Efficacy and Utility of the Pediatric General Surgery Telephone Call Follow-Up Versus Traditional Clinic Follow-Up

Sunday, October 27, 2013: 9:44 AM
Windermere Ballroom W (Hyatt Regency Orlando, formerly the Peabody)
Daniel von Allmen, MD, FACS, FAAP, Kevin S. Fischer, RN, MSN, APRN, Virginia Hogan, RN, MSN, APRN and Alesha Jager, RN, MSN, APRN, Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Efficacy and Utility of the Pediatric General Surgery Telephone Call Follow-up versus Traditional Clinic Follow-up

Abstract

Purpose

Standard follow-up following routine surgical procedures typically consist of an interim history to identify potential problems and a cursory physical exam.  However, these appointments rarely identify problems, occupy significant clinic resources, and require a significant investment by the family.  Previous studies have demonstrated the safety of telephone follow-up.  In August 2011, a telephone follow-up protocol was adopted for the entire practice.  A nurse practitioner contacted families by telephone 2 weeks following there select surgical procedure to assess for potential complications and answer any questions.  In the current study, the traditional postoperative clinic follow-up for a select group of pediatric general surgeries was replaced with a telephone call follow-up conducted by a surgery nurse practitioner. In this study the impact of telephone follow-up on patient satisfaction, clinic appointment utilization, and health care resources was measured. 

Methods

A retrospective review was conducted to compare 6 months prior to and 6 months after our implementation of the telephone protocol.  Several variables where looked at including the number of scheduled post-operative clinic appointments, the percentage of patients who had a successful follow-up, and the administrative cost associated with each method.  Families were also surveyed asking about there satisfaction with the new protocol.   

Results

Table 1 compares several measured variables 6 months prior to the implementation of our telephone follow-up protocol and 6 months after the implementation.    The overall numbers show that the telephone follow-up protocol had a significant decrease in the number of patients scheduled for a post-operative clinic appointment.  There was also a statically significant improvement in the percentage of successful follow-ups with the telephone protocol, and the new protocol resulted in a substantial administrative cost savings for the institution.  Finally, 93% (n=231) of families reported a high level of satisfaction with the protocol. 

Before

After

Outcome

Number of scheduled post-operative clinic appointments

1090

703

36% decrease

Successful completion of follow-up (percentage)

56

63

p < 0.01

Cost per completed encounter (clinic vs. phone)

$101.75

$12.50

88% cost savings

Conclusion

Telephone follow-up for uncomplicated select routine surgical procedure decreased the overall number of scheduled post-operative clinic appointments while increasing the rate of follow-up contact with patients and families.  The telephone follow-up satisfied families, allowed more efficient use of clinic resources, and a decreased cost to the institution.   Finally, the new protocol resulted in an inferred savings to patients and families with the elimination of taking time off work and school for a clinic follow-up.