Effect of telephone follow-up on surgical orthopedic recovery

Using an E-Health Application for Post-operative Monitoring After Inguinal Hernia Repair: A Feasibility Study

BACKGROUND

E-Health care is already well established in some (non-) surgical specialties and is considered as a means of improving patient-centred care. Considering the demand of remote health care changes, especially in the COVID-19 pandemic, it is essential to investigate the feasibility of e-Health care within one of the most performed surgery procedures: inguinal hernia repair.

METHODS

A total of 60 patients used the e-Health application in this study compliant. Primary objectives were to investigate the accuracy of the "deviating post-operative course" alerting by the e-Health application. Secondary objectives included patient perspective and e-Health costs analysis.

RESULTS

Forty-four patients reported no deviation in the post-operative course using the e-Health application of which 93.2% (n = 41) was in concordance with the findings during standard follow-up. Within 16 patients reporting a deviating post-operative course, a true complication was found in 25% (n = 4). Based on in-hospital costs, a hypothetical e-Health follow-up scenario was more expensive (€59.5 per patient) than current standard follow-up care (€28.2 per patient). Usage of the e-Health application showed a high perceived overall patient satisfaction: 4.2 (on a Likert-scale of 1-5).

CONCLUSION

An e-Health application is a promising tool for identifying patients who require in-person or phone follow-up assessment. Patients' perspectives surveys revealed high potential and willingness of using this application. A hypothetical e-Health follow-up scenario showed to be more expensive compared to current standard follow-up. If the identified (dis)advantages can be improved, e-Health follow-up care appears to be promising in terms of safety and feasibility. Future studies can leverage on this study and further investigate the use of e-Health within the field of general surgery.

Do postoperative telemedicine interventions with a communication feature reduce emergency department visits and readmissions?-a systematic review and meta-analysis

INTRODUCTION

Emergency department (ED) visits and readmissions after surgery are common and represent a significant cost-burden on the healthcare system. A notable portion of these unplanned visits are the result of expected complications or normal recovery after surgery, suggesting that improved coordination and communication in the outpatient setting could potentially prevent these. Telemedicine can improve patient-physician communication and as such may have a role in limiting unplanned emergency department visits and readmissions in postoperative patients.

METHODS

Major electronic databases were searched for randomized controlled trials and cohort studies in surgical patients examining the effect of postoperative telemedicine interventions with a communication feature on 30-day readmissions and emergency department visits as compared to current standard postoperative follow-up. All surgical subspecialties were included. Two independent reviewers assessed eligibility, extracted data, and evaluated risk of bias using standardized tools. Our primary outcomes of interest were 30-day ED visits and readmissions. Our secondary outcomes were patient satisfaction with the intervention.

RESULTS

29 studies were included in the final analysis. Fourteen studies were RCTs, and the remaining fifteen were cohort studies. Eighteen studies reported 30-day ED visit as an outcome. There was no overall reduction in 30-day ED visit in the telemedicine group (RR: 0.89, 95%CI: 0.70-1.12). Twenty-two studies reported 30-day readmission as an outcome. The overall pooled estimate did not show a difference in this outcome (RR: 0.90, 95%CI: 0.74-1.09). Fifteen studies reported a metric of patient satisfaction regarding utilization of the telemedicine intervention. All studies demonstrated high levels of satisfaction (> 80%) with the telemedicine intervention.

DISCUSSION

This review fails to demonstrate a clear reduction ED visits and readmissions to support use of a telemedicine intervention across the board. This may be in part explained by significant heterogeneity in the proportions of potentially preventable visits in each surgical specialty. As such, targeting interventions to specific surgical settings may prove most useful.

Ensuring continuity of patient care across the healthcare interface: Telephone follow-up post-hospitalization

AIMS

To implement pharmacist-led, postdischarge telephone follow-up (TFU) intervention and to evaluate its impact on rehospitalization parameters in polypharmacy patients, via comparison with a well-matched control group.

METHOD

Pragmatic, prospective, quasi-experimental study. Intervention patients were matched by propensity score techniques with a control group. Guided by results from a pilot study, clinical pharmacists implemented TFU intervention, added to routine integrated medicines management service.

