RNs and medical and radiation oncologists were surveyed at a single Canadian cancer center. The surveys collected demographic information and perceptions around the successes and challenges of this program.

RESULTS

Responses were received from 31/42 (74%) RNs and 29/48 (60%) oncologists. RNs reported calling an average of 4 patients/week, and the median time for each call was 20 min. For responding RNs, 21/31 (68%) felt patients were satisfied with the process, and 18/31 (58%) were satisfied with the quality and efficacy of care they were delivering. 25/31 (81%) RNs felt the telephone calls improved care when the patient came to the clinic. All (100%) oncologists were aware of the program, and 86% (25/29) felt it saved time at the consult visit. Areas for improvement included patients completing the forms themselves and including information on current symptoms and drug insurance status.

CONCLUSION

COVID-19 has resulted in many changes in oncology practice. Completion of patient self-reported health history documentation by an RN over the telephone prior to consultation visit received positive feedback from both RNs and oncologists. However, this process has considerable RN resource implications.

Patient pathway in a tertiary referral pelvic floor unit: Telephone triage assessment clinic

BACKGROUND

To meet the increasing demands for colorectal pelvic floor services, a dedicated telephone triage assessment clinic (TTAC) was set up to establish a more efficient pathway, and reduce waiting times and patient's visits to the hospital. The primary aim of this study was to review TTAC in patients suffering from pelvic floor dysfunction and assess its feasibility. Secondary aims include measurement of waiting times for TTAC, main presenting complaints, and main treatment outcomes, including the need for review by a consultant surgeon.

METHODS

Review of data collected retrospectively in a single tertiary referral center collected from an institutional database.

KEY RESULTS

Between January 2016 and October 2017, 1192 patients referred to our pelvic floor unit were suitable for TTAC. Of these, 694 patients had complete records. There were 66 without follow-up after the initial TTAC, leaving 628 patients for analysis. In all, 86% were females and 14% were males, with a mean age of 52 years (range: 18-89). The median waiting time for TTAC was 31 days (range: 0-184). The main presenting complaint during the TTAC was obstructive defecation in 69.4%, fecal incontinence in 28.5%, and rectal prolapse in 2.1%. In our study, 611 patients had conservative management (97.3%), with a median of three sessions per patient (range: 1-16), while 82 patients (13.1%) needed a surgical intervention. Only 223 patients (35.5%) were reviewed by a consultant at some stage during the study period.

CONCLUSIONS AND INFERENCES

To optimize resources, an adequate triage system allowed us to streamline the pathway for each individual patient with pelvic floor dysfunction according to their symptoms and/or test results with the aim of reducing waiting times and expediting treatment.

Exploring the role of the nutrition nurse specialist in an intestinal failure tertiary referral centre

The role of the nutrition nurse specialist (NNS) is diverse and is usually integral to a wider, multidisciplinary nutrition support team (NST). Practice frameworks have been developed to identify competencies within the NNS role. A mind-mapping technique was used with the NNS team and the wider NST to explore the role of the NNS in the authors' intestinal failure tertiary referral centre. The results of this were further compared with the published competency frameworks. The mind maps from the NNS team and NST demonstrated commonality. It was encouraging to see that colleagues seem to have a similar understanding of the NNS role and contribution to the wider service. Published competency frameworks did not entirely reflect the expanded scope of practice that is undertaken within this particular team. It is important for clinical nurse specialist teams to evaluate their role and service provision and to compare this against published competency frameworks.

Telemedicine follow-up is safe and efficacious for synthetic midurethral slings: a randomized, multi-institutional control trial

Introduction and hypothesis

The objective was to assess whether telemedicine-based follow-up is equivalent to office-based follow-up in the early postoperative period after routine synthetic midurethral sling placement.

Methods

This is a prospective, international, multi-institutional, randomized controlled trial. Patients undergoing synthetic midurethral sling placement were randomized to 3-week postoperative telemedicine versus office-based follow-up. The primary outcome was the rate of unplanned events. Secondary outcomes included patient satisfaction, crossover from telemedicine to office-based follow-up, and compliance with 3- to 5-month office follow-up.

Results

We included 238 patients (telemedicine: 121 vs office: 117). No differences in demographics or medical comorbidities were noted between the study groups (p = 0.09–1.0). No differences were noted in unplanned events: hospital admission, emergency department visit, or unplanned office visit or call (14% vs 12.9%, p = 0.85) or complications (9.9% vs 8.6%, p = 0.82). Both groups were equally “very satisfied” with their surgical outcomes (71.1% vs 69%, p = 0.2). Telemedicine patients were more compliant with 3- to 5-month office follow-up (90.1% vs 79.3%, p = 0.04).

Conclusions

After synthetic midurethral sling placement, telemedicine follow-up is a safe patient communication option in the early postoperative period. Telemedicine patients reported no difference in satisfaction compared with office-based follow-up but had greater compliance with 3- to 5-month follow-up.