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Rezaee ME, Mahon KM, Trock BJ, Nguyen THE, Smith AK, Hahn NM, Patel SH, Kates M. ERAS for Ambulatory TURBT: Enhancing Bladder Cancer Care (EMBRACE) randomised controlled trial protocol. BMJ Open 2024; 14:e076763. [PMID: 38858157 PMCID: PMC11168167 DOI: 10.1136/bmjopen-2023-076763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 03/12/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Transurethral resection of bladder tumour (TURBT) is one of the more common procedures performed by urologists. It is often described as an 'incision-free' and 'well-tolerated' operation. However, many patients experience distress and discomfort with the procedure. Substantial opportunity exists to improve the TURBT experience. An enhanced recovery after surgery (ERAS) protocol designed by patients with bladder cancer and their providers has been developed. METHODS AND ANALYSIS This is a single-centre, randomised controlled trial to investigate the effectiveness of an ERAS protocol compared with usual care in patients with bladder cancer undergoing ambulatory TURBT. The ERAS protocol is composed of preoperative, intraoperative and postoperative components designed to optimise each phase of perioperative care. 100 patients with suspected or known bladder cancer aged ≥18 years undergoing initial or repeat ambulatory TURBT will be enrolled. The change in Quality of Recovery 15 score, a measure of the quality of recovery, between the day of surgery and postoperative day 1 will be compared between the ERAS and control groups. ETHICS AND DISSEMINATION The trial has been approved by the Johns Hopkins Institutional Review Board #00392063. Participants will provide informed consent to participate before taking part in the study. Results will be reported in a separate publication. TRIAL REGISTRATION NUMBER NCT05905276.
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Affiliation(s)
- Michael E Rezaee
- The Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Katherine M Mahon
- The Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Bruce J Trock
- The Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - The-Hung Edward Nguyen
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Armine K Smith
- The Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Noah M Hahn
- The Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sunil H Patel
- The Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Max Kates
- The Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Amato CA, White NW, Tio JD, Rodriguez W, Matullo KS. Postoperative Instruction Retention, Written Versus Audiovisual Adjuncts: A Prospective Randomized Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:146-150. [PMID: 38903830 PMCID: PMC11185882 DOI: 10.1016/j.jhsg.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/19/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose Adherence to postoperative protocols is an integral perioperative intervention that impacts surgical outcomes. The focus of this study was to identify the baseline postoperative instruction retention of our traditional written format and compare that with the retention when using an audiovisual adjunct. We hypothesize that the addition of audiovisual adjuncts would result in greater patient retention of their postoperative instructions. Methods Sixty consecutive adult patients undergoing soft tissue procedures of the hand and wrist were enrolled prospectively at a single institution. Patients were randomized to receive postoperative instructions with either a written or an audiovisual adjunct format. Two days after surgery, a blinded investigator contacted the participants to administer a standardized phone questionnaire. Responses were recorded, and the data were analyzed by another blinded team member. Analysis was performed using χ 2 and Student t tests as appropriate. Results Fifty patients were included in the final analysis. The written group scored an average retention of 80%, whereas the audiovisual group showed a retention score of 85%. Demographic analysis of men versus women, and patients <60 versus >60 years of age did not demonstrate significant score differences. The subgroup analysis of patients receiving local anesthesia alone demonstrated significantly higher rates of percent correct and perfect recall in the audiovisual compared with the written-only group (87.5 vs 80.5 and 44% vs 7%, respectively). Conclusions For patients undergoing common soft tissue procedures of the hand, the addition of audiovisual supplementation to written instructions, especially in those undergoing wide awake, local anesthesia, no tourniquet procedures, is associated with higher rates of retention of a patient's postoperative instructions. The specific improvement in the local anesthesia cohort is especially relevant today due to an increased prevalence of wide awake, local anesthesia, no tourniquet style procedures, and the increasing reliance on patient engagement in postoperative care. Type of study/level of evidence Randomized control trial; Diagnostic Level 2b.
