B. Bednarski1, M. Katz1, J. Papadopoulos2, N. You1, M. Rodriguez-Bigas1, J. Skibber1, S. Matin2, G. Chang1 1University Of Texas MD Anderson Cancer Center,Surgical Oncology,Houston, TX, USA 2University Of Texas MD Anderson Cancer Center,Urology,Houston, TX, USA
Introduction:
Ileostomies are a routine part of the care of rectal cancer patients, but are associated with significant risk for dehydration, readmission, and acute kidney injury. Telemedicine has proven beneficial in decreasing readmission in chronic medical illnesses such as chronic heart failure, but its utility in the management of surgical patients is not well studied. The purpose of this study was to evaluate the feasibility of teleconferencing in the assessment of ileostomy output.
Methods:
An IRB-approved, prospective clinical trial was conducted at a single institution from November, 2014-June, 2015. Patients >18 years of age undergoing surgery with the potential for a new ileostomy were eligible. Teleconference rounds were conducted during their postoperative stay using Face Time on iPad2 tablets within a HIPPA compliant network. Teleconference rounds were followed immediately by in-person rounds. The attending surgeon evaluated the character of the ileostomy output via teleconference and subsequent in-person assessment utilizing 5-point likert scales: one rated thin to thick and one based on comparison to food products. The primary endpoint of feasibility was defined as 90% agreement between the teleconference and in-person assessments. Patient and physician satisfaction surveys were recorded. Secondary endpoints including output volume, need for antidiarrheal medications, and the incidence of dehydration related events (including need for outpatient intravenous fluids (IVFs) or readmission) were assessed.
Results:
Fifty patients were enrolled. Ileostomies were not required at surgery in ten patients who were excluded. Twelve patients did not have paired evaluations of the ostomy output and were unevaluable leaving 28 patient encounters with both teleconference and in-person evaluations. Agreement in the assessment of ileostomy output was 96.4% using the 5-point likert scale rated from thin to thick and 89.3% utilizing a comparison to food-based scale. Eleven patients (27.5%) were readmitted; including five patients for dehydration. An additional 3 patients required outpatient IVFs for an overall 20% rate of dehydration events (readmission or outpatient IVFs). Both patients and physicians viewed the teleconferencing favorably. For patients and physicians, 75% and 86.9%, respectively, felt videoconferencing should be a routine part of post-operative care. Similarly, 90.9% and 87%, respectively, felt comfortable with the use of videoconferencing in outpatient follow up.
Conclusion:
Teleconference evaluation is a feasible, reliable means of assessing ileostomy output with high patient and physician acceptance. While further study in the outpatient setting is warranted, the incorporation of early teleconference assessment after discharge may enable early intervention to improve patient outcomes by preventing dehydration and associated readmission.