Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9159, USA.
Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA.
Surg Endosc. 2021 Oct;35(10):5760-5765. doi: 10.1007/s00464-020-08055-9. Epub 2020 Oct 13.
Telemedicine has been shown to improve patient access to medical care while potentially improving overall healthcare efficiency. It has not been consistently explored on an acute care surgery service as a method of increasing clinic availability and efficiency within a safety-net hospital system. Socioeconomic hardships associated with an in-person clinic visit can deter patients with limited resources. A virtual clinic for post-operative laparoscopic cholecystectomy patients was developed. We hypothesized that a virtual follow-up increases clinic efficiency and availability for new patients without compromising patient safety.
A retrospective review of patient and clinic outcomes before and after implementing virtual post-op visits for uncomplicated laparoscopic cholecystectomy patients on an acute care surgery service was performed. Providers called post-operative patients using a standardized questionnaire. Data included outpatient clinic composition (new vs. post-operative patients), elective operations scheduled, emergency department visits, and loss to follow-up rates.
February to March 2017 was the baseline pre-intervention period, while February to March 2019 was post-intervention. Pre-intervention clinics consisted of 17% new and 50% post-op visits, in comparison to 31% new and 27% post-op visits in the post-intervention group (p < 0.01). Elective operations scheduled increased slightly from 8.4 to 11.5 per 100 patient visits, but was not statistically significant (p = 0.09). There was no change in the number of post-operative patients returning to the emergency department (p = 0.91) or loss to follow-up (p = 0.30) rates.
Through the implementation of virtual post-operative visits for laparoscopic cholecystectomy patients, clinic efficiency improved by increasing new patient encounters, decreasing post-operative volume, and trending towards increased operations scheduled. This change did not compromise patient safety. Further implementation of telemedicine on an acute care surgery service is a promising method to expand services offered to an at-risk population and increase efficiency in a resource-limited environment.
远程医疗已被证明可以改善患者获得医疗服务的机会，同时可能提高整体医疗保健效率。然而，在以安全网为基础的医院系统中，作为增加诊所可用性和效率的方法，其在急症外科服务方面的应用并未得到一致探索。与门诊就诊相关的社会经济困难可能会阻止资源有限的患者就诊。为此，我们为腹腔镜胆囊切除术患者开发了一个虚拟诊所。我们假设虚拟随访可以提高新患者的诊所效率和可用性，同时又不会影响患者安全。
我们对在急症外科服务中为接受简单腹腔镜胆囊切除术的患者实施虚拟术后随访前后的患者和诊所结果进行了回顾性分析。医生使用标准化问卷电话随访术后患者。数据包括门诊构成（新患者与术后患者）、择期手术安排、急诊科就诊和失访率。
2017 年 2 月至 3 月为干预前的基线期，而 2019 年 2 月至 3 月为干预后。与干预前组相比，干预后组的门诊中，新患者占比从 17%增加到 31%，而术后患者占比从 50%下降到 27%（p<0.01）。每 100 名患者就诊的择期手术安排略有增加，从 8.4 例增加到 11.5 例，但无统计学意义（p=0.09）。术后患者返回急诊科的数量（p=0.91）或失访率（p=0.30）均无变化。
通过为腹腔镜胆囊切除术患者实施虚拟术后随访，通过增加新患者就诊次数、减少术后就诊量，并有望增加手术安排，提高了诊所效率。这种变化并未影响患者安全。在急症外科服务中进一步实施远程医疗是一种很有前途的方法，可以向高危人群提供更多的服务，并在资源有限的环境中提高效率。