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Affiliation(s)
- Chad A. Amato
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Bethlehem, PA
| | - Nathan W. White
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Bethlehem, PA
| | - Juan D. Tio
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Bethlehem, PA
| | - William Rodriguez
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Bethlehem, PA
| | - Kristofer S. Matullo
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Bethlehem, PA
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Elsener M, Santana Felipes RC, Sege J, Harmon P, Jafri FN. Telehealth-based transitional care management programme to improve access to care. BMJ Open Qual 2023; 12:e002495. [PMID: 37940335 PMCID: PMC10632879 DOI: 10.1136/bmjoq-2023-002495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The transition from hospital to home is a vulnerable time for patients and families that can be improved through care coordination and structured discharge planning. LOCAL PROBLEM Our organisation aimed to develop and expand a programme that could improve 30-day readmission rates on overall and disease-specific populations by assessing the impact of a telehealth outreach by a registered nurse (RN) after discharge from an acute care setting on 30-day hospital readmission. METHODS This is a prospective observational design conducted from May 2021 to December 2022 with an urban, non-academic, acute care hospital in Westchester County, New York. Outcomes for patients discharged home following inpatient hospitalisation were analysed within this study. We analysed overall and disease-specific populations (congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and pneumonia (PNA)) as compared with a 40-month prestudy cohort. INTERVENTIONS Patients were identified in a non-random fashion meeting criterion of being discharged home after an inpatient admission. Participants received a telephonic outreach by an RN within 72 hours of discharge. Contacted patients were asked questions addressing discharge instructions, medication access, follow-up appointments and social needs. Patients were offered services and resources based on their individual needs in response to the survey. RESULTS 68.2% of the 24 808 patients were contacted to assess and offer services. Median readmission rates for these patients were 1.2% less than the prestudy cohort (11.0% to 9.8%). Decreases were also noted for disease-specific conditions (CHF (14.3% to 9.1%), COPD (20.0% to 13.4%) and PNA (14.9% to 14.0%)). Among those in the study period, those that were contacted between 24 and 48 hours after discharge were 1.2 times less likely to be readmitted than if unable to be contacted (254/3742 (6.8%) vs 647/7866 (8.2%); p=0.005). CONCLUSIONS Using a multifaceted telehealth approach to improve patient engagement and access reduced 30-day hospital readmission for patients discharged from the acute care setting.
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Affiliation(s)
- Michelle Elsener
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | | | - Jonathan Sege
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | - Priscilla Harmon
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | - Farrukh N Jafri
- Emergency Department, White Plains Hospital, White Plains, New York, USA
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Harbour S, Mukherjee H, Davison SP, DiLeonardo M. Hotline to Helpline: Reducing On-call Demands. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5346. [PMID: 37850200 PMCID: PMC10578723 DOI: 10.1097/gox.0000000000005346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/08/2023] [Indexed: 10/19/2023]
Abstract
Background There is a growing societal trend in plastic surgery patients of viewing their medical care as a commodity product rather than as a healthcare service. Our four-provider private plastic surgery practice noticed this phenomenon through our patients' trend of overusing the emergency after-hours service call line. To affect this behavior, we designed a study educating patients on the emergency service call line's purpose and how to handle nonurgent issues independently. Methods After a 6-month preintervention phase to categorize after-hours emergency calls, We improved preoperative patient education and implemented in-office protocols for quicker provider responses. Postintervention data were collected for another 6 months and compared statistically with the preintervention data. Results In the preinterventional period, we saw a total of 236 after-hours phone calls. The intervention led to a 22% significant reduction in total calls (P = 0.007). Calls were categorized as nonurgent, urgent, and emergent. While emergent calls remained unchanged (P = 0.56), nonurgent calls significantly decreased (P = 0.005). The most common nonurgent calls were regarding pain, routine postoperative concerns, and drain care, with the intervention resulting in a significant reduction of routine postoperative swelling/bruising/discomfort calls (P = 0.04) but not changing pain (P = 0.23) or drain-related calls (P = 0.78). Conclusions We found that targeted preoperative patient education coupled with a real-time action board in the office, to ensure timely response to patient questions during office hours, can positively impact after-hours call use, and improve overall patient outcomes by catching urgent issues earlier.