RESULTS

Using an intention to treat approach, reductions in 30- and 90-day readmission rates for intervention patients compared with controls were 9.9% [odds ratio = 0.57; 95% confidence interval (CI): 0.36-0.90; P < 0.001] and 15.2% (odds ratio = 0.53; 95% CI: 0.36-0.79; P = 0.021) respectively. Marginal mean time to readmission was 70.9 days (95% CI: 66.9-74.9) for intervention group compared with 60.1 days (95% CI: 55.4-64.7) for controls. Mean length of hospital stay compared with control was (8.3 days vs. 6.7 days; P < 0.001). Benefit: cost ratio for 30-day readmissions was 29.62, and 23.58 for 90-day interval. Per protocol analyses gave more marked improvements. In intervention patients, mean concern scale score, using Beliefs about Medicine Questionnaire, was reduced 3.2 (95% CI: -4.22 to -2.27; P < 0.001). Mean difference in Medication Adherence Report Scale was 1.4 (22.7 vs. 24.1; P < 0.001). Most patients (83.8%) reported having better control of their medicines after the intervention.

CONCLUSIONS

Pharmacist-led postdischarge structured TFU intervention can reduce 30- and 90-day readmission rates. Positive impacts were noted on time to readmission, length of hospital stay upon readmission, healthcare costs, patient beliefs about medicines, patient self-reported adherence and satisfaction.

Holding It Together-Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study

Background

There is an emerging trend to perform surgeries as day surgery. After a day surgery, most of the recovery period takes place at home, and patients are responsible for their own recovery. It has been suggested that electronic health (eHealth) technologies can support patients in this process. A mobile app has recently been developed to assess and follow up on postoperative recovery after a day surgery.

Objective

The aim of this study was to explore experiences associated with postoperative recovery after a day surgery in patients using a mobile app to assess the quality of their recovery.

Methods

This is a qualitative interview study with an explorative and descriptive design. Participants were recruited from 4 different day surgery units in different parts of Sweden. The study included 18 participants aged >17 years who had undergone day surgery and used the Recovery Assessment by Phone Points, a mobile app for follow-up on postoperative recovery after day surgery. Participants were purposively selected to ensure maximum variation. Semistructured individual interviews were conducted. Data were analyzed using thematic analysis.

Results

A total of two themes and six subthemes emerged from the data: (1) the theme Give it all you’ve got with the subthemes Believing in own capacity, Being prepared, and Taking action, where participants described their possibilities of participating and themselves contributing to improving their postoperative recovery; and (2) the theme The importance of feeling safe and sound with the subthemes Feeling safe and reassured, Not being acknowledged, and Not being left alone, which describe the importance of support from health care professionals and next of kin.

Conclusions

It is important that patients feel safe, reassured, and acknowledged during their postoperative recovery. They can achieve this themselves with sufficient support and information from the health care organization and their next of kin. Using a mobile app, both for assessment and to enable contact with the day surgery unit during the postoperative recovery period, can improve care and create a feeling of not being alone after surgery. We propose that postoperative recovery starts in the prerecovery phase when patients prepare for their recovery to get the best possible outcome from their surgery.

Factors Associated With Patient-Initiated Telephone Calls After Orthopaedic Trauma Surgery

OBJECTIVES

The primary aim of this study is to investigate the incidence of early patient-initiated postoperative telephone calls and reasons for those calls. Secondary goals are to determine perioperative predictive factors for calls including the procedures most frequently associated with them.

DESIGN

Retrospective chart review.

SETTING

Academic Level-1 Trauma Center.

PATIENTS/PARTICIPANTS

Six hundred eighty-four patients who underwent surgical treatment by our orthopaedic trauma division between 01/01/2014 and 31/12/2014.

MAIN OUTCOME MEASUREMENTS

Patient-initiated telephone call documented within 14 days after discharge.

RESULTS

Twenty-nine percent (n = 199) of patients initiated a telephone call within 14 days after discharge. The most common reasons for telephone calls were pain control (22%), bathing/dressing/wound questions (16%), and questions regarding discharge medications (8%). The procedures associated with the highest percentage of telephone calls were tibial shaft intramedullary nailing (36.0%), calcaneus open reduction internal fixation (31.3%), and cephalomedullary nailing for proximal femur fractures (29.3%). Perioperative factors predictive of an increase in phone calls included discharge directly to home, higher baseline level of health of the patient (based on comorbidities and the American Society for Anesthesiologists score), and a more robust support network (based on marital and employment status).

