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使用安全在线患者门户的术后护理:改变普通外科的(互)面孔。

Postoperative Care Using a Secure Online Patient Portal: Changing the (Inter)Face of General Surgery.

作者信息

Kummerow Broman Kristy, Oyefule Omobolanle O, Phillips Sharon E, Baucom Rebeccah B, Holzman Michael D, Sharp Kenneth W, Pierce Richard A, Nealon William H, Poulose Benjamin K

机构信息

Department of Surgery, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center, Tennessee Valley Health care System, Veterans Affairs Medical Center, Nashville, TN.

Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.

出版信息

J Am Coll Surg. 2015 Dec;221(6):1057-66. doi: 10.1016/j.jamcollsurg.2015.08.429. Epub 2015 Sep 23.

Abstract

BACKGROUND

Many patients seek greater accessibility to health care. Meanwhile, surgeons face increasing time constraints due to workforce shortages and elevated performance demands. Online postoperative care may improve patient access while increasing surgeon efficiency. We aimed to evaluate patient and surgeon acceptance of online postoperative care after elective general surgical operations.

STUDY DESIGN

A prospective pilot study within an academic general surgery service compared online and in-person postoperative visits from May to December 2014. Included patients underwent elective laparoscopic cholecystectomy, laparoscopic ventral hernia repair, umbilical hernia repair, or inguinal hernia repair by 1 of 5 surgeons. Patients submitted symptom surveys and wound pictures, then corresponded with their surgeons using an online patient portal. The primary outcome was patient-reported acceptance of online visits in lieu of in-person visits. Secondary outcomes included detection of complications via online visits, surgeon-reported effectiveness, and visit times.

RESULTS

Fifty patients completed both online and in-person visits. Online visits were acceptable to most patients as their only follow-up (76%). For 68% of patients, surgeons reported that both visit types were equally effective, while clinic visits were more effective in 24% and online visits in 8%. No complications were missed via online visits, which took significantly less time for patients (15 vs 103 minutes, p < 0.01) and surgeons (5 vs 10 minutes, p < 0.01).

CONCLUSIONS

In this population, online postoperative visits were accepted by patients and surgeons, took less time, and effectively identified patients who required further care. Further evaluation is needed to establish the safety and potential benefit of online postoperative visits in specific populations.

摘要

背景

许多患者寻求更便捷的医疗服务。与此同时,由于劳动力短缺和更高的绩效要求,外科医生面临着越来越大的时间限制。在线术后护理可能会改善患者就医机会,同时提高外科医生的效率。我们旨在评估择期普通外科手术后患者和外科医生对在线术后护理的接受程度。

研究设计

2014年5月至12月,在一家学术性普通外科服务机构内进行了一项前瞻性试点研究,比较了在线和面对面的术后随访。纳入的患者接受了5名外科医生之一进行的择期腹腔镜胆囊切除术、腹腔镜腹疝修补术、脐疝修补术或腹股沟疝修补术。患者提交症状调查和伤口照片,然后通过在线患者门户与他们的外科医生进行沟通。主要结果是患者报告对在线随访代替面对面随访的接受程度。次要结果包括通过在线随访检测并发症、外科医生报告的有效性以及随访时间。

结果

50名患者完成了在线和面对面随访。大多数患者接受在线随访作为他们唯一的后续随访(76%)。对于68%的患者,外科医生报告两种随访方式同样有效,而24%的患者认为门诊随访更有效,8%的患者认为在线随访更有效。通过在线随访没有遗漏任何并发症,患者进行在线随访所需时间明显更少(15分钟对103分钟,p<0.01),外科医生进行在线随访所需时间也明显更少(5分钟对10分钟,p<0.01)。

结论

在这一人群中,患者和外科医生都接受在线术后随访,随访时间更短,并且能够有效识别需要进一步护理的患者。需要进一步评估以确定在线术后随访在特定人群中的安全性和潜在益处。

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