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Fan P, Liao M, Xiao L, Yao G, Lin Y, Gan X, Xie Z, Zhu Y. The efficiency of quick response code versus telephone contact for post-discharge follow-up after ophthalmic day surgery: a randomized controlled trial. Int Ophthalmol 2023; 43:2669-2677. [PMID: 36894822 PMCID: PMC9998011 DOI: 10.1007/s10792-023-02666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/19/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To assess and compare the efficiency of quick response (QR) code versus telephone contact for post-discharge follow-up in patients receiving low-risk ophthalmic day surgery. METHODS One hundred and sixty patients undergoing strabismus day-care surgery with general anesthesia were randomly allocated to either the intervention group using QR code (QR group) or the control group receiving telephone call (TEL group) for post-discharge follow-up. The primary outcome was the follow-up overall attendance rate on the second postoperative day. Secondary outcomes included attendance rate at the first scheduled follow-up, number of text message reminders, elapsed time and estimated cost for follow-up, omission rate of follow-up responses, and patient satisfaction. RESULTS The overall attendance rate of follow-up was significantly higher in the QR group than that in the TEL group (97.5% vs. 87.5%, p = 0.016). As compared with the TEL group, the QR group significantly reduced the number of text message reminders with higher attendances at the first scheduled follow-up (p < 0.001, p = 0.001). Besides, the TEL group cost a median time of 258 s and a median cost of RMB 5.8 yuan to complete a follow-up consultant, but was associated with a significantly high omission rate of follow-up responses comparing to the QR group (p = 0.002). Patient satisfaction was comparable between two groups. CONCLUSION QR code follow-up can be more efficient than traditional telephone contact in assessing the post-discharge recovery after strabismus day surgery, which provides a safe and intuitively alternative follow-up pathway for identifying issues that may necessitate further clinical care for more low-risk ophthalmic day surgeries.
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Affiliation(s)
- Peiting Fan
- Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060 China
| | - Minyan Liao
- Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060 China
| | - Liwen Xiao
- Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060 China
| | - Guanjing Yao
- Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060 China
| | - Yiquan Lin
- Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060 China
| | - Xiaoliang Gan
- Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060 China
| | - Zhubin Xie
- Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060 China
| | - Yanling Zhu
- Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060 China
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Muacevic A, Adler JR, Barbosa H, Coroa M, Brás A, Amaro L. Individualized Care and Follow-Up in Outpatient Surgery: A Pilot Study. Cureus 2023; 15:e33698. [PMID: 36788820 PMCID: PMC9922033 DOI: 10.7759/cureus.33698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/14/2023] Open
Abstract
Introduction In outpatient surgery, post-discharge follow-up calls are essential for identifying complications and are considered a cost-effective intervention. Currently, there is a lack of scientific evidence to support the development and validation of standardized protocols adjusted to patients' specificities. Our aim is to develop a personalized model for our outpatient surgery unit (OSU) to create an individualized follow-up strategy in the future. Material and methods We performed a retrospective, cohort, single-center study, including patients undergoing surgery at an OSU of a tertiary hospital in Portugal, for three months. Follow-up calls were performed on the seventh and fourteenth days after discharge. The variables analyzed included: sex, age, surgical specialty, anesthetic technique, American Society of Anesthesiologists (ASA) physical status classification, surgery duration, and complications. A binary logistic regression was adjusted for the complications detected in each call. Results Nine-hundred eighty-four (984) patients were included, of which 79.8% (n=785) and 75.3% (n=741) answered the follow-up calls on the seventh and fourteenth days after discharge, respectively. Complications were reported in 47.1% (n=370) and 29.8% (n=221) of these calls, respectively, with pain having the highest incidence rate (44.7% in the first call; 26.6% in the second). The type of anesthesia and surgical specialty were independent risk factors for complications (p<0.001). Each minute increase in surgery duration increased by 1.1% the odds of complications (95% confidence interval 1.003-1.018) in the first call. Compared with no anesthesiology involvement, general anesthesia, regional anesthesia, and monitored anesthetic care are 2.52, 2.04, and 1.75 times more likely to have complications detected in the first call and 3.21, 2.36, and 3.11 times more likely to have complications on the second (p<0.05 for all). A model that predicts the detection of complications in each call was created. Discussion Outpatient surgery may allow procedures to be carried out safely, efficiently, and cost-effectively. To optimize the outcomes, it is important to quantify results as a tool for honing our strategies. The present study recognized the influence of several variables in the incidence of post-discharge complications. Also, considering the complications reported, pain was the most frequent among the reports and should not be neglected. In our reality, no follow-up calls are routinely performed after the seventh day, and complications were reported in that period, meaning some patients probably should be accompanied for a longer period. Conclusions To ensure the quality of care and patient safety and satisfaction, it is essential to identify and manage postoperative complications. Despite not being a routine contact, the incidence rate of complications on the seventh and fourteenth postoperative days is noted. According to our investigation, the type of anesthesia, surgical specialty, and duration of surgery should be carefully considered when establishing individualized follow-up plans. These plans, using tools adjusted to the population of each OSU, such as the calculator presented, may allow the available resources to be used with the greatest potential benefit for both patients and healthcare systems.
