Telehealth Safe for Some Postoperative Evaluations

James Brice

July 10, 2013

Hands-on ambulatory surgery in some instances can be followed by hands-off telehealth assessments for postoperative patient, according to a new prospective case series from the Palo Alto Veterans Administration Health System in northern California.

The study, by certified medical assistant Kimberly Hwa, MMS, PA-C, and Sherry M. Wren, MD, a professor of general surgery at Stanford Medical School in California, suggests telehealth can safely substitute for the standard postoperative clinic visit while maintaining a high level of patient satisfaction. The study was published online July 10 in JAMA Surgery.

Their findings were based on clinical experience with 115 patients who underwent elective open hernia repair and 26 patients who had laparoscopic cholecystectomy at the VA Palo Alto Hospital in California.

Both groups received postoperative follow-up involving telephone calls about 3 weeks after surgery from a physician assistant. The physician assistant performed the assessment using a scripted template that covered the most frequent postoperative complications for each procedure.

Overall, 78% (110) of patients were successfully contacted. Of those, 63 (70.8%) hernia patients and 19 (90.5%) cholecystectomy patients accepted telehealth as their exclusive mechanism for follow-up.

The physician assistant identified postoperative complications for 4.8% of the patients who underwent herniorrhaphy. Two complications involved minor wound issues treated within 30 days of surgery. One serious complication of hematoma presented acutely and required 3 emergency department interventions despite close follow-up in the clinic.

The physician assistant detected no complications from telephone consultations with cholecystectomy patients.

The authors found that nearly all patients expressed great satisfaction with the telephone follow-up method. It was credited with saving patients time and reducing their travel expenses, as well as with enabling physicians to free up more time for other patients.

The authors note that encouraging results regarding the safety and convenience of postoperative telephone follow-up have been reported in previous studies that evaluated their use in chronic medical and surgical settings for outpatient anorectal surgery, outpatient laparoscopic cholecystectomy, and pediatric adenotonsillectomy.

"This pilot project was received very positively by our surgical staff and convincingly demonstrated to them that the vast majority of selected ambulatory patient follow-up could be done by telephone, with referral to the clinic based on the telephone evaluation," the researchers write.

In an accompanying editorial, Glenn T. Ault, MD, associate professor of colorectal surgery at the University of Southern California Norris Cancer Center and Hospital in Los Angeles, placed the study into the context of impending Medicare and Medicaid reimbursement cuts for disproportionate share hospitals. The study is also timely because of a possible movement away from the global payment system for surgeries, he writes.

Telehealth follow-up could become a good way to reduce costs while maintaining an appropriate margin of safety for patients after ambulatory surgery, he notes.

"This may be an opportunity to value non-face-to-face patient encounters, recognizing this would be a lower expense to the system but would require appropriate valuation for expense and work of the physician and midlevel provider," Dr. Ault concludes.

The authors and Dr. Ault have disclosed no relevant financial relationships.

JAMA Surg. Published online July 10, 2013.


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