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Implementation of a Telephone Postoperative Clinic in an Integrated Health System.

Abstract：

BACKGROUND:Earlier work suggested that telephone follow-up could be used in lieu of in-person follow-up after surgery, saving patients time and travel and maximizing use of scarce surgeon and facility resources. We report our experience implementing and evaluating telephone postoperative follow-up within an integrated health system. STUDY DESIGN:We conducted a pre-post evaluation of a general surgery telephone postoperative clinic at a tertiary care Veterans Affairs facility from April 2015 to February 2016. Patients were offered a telephone postoperative visit from a surgical provider in lieu of an in-person clinic visit. Telephone clinic operating procedures were refined through iterative cycles of change using the Plan-Do-Study-Act method. The study period included 2 months pre-intervention and 9 months post-intervention. The primary end point was mean number of clinic visits per eligible patient before and after telephone clinic implementation. Secondary outcomes were rates of emergency department visits and readmissions before vs after telephone clinic implementation and complication rates in patients scheduled for telephone vs in-person postoperative care. RESULTS:During the study period, 200 patients underwent eligible operations, 29 pre-intervention and 171 post-intervention. In-person clinic use decreased from 0.83 visits per eligible patient pre-intervention to 0.40 after implementation of the telephone clinic (p < 0.01). There was no difference in rates of emergency department presentation or readmission in eligible patients (0.17 visits/patient pre-intervention vs 0.12 post-intervention; p = 0.36). Complication rates were comparable for eligible patients who were and were not scheduled for telephone care (6% vs 8%; p = 0.31). CONCLUSIONS:Telephone postoperative care can be used in select populations as a triage tool to identify patients who require in-person care and decrease overall in-person clinic use.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Kummerow Broman K,Roumie CL,Stewart MK,Castellanos JA,Tarpley JL,Dittus RS,Pierce RA

doi

10.1016/j.jamcollsurg.2016.07.010

subject

Has Abstract

pub_date

2016-10-01 00:00:00

pages

644-51

issue

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(16)30690-1

journal_volume

223

pub_type

临床试验,杂志文章

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Implementation of a Telephone Postoperative Clinic in an Integrated Health System.