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Khair A, Cromwell PM, Abdelatif A, Boland F, O'Reilly C, Maudarbaccus N, Aremu M, Arumugasamy M, Walsh TN. Text Messaging, Telephone, or In-Person Outpatient Visit to the Surgical Clinic: A Randomized Trial. J Surg Res 2022; 280:226-233. [PMID: 36007481 PMCID: PMC9394432 DOI: 10.1016/j.jss.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Routine outpatient follow-up visits for surgical patients are a source of strain on health-care resources and patients. With the COVID-19 pandemic adding a new urgency to finding the safest follow-up arrangement, text message follow-up might prove an acceptable alternative to a phone call or an in-person clinic visit. METHODS An open-label, three-arm, parallel randomized trial was conducted. The interventions were traditional in-person appointment, a telephone call, or a text message. The primary outcome was the number of postdischarge complications identified. The secondary outcomes were patient satisfaction with follow-up, future preference, default to follow-up, and preference to receiving medical information by text message. RESULTS Two hundred eight patients underwent randomization: 50 in the in-person group, 80 in the telephone group, and 78 in the text message group. There was no difference in the number of reported complications: 5 (10%) patients in the in-person group, 7 (9%) patients in the text group, and 11 (14%) patients in the telephone group (P = 0.613). The preferred method of follow-up was by telephone (106, 61.6%). The least preferred was the in-person follow-up (15, 8.7%, P = 0.002), which also had the highest default rate (44%). CONCLUSIONS There was no evidence that text messages and telephone calls are unsafe and ineffective methods of follow-up. Although most patients are happy to receive results by text message, the majority of patients would prefer a telephone follow-up and are less likely to default by this method. Health-care systems should develop telehealth initiatives when planning health-care services in the wake of the COVID-19 pandemic.
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Affiliation(s)
- Areeg Khair
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul M Cromwell
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Asila Abdelatif
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colum O'Reilly
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nadiim Maudarbaccus
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Muyiwa Aremu
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mayilone Arumugasamy
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom N Walsh
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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Blanco E, Samuels S, Kimball R, Patel D, Citty S, Spader H. Impact of Telephone Follow-Up on Patient Satisfaction in a Pediatric Neurosurgery Clinic. J Patient Exp 2021; 7:1255-1259. [PMID: 33457573 PMCID: PMC7786778 DOI: 10.1177/2374373520919210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Patient satisfaction is a key metric used to measure quality in health care. However, patient satisfaction measures in the pediatric population are less studied and understood than in the adult population. The purpose of this study was to evaluate the impact of telephone follow-up on patient satisfaction in an outpatient pediatric neurosurgery clinic. A standardized telephone follow-up call was performed within 1 week of a child’s clinic visit. Pearson’s χ2 or Fisher’s exact tests were used to assess changes in patient satisfaction measures after implementation of the telephone follow-up call initiative. The proportion of overall “top-box” physician rating significantly increased from 85.5% in 2017 to 95.6% in 2018 (P = .04). There was also a nonsignificant upward trend in the proportion of respondents noting that they would recommend this provider, as well as in all measures of physician communication quality and office staff quality. A simple telephone call to new patients after an outpatient pediatric neurosurgery clinic visit resulted in statistically significant and clinically meaningful changes in patient satisfaction scores.
