T. L. White1, J. Moss1, P. Watts1, J. Cannon1, D. Chu1, G. Kennedy1, S. Vickers1, M. Morris1 1University Of Alabama At Birmingham,Birmingham, AL, USA
Introduction: Post-operative education, discharge instructions, and follow-up appointments provide a foundation for new ostomates leaving the hospital, but a gap in care remains. Studies show that having a stoma is an independent predictor of hospital readmission. Patients with new stomas utilize resources, including hospital based acute care, twice as much as colorectal patients without an ostomy. Telehealth has an emerging role post-operatively, allowing visual inspection of the patient while providing verbal support during virtual visits before clinic follow-up. The purposes of this project are to determine the feasibility of Virtual Postoperative Visits (VPOVs), to define specific issues patients want addressed during VPOVs, and to assess whether patients are satisfied with a virtual format. Our hypothesis is that virtual post-operative visits will be feasible and will address patient centered goals of care following discharge with a new stoma.
Methods: In this pilot project, we recruited 10 patients who attended 2 VPOVs following hospital discharge in addition to routine post-operative WOCN education and a post-operative clinic appointment. The VPOVs were conducted and recorded using UAB approved, HIPAA compliant video conferencing software. Descriptive statistics were used to analyze data gathered from a survey assessing patient satisfaction.
Results: The mean age of our 10 patients recruited was 40 and 80% were women. Surgical procedures included robotic, laparoscopic, and open colectomies with 80% resulting in an ileostomy and 20% in a colostomy. Of the patients enrolled, 90% successfully completed two VPOVs. The mean time to the first VPOV was 9 days post-discharge (range 2-7 days) and none of the patients enrolled were readmitted. Ninety percent of patients felt VPOVs helped manage the ostomy and agreed that VPOVs should be part of the discharge plan. All patients felt comfortable with the virtual format. Common themes addressed during VPOVs included pouching issues and skin irritation. Barriers to enrolling patients into our VPOV pilot study included lack of access to technology and HIPPA compliant software for smart phones.
Conclusion: The immediate post-operative period is a tenuous time for new ostomates. Overall, VPOVs are feasible and patients are very satisfied with VPOVs in addressing their patient centered goals of care. Bridging the period between hospital discharge and initial clinic follow-up by using culturally sensitive, educational, and timely interventions should be a priority in this population. Future work will focus on large scale implementation of VPOVs for patients with new stomas.