Authors (including presenting author) :
Sin MWS(1), Choi WK(1), Lo WC(1), Szeto L(1)
Affiliation :
(1) Department of Anaesthesia & Operating Theatre Services, Tseung Kwan O Hospital
Introduction :
Ensuring positive patient outcomes and facilitating speedy recovery from surgery are important missions of the perioperative team. Traditionally, nurses would follow up day surgery patient one day after operation by phone calls. However, this method had limitations in assessing wounds and non-verbal cues, which were crucial for early complications detection. At Tseung Kwan O Hospital Ambulatory Surgery Services, we offer telehealth technologies to improve patient safety and satisfaction in the postoperative care.
Objectives :
This study aimed to assess the efficacy of telehealth consultations in improving postoperative recovery among day surgery patients compared to traditional telephone follow-ups. The PICO framework focused on postoperative patients (Population), telehealth consultations (Intervention), phone follow-ups (Comparison), and recovery outcomes in home setting (Outcome).
Methodology :
The project was implemented in December 2023, involving the recruitment of 29 patients in the telehealth group and compared with 31 patients in the phone follow-up group, both with similar characteristics (patient demographics). Clear inclusion criteria (e.g. Patient with high anaesthetic risk/received postoperative treatment before discharge etc.), and exclusion criteria (e.g. language barrier/ unable to access smartphone etc.) were well established. Five specialties and seven types of day surgery were included. Target participants were invited and educated on using the HA Go app for telehealth on admission day. Key outcome measures included postoperative complications with immediate treatment, unnecessary hospital visits: AED admission within 7 days and readmission within 30 days after operation, patient and carers' satisfaction were used for the project evaluation.
Result & Outcome :
Teleconsultations averaged 17 minutes, while phone follow-ups lasted about 3 minutes. The telehealth group detected seventeen postoperative complications compared to seven in the phone group, resulting in a relative risk (RR) of 0.26, indicating teleconsultations were 2.6 times more effective in identifying postoperative complications. The Number Need to Treat (NNT) was -3, signifying that for every three teleconsultations conducted, one additional postoperative complication was identified that would have been missed through phone follow-ups. Only one patient in the telehealth group required AED admission within 7 days, compared to four in the phone group, demonstrating a 73% lower risk of AED admission in telehealth group when compared with phone group. Additionally, there was one readmission in the phone group and none in the telehealth group within 30 days after operation, reflecting an 89% lower risk of readmission in the telehealth group when compared to the phone group. Patient and carers' satisfaction average 3.759 out of 4 for the postoperative telehealth services, with patient and carers expressing confidence in the nurses' ability to provide appropriate postoperative advice.
Overall, the results indicate teleconsultation is an effective approach for postoperative monitoring, facilitating early detection of postoperative complications and reducing unnecessary hospital visits. Future efforts will explore extension of telehealth to other specialties and the development of hybrid care telehealth systems (e.g. including Pain nurse, CNS nurse, physio etc.) to strengthen local telehealth resources for enhancing patient safety.