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Affiliation(s)
- Erica Blanco
- College of Nursing, University of Florida, Gainesville, FL, USA
| | - Shenae Samuels
- Office of Human Research, Memorial Healthcare System, Hollywood, FL, USA
| | - Rebekah Kimball
- College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Daxa Patel
- Division of Pediatric Neuroscience, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Sandra Citty
- College of Nursing, University of Florida, Gainesville, FL, USA
| | - Heather Spader
- Division of Pediatric Neuroscience, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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Kim JK, Lee MJ, Chua ME, Ming JM, Lorenzo AJ, Farhat WA, Bagli DJ, Papanikolaou F, Koyle MA. Do post-operative phone calls enhance family satisfaction and outcomes after outpatient pediatric urological surgeries? A prospective study. Pediatr Surg Int 2021; 37:161-167. [PMID: 33136281 DOI: 10.1007/s00383-020-04770-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This study assesses whether post-operative check-in phone calls (POPC) performed within 48 h of outpatient pediatric urological surgeries by a non-medical professional (NMP) would increase patient/family satisfaction and minimize extraneous resource use by increasing email/telephone communication, while reducing emergency department (ED) visits within 30 days of that procedure. METHODS Families of patients undergoing ambulatory pediatric urology surgeries were enrolled over 8 weeks. Group 1 did not receive POPC. Group 2 received a POPC within 48 h of their operation by a NMP. Both groups received a phone-call survey 2 weeks after surgery to assess families' perioperative satisfaction. RESULTS In total, 74 families were enrolled (Group 1 = 44, Group 2 = 31). The response rates to phone surveys for Groups 1 and 2 were 59.1% and 77.4%, respectively. POPC did not improve perioperative satisfaction, nor did it significantly promote the use of nursing email/telephone communication (19.2% vs. 4.2%, p = 0.128) or reduce ED visits (15.4% vs. 0.0%, p = 0.111). However, all families in Group 2 thought POPC was timed appropriately and 79.1% perceived it to be helpful in reducing post-operative anxiety. CONCLUSION POPC by a NMP within 48 h of surgery may not affect perioperative satisfaction of families of patients undergoing same-day pediatric urology surgery but may have an impact in reducing post-operative anxiety.
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Affiliation(s)
- Jin K Kim
- Division of Urology, Department of Surgery, University of Toronto, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Canada.
| | - Min Joon Lee
- Division of Urology, Department of Surgery, University of Toronto, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Canada
| | - Michael E Chua
- Division of Urology, Department of Surgery, University of Toronto, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Canada
| | - Jessica M Ming
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Canada
- Division of Urology, Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, University of Toronto, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Canada
| | - Walid A Farhat
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Darius J Bagli
- Division of Urology, Department of Surgery, University of Toronto, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Canada
| | - Frank Papanikolaou
- Division of Urology, Department of Surgery, University of Toronto, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Canada
| | - Martin A Koyle
- Division of Urology, Department of Surgery, University of Toronto, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Canada
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Computer- and Telephone-Delivered Interventions on Patient Outcomes and Resource Utilization in Patients With Orthopaedic Conditions: A Systematic Review and Narrative Synthesis. Orthop Nurs 2020; 39:340-352. [PMID: 32956277 DOI: 10.1097/nor.0000000000000699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As the number of patients with orthopaedic conditions has risen continuously, hospital-based healthcare resources have become limited. Delivery of additional services is needed to adapt to this trend. PURPOSE The purpose of this study was to describe the current literature of computer- and telephone-delivered interventions on patient outcomes and resource utilization in patients with orthopaedic conditions. METHODS The systematic review was conducted in January 2019. The standardized checklist for randomized controlled trials was used to assess the quality of the relevant studies. A meta-analysis was not possible due to heterogeneity in the included studies, and a narrative synthesis was conducted to draw informative conclusions relevant to current research, policy, and practice. RESULTS A total of 1,173 articles were retrieved. Six randomized controlled trials met the inclusion criteria, providing evidence from 434 individuals across four countries. Two studies reported findings of computer-delivered interventions and four reported findings of telephone-delivered interventions. The patients who received both computer- and telephone-delivered interventions showed improvements in patient outcomes that were similar or better to those of patients receiving conventional care. This was without any increase in adverse events or costs. CONCLUSION Computer- and telephone-delivered interventions are promising and safe alternatives to conventional care. This review, however, identifies a gap in evidence of high-quality studies exploring the effects of computer- and telephone-delivered interventions on patient outcomes and resource utilization. In future, these interventions should be evaluated from the perspective of intervention content, self-management, and patient empowerment. In addition, they should consider the whole care journey and the development of the newest technological innovations. Additionally, future surgery studies should take into account the personalized needs of special, high-risk patient groups and focus on patient-centric care to reduce postdischarge health problems and resource utilization in this population.