CONCLUSIONS

This study identifies the incidence and common reasons for patient-initiated calls after orthopaedic trauma surgery and an analysis of perioperative factors predictive of increased phone calls. These data give direction for communication at the time of discharge to improve efficiency, patient care, and patient satisfaction.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Preferred parental method of post-operative tonsillectomy and adenoidectomy follow-up (phone call vs. clinic visit)

INTRODUCTION

Tonsillectomy is the second most common procedure performed in the United States. Over 530,000 tonsillectomies are performed on children under 15 years of age in the United States, accounting for 16% of surgeries in this age group, resulting in missed school for patients of school-age and also resulting in missed work for caregivers. This study compared parent preferences for in-clinic follow-up (CFU) to telephone interview follow-up (TFU) after tonsillectomy.

MATERIALS AND METHODS

One hundred twenty-one parents of children who underwent a tonsillectomy and/or adenoidectomy were recruited to complete a survey about their child's post-operative visit.

RESULTS

Statistical analyses were performed using t-test, Wilcoxon rank-sum, and Fischer's exact tests where appropriate. 60.3% of the surveys were completed as a TFU and the remainder were completed as a CFU. There were no statistical differences in the children's age, the time to follow-up, satisfaction with their follow-up, or the frequency of unresolved symptoms. Of parents receiving TFU, 91.8% disagreed they would have preferred a CFU, with 86.3% strongly disagreeing, and only 5.5% expressing that they would have preferred a CFU. Of the parents with CFU, 47.9% expressed a preference for a TFU. For CFU, 43.9% of parents missed work and 58.1% of their school-age children missed school.

CONCLUSION

Our study results indicate that parents receiving phone follow-up strongly preferred this method to an in-clinic follow-up, and that nearly half of all parents receiving in-clinic follow-up would have preferred a telephone follow-up. In select patients, telephone follow-up after tonsillectomy may increase patient satisfaction and decrease days of missed work and school.

Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study

PURPOSE

Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs.

METHODS

Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs.

FINDINGS

There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs.

CONCLUSION

There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research.

Nurse-led telephone follow-up after total knee arthroplasty--content and the patients' views

AIM AND OBJECTIVES

To generate information on how telephone follow-up consultations, structured by nursing status according to the VIPS-model, functioned after total knee arthroplasty. The objectives were to unfold the content of the telephone follow-ups according to the structure for nursing status and to explore the patients' views of the telephone follow-ups.

BACKGROUND

The length of stay in hospital following total knee arthroplasty has fallen markedly, and patients now have to be responsible for their recovery from a very early stage. After discharge, patients may experience a variety of health problems. A clinical trial was conducted to evaluate the effect of telephone follow-up, and information on how the telephone follow-ups functioned is relevant for implementation into clinical practice.

DESIGN

A qualitative design was used.

METHOD

One hundred and four case reports from telephone follow-up consultations and individual interviews with 10 patients formed the data material. Content analysis was used for the analysis.

RESULTS

The content of the telephone follow-ups included dialogues relating to all key subjects for nursing status except 'culture/spirituality'. The structured Telephone follow-up was valued by total knee arthroplasties patients as representing a holistic approach and providing adequate information, counselling and support after discharge to home. Three categories were identified with regard to the patients' views: 'A means for reflection and provision of adequate information and counselling', 'Supportive' and 'Not the only resource for support and counselling'.

CONCLUSION

Nursing status according to the VIPS model is a comprehensive structure to identify the need for counselling, information and support after total knee arthroplasty. The structured telephone follow-ups were valued for representing a holistic approach and providing adequate information, counselling and support after discharge to home. Conducting telephone follow-up with a holistic approach demands specialised and broad nursing experience.

RELEVANCE TO CLINICAL PRACTICE

Postdischarge follow-up is important.

