K. Harkey1, N. Kaiser1, K. Mayr2, C. E. Reinke1 2Carolinas Healthcare System,Informatoin & Analytics Services,Charlotte, NC, USA 1Carolinas Medical Center,Department Of Surgery,Charlotte, NC, USA
Introduction: Cost of surgical care for patients involves both direct and indirect costs. The time investment required for routine postoperative care has not been previously studied. We evaluated the travel time to the clinic and the percent of time at the clinic spent with the surgical team. This quality improvement project aimed to quantify the time investment required by patients for postoperative clinic visits after laparoscopic cholecystectomy or laparoscopic appendectomy.
Methods: We performed prospective data collection of patient visits at a surgical clinic and retrospective determination of the distance and travel time required for each visit. Patients presenting after a laparoscopic appendectomy or laparoscopic cholecystectomy were identified and an independent observer recorded discrete time points of the visit: check-in, patient in-room, surgical team member in-room, surgical team member out of room, patient discharge. Travel time and distance was determined between each patient’s home address and our clinic address using road network speed limit and mileage analysis. Geospatial information software (ArcGIS, Network Analysis Extension) calculated the individual drive times & distances for each patient to the clinic; those times and distances were then summarized.
Results:86 patients were identified as having scheduled 88 follow-up appointments. Mean age was 48 years, 55% were female, and 63% were presenting after a cholecystectomy. Of the scheduled appointments, 85% were successfully completed, 13% were a “no-show” and 2% of them were cancelled by the patient 2-3 days prior to their scheduled appointment. Patients spent an average of 51 minutes in our clinic (range 25-116) and on average 21% of that time was spent with a surgical team member (range 2%-52%). The mean one-way travel distance to our clinic was 29 miles and the mean travel time was 37 minutes.
Conclusion: For patients who have scheduled follow-up appointments after an appendectomy or cholecystectomy in an emergency general surgery clinic, a relatively small percent of their clinic time is spent with the surgical team member. When looked at as a percentage of total visit time—including travel—the time investment required for this visit with a surgical team member is substantial. This does not account for additional time costs of parking and locating the clinic. 15% of scheduled appointments were either cancelled with short notice or the patient did not show up, creating inefficiencies in our surgical clinic and likely representing a low patient-perceived ratio of benefit to burden. This data demonstrates need for development of novel methods of providing follow-up care for surgical patients to improve patient-centeredness.