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Jansson MM, Rantala A, Miettunen J, Puhto AP, Pikkarainen M. The effects and safety of telerehabilitation in patients with lower-limb joint replacement: A systematic review and narrative synthesis. J Telemed Telecare 2020; 28:96-114. [PMID: 32316837 DOI: 10.1177/1357633x20917868] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION As the number of patients undergoing primary lower-limb joint replacement has risen continuously, hospital-based healthcare resources have become limited. Delivery of any ongoing rehabilitation needs to adapt to this trend. This systematic literature aimed to examine the effects and safety of telerehabilitation in patients with lower-limb joint replacement. METHODS A systematic review of randomized controlled trials was conducted according to procedures by the Joanna Briggs Institute. Studies published prior to February 2020 were identified from Medline Ovid, Scopus, Ebsco Databases and Web of Science. Reference lists of relevant studies were also manually checked to find additional studies. Two researchers conducted study selection separately. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results whereas effect sizes were estimated for different outcomes. RESULTS Nine studies with 1266 patients were included. Study quality was predominantly affected by the lack of blinding. The patients who completed telerehabilitation showed an improvement in physical functioning that was similar to that of patients completing conventional in-person outpatient physical therapy without an increase in adverse events or resource utilization. The effect of telerehabilitation on physical functioning, however, was assessed as heterogeneous and moderate- to low-quality evidence. DISCUSSION Telerehabilitation is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. However, more robust studies are needed to build evidence about telerehabilitation.
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Affiliation(s)
- Miia M Jansson
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Finland.,Oulu University Hospital, Finland
| | - Arja Rantala
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Finland
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Finland.,Martti Ahtisaari Institute, University of Oulu, Finland.,VTT, Technical Research Centre of Finland, Finland
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12
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Jansson M, Vuorinen AL, Harjumaa M, Similä H, Koivisto J, Puhto AP, Vesty G, Pikkarainen M. The digital patient journey solution for patients undergoing elective hip and knee arthroplasty: Protocol for a pragmatic randomized controlled trial. J Adv Nurs 2020; 76:1436-1448. [PMID: 32133684 DOI: 10.1111/jan.14343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
AIM To describe a randomized controlled trial (RCT) protocol that will evaluate the effectiveness of a digital patient journey (DPJ) solution in improving the outcomes of patients undergoing total hip and knee arthroplasty. BACKGROUND There is an urgent need for novel technologies to ensure sustainability, improve patient experience, and empower patients in their own care by providing information, support, and control. DESIGN A pragmatic RCT with two parallel arms. METHODS The participants randomized assigned to the intervention arm (N = 33) will receive access to the DPJ solution. The participants in the control arm (N = 33) will receive conventional care, which is provided face to face by using paper-based methods. The group allocations will be blinded from the study nurse during the recruitment and baseline measures, as well as from the outcome assessors. Patients with total hip arthroplasty will be followed up for 8-12 weeks, whereas patients with total knee arthroplasty will be followed up for 6-8 weeks. The primary outcome is health-related quality of life, measured by the EuroQol EQ-5D-5L scale. Secondary outcomes include functional recovery, pain, patient experience, and self-efficacy. The first results are expected to be submitted for publication in 2020. IMPACT This study will provide information on the health effects and cost benefits of using the DPJ solution to support a patient's preparation for surgery and postdischarge surgical care. If the DPJ solution is found to be effective, its implementation into clinical practice could lead to further improvements in patient outcomes. If the DPJ solution is found to be cost effective for the hospital, it could be used to improve hospital resource efficiency.
