Extending Enhanced Recovery after Surgery Protocols to the Post-Discharge Setting: A Phone Call Intervention to Support Patients after Expedited Discharge after Pancreaticoduodenectomy

Abstract

The goal of this pilot study was to track patient outcomes after an expedited discharge after enhanced recovery after surgery (ERAS) pathway for pancreaticoduodenectomy (PD). A quantitative content analysis approach was used. All PD patients in a single academic medical center between February 2017 and June 2018 were called twice by specialized physician extenders after discharge. A semi-structured interview approach was used to identify patient's symptoms or concerns, proactively educate them, and provide outpatient management when indicated. A detailed narrative of the conversation was documented. Ninety patients (mean age 66.3; 58.1% males) were included in the study. Of all, 88.9 per cent of the patients received follow-up phone calls in accordance with our PD ERAS protocol. Among the 80 patients called, 71 (88.8%) reported at least one symptom, issue, or self-care need. The most common issues involved bowel movements and nutrition. A total of 147 interventions were performed to address patient needs including medication management, local care coordination, and outpatient referral to a healthcare provider. The intervention led to the identification of 15 patients for earlier evaluation. This identification was associated with the total number of reported symptoms ( X2 = 15.6, P = 0.004). Most patients require additional care after discharge after traditional ERAS pathways. ERAS transitional care protocols uncovered an unmet need for additional patient support after PD.

Care Fragmentation and Mortality in Readmission after Surgery for Hepatopancreatobiliary and Gastric Cancer: A Patient-Level and Hospital-Level Analysis of the Healthcare Cost and Utilization Project Administrative Database

“…The outlier outcomes of these patients is certainly multifactorial, but may be due to rare complications, the interaction of pre-existing comorbidities, and postoperative complications, or extensive operations (eg, multivisceral, vascular resection) with accompanying risk that is not well-captured using administrative coding. In addition, these outlier patients are managed differently after discharge in our practice through managed care (higher rates of discharge to a care facility or with home health, which has been associated with readmissions 46 ) and closer clinical observation (repeat visits for diagnostic procedures such as drain studies or more frequent inperson or telehealth follow-up 47 ), introducing bias in follow-up data.…”

What's going on after hospital? – Exploring the transition from hospital to home and patient experiences of nurse‐led follow‐up phone calls

“…Compared with open surgery, this has led to a significantly lower occurrence of physical complications, curtailing the hospitalisation period (Begum et al, 2014; Kehlet & Wilmore, 2008). Despite the promising benefits of ERAS and improvements in patient outcomes (Ljungqvist et al, 2017; Taurchini et al, 2018), research also highlight potential challenges and unmet needs for the patients requiring additional care after discharge (Senturk et al, 2017; Takchi et al, 2020). From the patients' perspective, the article titled Regaining familiarity with own body after treatment for operable lung cancer – a qualitative longitudinal exploration illuminates how transitioning home after surgery is considered to be a critical moment requiring follow‐up for patients in ERAS (Missel et al, 2016).…”

Optimizing Discharge After Shorter Hospitalizations: Lessons Learned Through After-Hours Calls with Thoracic Surgical Patients

“…Prior studies have demonstrated the efficacy of clinicianinitiated, post-discharge telephone follow-up in identifying and addressing patient concerns and postoperative issues, with associated decreased emergency room visits and readmission rates. [11][12][13][14] Thus, some surgical groups have extended their ERAS protocols to include a post-discharge clinician-initiated follow-up phone call to address patient concerns or symptoms that may warrant re-evaluation by a provider. 12,15 We have previously demonstrated that approximately 33% of patients discharged after pulmonary resection experienced ongoing or new concerns after return home.…”

“…[11][12][13][14] Thus, some surgical groups have extended their ERAS protocols to include a post-discharge clinician-initiated follow-up phone call to address patient concerns or symptoms that may warrant re-evaluation by a provider. 12,15 We have previously demonstrated that approximately 33% of patients discharged after pulmonary resection experienced ongoing or new concerns after return home. 15 Post-discharge clinician-initiated phone calls are an effective strategy for evaluating such concerns, enabling minor issues to be addressed via telephone counseling and providing a means to identify major issues that require escalation of the level of care.…”