From the Departments of Surgery (Soegaard Ballester, Ginzberg, Finn, Passman, Stein, Mahmoud, Kelz, Wachtel), Hospital of the University of Pennsylvania, Philadelphia, PA.
Neurosurgery (Miranda, Blue), Hospital of the University of Pennsylvania, Philadelphia, PA.
J Am Coll Surg. 2024 Aug 1;239(2):114-124. doi: 10.1097/XCS.0000000000001068. Epub 2024 Jul 17.
Federal regulations require a history and physical (H&P) update performed 30 days or less before a planned procedure. We evaluated the use and burdens of H&P update visits by determining impact on operative management, suitability for telehealth, and visit time and travel burden.
We identified H&P update visits performed in our health system during 2019 for 8 surgical specialties. As available, up to 50 visits per specialty were randomly selected. Primary outcomes were interval changes in history, examination, or operative plan between the initial and updated H&P notes, and visit suitability for telehealth, as determined by 2 independent physician reviewers. Clinic time was captured, and round-trip driving time and distance between patients' home and clinic ZIP codes were estimated.
We identified 8,683 visits and 362 were randomly selected for review. Documented changes were most commonly identified in histories (60.8%), but rarely in physical examinations (11.9%) and operative plans (11.6%). Of 362 visits, 359 (99.2%) visits were considered suitable for telehealth. Median clinic time was 52 minutes (interquartile range 33.8 to 78), driving time was 55.6 minutes (interquartile range 35.5 to 85.5), and driving distance was 20.2 miles (interquartile range 8.5 to 38.4). At the health system level, patients spent an estimated aggregate 7,000 hours (including 4,046 hours of waiting room and travel time) and drove 142,273 miles to attend in-person H&P update visits in 2019.
Given their minimal impact on operative management, regulatory requirements for in-person H&P updates should be reconsidered. Flexibility in update timing and modality might help defray the substantial burdens these visits impose on patients.
联邦法规要求在计划手术前 30 天内或更短时间内进行病史和体检（H&P）更新。我们通过确定对手术管理的影响、是否适合远程医疗以及就诊时间和旅行负担，评估了 H&P 更新就诊的使用情况和负担。
我们确定了 2019 年在我们的医疗系统中进行的 8 种外科专业的 H&P 更新就诊。在有条件的情况下，每个专业随机选择最多 50 次就诊。主要结果是在初始 H&P 记录和更新 H&P 记录之间的病史、检查或手术计划的间隔变化，以及由 2 名独立医生审查员确定的就诊是否适合远程医疗。记录了就诊时间，并估计了患者家庭住址和诊所邮政编码之间的往返驾驶时间和距离。
我们确定了 8683 次就诊，其中 362 次就诊被随机选择进行审查。病史记录中最常见的是有更改（60.8%），但体格检查（11.9%）和手术计划（11.6%）中很少有更改。在 362 次就诊中，359 次（99.2%）就诊被认为适合远程医疗。中位数就诊时间为 52 分钟（四分位距 33.8 至 78），驾驶时间为 55.6 分钟（四分位距 35.5 至 85.5），驾驶距离为 20.2 英里（四分位距 8.5 至 38.4）。在整个医疗系统中，患者在 2019 年预计总共花费了 7000 个小时（包括 4046 个小时的候诊室和旅行时间），并行驶了 142273 英里，以进行面对面的 H&P 更新就诊。
鉴于它们对手术管理的影响很小，应重新考虑对面对面 H&P 更新的监管要求。更新时间和方式的灵活性可能有助于减轻这些就诊给患者带来的巨大负担。