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Affiliation(s)
- Miia Jansson
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| | | | | | - Heidi Similä
- VTT Technical Research Centre of Finland, Oulu, Finland
| | - Jonna Koivisto
- Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland
| | - Gillian Vesty
- School of Accounting, RMIT University, Melbourne, Australia
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,VTT Technical Research Centre of Finland, Oulu, Finland.,Martti Ahtisaari Institute, Oulu Business School, Oulu University, Oulu, Finland
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13
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Carlock TC, Barrett JR, Kalvelage JP, Young JB, Nunez JM, Colonna AL, Enniss TM, Nirula R, McCrum ML. Telephone Follow-Up for Emergency General Surgery Procedures: Safety and Implication for Health Resource Use. J Am Coll Surg 2019; 230:228-236. [PMID: 31654733 DOI: 10.1016/j.jamcollsurg.2019.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is unknown whether replacing clinic follow-up visits with telephone follow-up for low-risk core emergency general surgery (cEGS) procedures is safe. We measured the efficacy of telephone follow-up to determine if it could safely reduce the need for routine postoperative clinic visits in this population. STUDY DESIGN Low-risk nonelective laparoscopic appendectomy, laparoscopic cholecystectomy, umbilical hernia, and inguinal hernia repair patients received telephone follow-up for symptoms concerning for surgical complication within 10 days of discharge. Clinic appointments were made if critical thresholds were reached. Outcomes of interest included rates of completed telephone screens, clinic visits avoided, and missed complications at 30 days postoperatively. RESULTS Of 402 patients screened, 62 (15.4%) were scheduled for a clinic visit due to threshold responses and 27 (6.7%) were scheduled per patient request, while 275 (68.4%) patients screened negative and did not attend a clinic visit. One hundred sixty-three (59.3%) of the negative screen cohort were contacted after 30 days. Nine (5.5%) patients in this cohort were diagnosed with low-grade complications; no high-grade (Clavien-Dindo ≥ 3) complications were missed by telephone screening. Twenty surgery-related complications were identified in the full patient population; early telephone screening successfully identified the single high-grade complication. CONCLUSIONS Post-discharge telephone follow-up in cEGS patients reduced the need for clinic follow-up visits by 68%. Missed complications were infrequent and low grade; telephone screening identified the single high-grade complication. Telephone follow-up for low-risk EGS patients is safe and increases efficiency of postoperative resource use.
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Affiliation(s)
- Tanner C Carlock
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - James R Barrett
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - James P Kalvelage
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jason B Young
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jade M Nunez
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Alexander L Colonna
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Toby M Enniss
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Raminder Nirula
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Marta L McCrum
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT.
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Jansson MM, Harjumaa M, Puhto AP, Pikkarainen M. Healthcare professionals' perceived problems in fast-track hip and knee arthroplasty: results of a qualitative interview study. J Orthop Surg Res 2019; 14:294. [PMID: 31484536 PMCID: PMC6727416 DOI: 10.1186/s13018-019-1334-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022] Open
Abstract
Background Fast-track and outpatient arthroplasty methodologies combine evidence-based clinical features with organizational optimization resulting in a streamlined pathway from admission to discharge and beyond. This qualitative study explored perceived problems of healthcare professionals during fast-track hip and knee arthroplasty. Methods Semi-structured interviews were conducted with four surgeons, two anesthesiologists, ten nurses, and four physiotherapists. An inductive content analysis was used to analyze the data. NVivo qualitative data analysis software was used. Results Analysis of the data revealed eight main categories of problems: patient selection, referrals, meeting the Health Care Guarantee, patient flow, homecare, patient counseling, transparency of the journey, and receiving feedback. In addition, problems related to information flows and communication, responsibilities between different stakeholders, and existing information systems were identified. Conclusions The study revealed that healthcare professionals perceived several problems during the fast-track journey that reduce its effectiveness and make it more difficult to meet the Health Care Guarantee. Problems could be alleviated by changing internal and external organizational practices, as well as by developing new information and communication technologies that would provide up-to-date communication channels for healthcare professionals and patients. In addition, new collaboration mechanisms should be developed in order to solve the problems that occur across different organizations.
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Affiliation(s)
- Miia Marika Jansson
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland, P.O.Box 1100, FI-90571, Oulu, Finland
| | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, P.O.Box 21, FI-90029, Oulu, Finland
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,VTT Technical Research Centre of Finland, P.O.Box 1100, FI-90571, Oulu, Finland.,Martti Ahtisaari Institute, Oulu Business School, Oulu University, P.O.Box 8000, FI-90014, Oulo, Finland
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