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Original Investigation | Pacific Coast Surgical Association

Telehealth Follow-up in Lieu of Postoperative Clinic Visit for Ambulatory Surgery:  Results of a Pilot Program

Kimberly Hwa, MMS, PA-C1; Sherry M. Wren, MD1,2
[+] Author Affiliations
1Palo Alto Veterans Administration Health Care System, Palo Alto, California
2Stanford University School of Medicine, Stanford, California
JAMA Surg. 2013;148(9):823-827. doi:10.1001/jamasurg.2013.2672.
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Published online

Importance  Telehealth encounters can safely substitute for routine postoperative clinic visits in selected ambulatory surgical procedures.

Objective  To examine whether an allied health professional telephone visit could safely substitute for an in-person clinic visit.

Design  Prospective case series during a 10-month study period from October 2011 to October 2012 (excluding July and August 2012).

Setting  University-affiliated veterans hospital.

Patients  Ambulatory surgery patients who underwent elective open hernia repair or laparoscopic cholecystectomy during the 10-month study period.

Interventions  Patients were called 2 weeks after surgery by a physician assistant and assessed using a scripted template. Assessment variables included overall health, pain, fever, incision appearance, activity level, and any patient concerns. If the telephone assessment was consistent with absence of infection and return to baseline activities, the patient was discharged from follow-up. Patients who preferred a clinic visit were seen accordingly.

Main Outcomes and Measures  Percentage of patients who accepted telehealth follow-up and complications that presented in telehealth patients within 30 days of surgery.

Results  One hundred fifteen open herniorrhaphy and 26 laparoscopic cholecystectomy patients had attempted telehealth follow-up. Seventy-eight percent (110) of all patients were successfully contacted; of those, 70.8% (63) of hernia patients and 90.5% (19) of cholecystectomy patients accepted telehealth as the sole means of follow-up. Complications in the telehealth patients were zero for cholecystectomy and 4.8% (3) for herniorrhaphy. Nearly all patients expressed great satisfaction with the telephone follow-up method.

Conclusions  Telehealth can be safely used in selected ambulatory patients as a substitute for the standard postoperative clinic visit with a high degree of patient satisfaction. Time and expense for travel (7-866 miles) were reduced and the freed clinic time was used to schedule new patients.

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Figures

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Figure 1.
Flow Schema of Eligible Telehealth Patients
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Figure 2.
Round-trip Mileage and Travel Time

A, Round-trip distance traveled from patients’ homes to the Palo Alto Veterans Administration Hospital as calculated by Google Maps. B, Round-trip commute distance measure during clinic hours as calculated by Google Maps.

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