J. M. Soegaard Ballester2,5, C. Neylan3, M. F. Scott1, L. Owei1, R. Rosin5,6,7, C. W. Hanson1,2,4,5, J. B. Morris1 1University Of Pennsylvania,Department Of Surgery/Perelman School Of Medicine,Philadelphia, PA, USA 2University Of Pennsylvania,Perelman School Of Medicine,Philadelphia, PA, USA 3Rutgers University,Robert Wood Johnson Medical School,New Brunswick, NJ, USA 4University Of Pennsylvania,Department Of Anesthesia/Perelman School Of Medicine,Philadelphia, PA, USA 5University Of Pennsylvania,University Of Pennsylvania Health System,Philadelphia, PA, USA 6University Of Pennsylvania,Penn Medicine Center For Health Care Innovation,Philadelphia, PA, USA 7University Of Pennsylvania,Leonard Davis Institute,Philadelphia, PA, USA
Introduction: Focusing on delivery of high-value care, we describe our implementation of telephone postoperative visits (TPOVs) as alternatives to in-person follow-up after routine, low-risk surgery. Our pilot sought to assess the feasibility of offering TPOVs as well as to evaluate patient satisfaction and clinical outcomes.
Methods: Enabling TPOVs required submitting a policy proposal to the Department of Health, evaluating implications for surgical global period reimbursement, and updating provider credentials and privileges. We offered TPOVs to all clinically eligible, in-state patients scheduled for appropriate low-risk surgeries, such as: laparoscopic cholecystectomy (LC), open inguinal hernia repair (IHR), umbilical hernia repair (UHR), and minor ventral hernia repair (mVHR). The attending surgeon determined clinical eligibility by assessing the patient’s surgical plan and global clinical picture. Out-of-state patients were excluded given current regulations governing the practice of medicine across state lines. Within 2 weeks of surgery, an advanced practitioner conducted the TPOV following a structured template addressing all postoperative milestones. Patients were discharged from routine follow-up if both they and the practitioner agreed that recovery was satisfactory.
Results: Of 64 eligible patients, 62 opted for a TPOV between April and August 2016 (Figure 1), with most citing convenience (56%), travel (31%), and time (18%) as main motivations. The average patient opting in was 54 years old (range 22−90, 34% ≥ 65) and lived 19.4 miles from our clinic (range 0.9−121.0).
Of 24 patients completing TPOVs, all were satisfied with the TPOV as their sole postoperative visit (POV) and 21 were discharged from routine follow-up. Three required additional remote management, including diagnosis and treatment of a UTI, monitoring of a wound hematoma via electronically transmitted pictures, and review of postoperative LFTs. On average, TPOVs lasted 9.13 minutes, compared to the 86.3-minute mean end-to-end in-clinic POV time for this surgeon. Adding round-trip driving times from Google Maps, we estimate each patient saved an average of 159−228 minutes, or 95−96% of the time that they would have spent coming to clinic for their POV.
Conclusion: We have successfully piloted TPOVs at our urban surgical practice with plans to scale our implementation. Many patients, including those with shorter travel times, find TPOVs more convenient than in-clinic visits. Moreover, estimates of time saved are compelling. Telehealth is a rapidly evolving delivery paradigm, with changing regulations and reimbursement. Widespread adoption will be contingent upon ensuring equivalent—or improved—outcomes.
