Reducing ER Visits and Readmissions after Head and Neck Surgery Through a Phone-based Quality Improvement Program

Abstract

Objective: Evaluate the impact of a patient phone calls and virtual wound checks within 72 hours of discharge on reducing emergency room (ER) visits and readmissions. Methods: Single arm trial with comparison to historical control data of patients undergoing multi subsite head and neck cancer operations or laryngectomy between July 2017 and June 2018 at a tertiary academic medical center. Patients were contacted within 72 hours of hospital discharge. As a supplement to the call, patients were given the opportunity to video conference with and/or send pictures to the provider with additional questions via a designated wound care phone. Results: Ninety-one patients met inclusion criteria, of whom 83 (91.2%) were contacted. Six patients (7%) were readmitted, of whom three had not been able to be reached. The patients who had been unable to be contacted were readmitted for dysphagia (2), and a urinary tract infection (1). The contacted patients were advised to go the ER during the call for concerns for postoperative bleeding (2) and gastrointestinal bleeding (1). Twenty-five patients (30%) utilized the wound care phone. 18 patients (21.7%) reported that the phone call survey prevented them from going to the ER. When compared to the prior year, there was as statistically significant decrease in ER visits ( P < .05), and no change in readmissions. Conclusions: Implementation of a phone call in the early postoperative period has the potential to decrease unnecessary ER visits and enhance patient satisfaction. This may decrease strain on the health care system and improve patient care. Level of Evidence: Level 4

Outcomes With a Mobile Digital Health Platform for Patients Undergoing Spine Surgery: Retrospective Analysis

“…Prior research on postoperative ER visits has discovered that early postoperative phone calls and telehealth visits from clinical personnel can help minimize ER visits [ 13 , 14 ], implying that early patient engagement and communication can help alleviate the health care system’s burden. Although telehealth visits and phone calls may alleviate some of the strain on health care resources, they are time-consuming and difficult to scale.…”

Impact of post-discharge phone calls on non-urgent hospital returns < 90 days following primary bariatric surgery

“…Similarly, in patients being treated for colorectal cancer, a pilot randomized control trial examining the effectiveness of a nurse-delivered telephone supportive intervention demonstrated a non-significant reduction in presentations to emergency department (21% vs 33%; p = 0.23) and readmission to the hospital (37% vs 47%; p = 0.37), 6 months after surgery [ 16 ]. Conversely, Shah et al demonstrated a significant decrease in ED visits (19.2% vs 6.6%; p = 0.01) but not readmissions (10.2% vs 7%; p = 0.4) in patients called within 72 h of being discharged after multi-site head and neck cancer operations and total laryngectomies [ 17 ], and Iqbal et al demonstrated that discharge phone calls, post-ileostomy creation, significantly decreased readmission for dehydration from 65 to 16% ( p = 0.002), albeit calls were being made daily for 3 weeks [ 18 ].…”

Using telemedicine to facilitate social distancing in otolaryngology: A systematic review

“…This review identified a number of telemedical interventions which do not require the use of specialised equipment and can be implemented with simple Internet-capable devices that patients already have at home. Five studies used the basic camera and microphone functions of smartphones to diagnose otorhinolaryngologic disorders 8 , 14 , 17 , 18 , 40 and three studies used highly sensitive questionnaires, administered over a basic telephone call, to monitor for post-procedural complications and disease recurrence. 7 , 9 , 10…”