Application of telenursing in nursing practice: an integrative literature review

AIMS AND BACKGROUND

Telenursing is the use of technological resources and communication systems to encourage the development of nursing. Its efficiency has been demonstrated to help countries overcome barriers to healthcare. This study investigates the current telenursing strategies utilized in nursing practice, as found in the literature.

METHOD

Integrative literature review of the application of telenursing, using the descriptors: telenursing, nursing care and communication means, in Portuguese, English and Spanish, between 2003 and 2013.

RESULTS

Telenursing is found particularly in care through telephone use for health services and orientations. The country with the largest number of research publications was the United States with 14 (37.8%), followed by Canada and the United Kingdom.

FINAL CONSIDERATIONS

It could be verified that telenursing is growing, in view of its presence in different countries, with strong evidence and benefits of its use. It proves to be an efficient tool to help countries overcome geographical barriers and provide health care information to the population.

Integrated literature review of postdischarge telephone calls

This systematic review of the literature assessed the impact of a postdischarge telephone call on patient outcomes. Nineteen articles met inclusion criteria. Data were extracted and an evidence table was developed. The content, timing, and professional placing the call varied across studies. Study strength was low and findings were inconsistent. Measures varied across studies, many sample sizes were small, and studies differed by patient population. Evidence is inconclusive for use of phone calls to decrease readmission, emergency department use, patient satisfaction, scheduled and unscheduled follow-up, and physical and emotional well-being. Among these studies, there was limited support for medication-focused calls by pharmacists but no support for decreasing readmission. Health care providers benefited from feedback but did not need to place the call to realize this benefit. Inpatient nurses were unable to manage the volume of calls. There was no standardized approach to the call, training, or documentation requirements.

A randomized clinical trial of a nurse telephone follow-up on paediatric tonsillectomy pain management and complications

AIMS

To determine the effect of a nurse telephone follow-up on paediatric post-tonsillectomy pain intensity, complications, and use of other healthcare services.

BACKGROUND

After tonsillectomy, children experience moderate-to-severe pain for days. Parents tend to give insufficient analgesia, with resulting increases in pain and postoperative complications. In adults, nurse telephone follow-up for ambulatory surgeries reduces postoperative pain.

DESIGN

The study design was a randomized clinical trial.

METHODS

In this trial, children aged 4-12 years undergoing elective tonsillectomy in June-October 2010 were assigned to a nurse telephone follow-up with parents on postoperative days 1, 3, 5 and 10, or standard care with no follow-up but data collection. Outcomes included pain intensity, analgesics administered, complications, and healthcare use.

RESULTS

Of 45 participants, the intervention group (n = 24) received more analgesics on postoperative days 1 and 3, increased their fluid intake at days 1 and 3, but had more constipation at day 3 than the control group (n = 21). There was no significant difference regarding pain intensity or use of healthcare resources.

CONCLUSION

Nurse telephone follow-up was beneficial for some pain management and prevention of complications, although better analgesic treatments are needed. The intervention was simple, safe, and appreciated by parents.

Effects of post-discharge telephone calls on the rate of emergency department visits in paediatric patients

AIM

The aim of this study was to evaluate the effects of post-discharge telephone calls on the rate of emergency department (ED) visits within 3 days following hospitalisation in paediatric patients.

METHODS

Patients hospitalised on the Paediatric Service from May 2008 through December 2008 were included in the intervention group and patients hospitalised from May 2007 through December 2007 were included in the control group. Within 3 days of hospital discharge, nurse practitioners attempted daily to contact caregivers in the intervention group and asked children conditions and provided health information.

RESULTS

There were 643 patients in the intervention group and 642 patients in the control group, respectively. Characteristics of the intervention and control groups were similar with respect to age, sex and days of hospitalisation. Ninety-two per cent of patients in the intervention group received a telephone call from a nurse practitioner within 3 days of hospital discharge. Significantly fewer patients in the intervention group (3 patients, 0.47%) had a subsequent visit to the ED within 3 days of hospital discharge than in the control group (11 patients, 1.71%) (P= 0.034).

CONCLUSIONS

Telephone follow-up is an effective way of providing health information, managing remaining symptoms, recognising complications, advising patients of medical alternatives and giving reassurance; this may reduce unnecessary patient ED visits.