Impact of smartphone digital photography, email, and media communication on emergency room visits post-hypospadias repair

Abstract

Introduction: Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates. Methods: This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for ER visits within 30 days postoperatively was assessed by another physician, who was blinded of patient group assignment. The reasons were categorized as: unnecessary ER visit, indicated ER visit, or visit unrelated to hypospadias surgery. Chi-square test and T-test were used for statistical analysis. Relative risk (RR) and corresponding 95% confidence interval (CI) were also calculated. Statistical significance was set at p<0.05. Results: Over a 14-month period, 96 patients underwent hypospadias repair (81 in Group A, 15 in Group B 5). No significant difference was noted between groups for overall ER return rate (RR 0.46, 95% CI 0.21, 1.0). However, the number of ER visits for wound check not requiring intervention was significantly lower in Group A than in Group B (RR 0.14, 95% CI 0.035, 0.56); likewise, a higher number of ER visits requiring intervention was noted in Group A compared with Group B, although statistically this was not significant (RR 1.67, 95% CI 0.23, 12.21). Conclusions: Email communication with the use of smartphone digital photography significantly reduced the number of unnecessary ER visits for post-hypospadias wound checks.

High Acuity of Postoperative Consults to Emergency General Surgery at an Urban Safety Net Hospital

“…In other surgical specialties, the use of a nurse answering service or even smart phones for wound evaluation has been shown to decrease presentation to the emergency department for nonacute issues. 14,15 Physicians on-call could have reassured Skin and soft tissue (10) 5 (50%) 0 (0%) 0 (0%) 10 (100%)…”

Use of mobile health technologies for postoperative care in paediatric surgery: A systematic review

“…24 Chua et al showed that patients sending smartphone pictures of their operative sites after hypospadias repair to a urology clinic nurse had a significant decrease in rate of return to the emergency department (ED) for wound checks compared to those who did not send pictures (relative risk ¼ 0.14, p ¼ 0.01), but no difference in ED visits for other reasons. 26 Three other studies evaluating complication rates in patients undergoing multistage single-ventricle repair procedures using wireless monitoring systems found no significant differences in the number of unplanned ED visits between the mHealth and control groups. [27][28][29] Among those, Shirali et al had zero interstage deaths among the 30 patients using the CHAMP wireless monitoring system (a tablet app monitoring singleventricle patients at home during their interstage period) compared to nine deaths among 53 historical controls (17% mortality, p ¼ 0.023).…”

The Doctor Will See Yourself Now: Review and Discussion of a Mass-market Self-service Technology for Medical Advice

“…Free healthcare services providing health information have been touted as potentially useful solutions, preventing individuals entering the healthcare system at the wrong entry point (Hwang, Liao, Griffin, & Foley, 2012). This has included phone consultations (Hallfors, Saku, Makinen, & Madanat, 2018), and more recently the utilization of digital platforms (Bahadori, Teymourzadeh, & Mousavi, 2018) such as email and smartphone communications (Chua et al, 2017). These free services have the added benefit of being a potentially useful way to reach non-insured and/or low income groups which may benefit in particular with a trusted health information source (Hwang et al, 2012).…”