324 DEVELOPMENT AND IMPLEMENTATION OF A VISUAL ASSESSMENT TOOL FOR PARENTAL INSTRUCTION AND GUIDANCE AFTER PEDIATRIC AMBULATORY PENILE SURGERY

Abstract

You have accessJournal of UrologyPediatrics: Andrology-Cryptorchidism & Varicoceles1 Apr 2011324 DEVELOPMENT AND IMPLEMENTATION OF A VISUAL ASSESSMENT TOOL FOR PARENTAL INSTRUCTION AND GUIDANCE AFTER PEDIATRIC AMBULATORY PENILE SURGERY Caleb Nelson, Ilina Rosoklija, and Rosemary Grant Caleb NelsonCaleb Nelson Boston, MA More articles by this author , Ilina RosoklijaIlina Rosoklija Boston, MA More articles by this author , and Rosemary GrantRosemary Grant Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.407AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The transition to pediatric ambulatory surgery has shifted post-operative care responsibilities from trained hospital staff to the child's parents. Most of these parents have little or no medical training or experience, yet are expected to perform assessment and wound care. The lack of experience may be particularly manifest after procedures such as surgical circumcision, where the surgical site is an external structure that parents examine multiple times each day. We sought to develop a visual tool to assist parents in assessing healing after surgical circumcision and revision. METHODS With parental permission, photographic images of the penis were obtained on post-operative days 0, 1, 2, 3, 5, 7, 10, 14 and 21. Images of 16 patients with normal healing were compiled into an atlas. Utility of the atlas was assessed during 2 month-long periods, with standard instructions provided during the first month (M1), and the atlas provided during the second month (M2). Post-op, families were contacted by phone and administered an 8-item post-operative parental survey of anxiety and satisfaction, based on the State-Trait Anxiety Inventory and the Amsterdam Scale. Additional outcomes included qualitative parental responses to the atlas, as well as the number of post-operative phone contacts. RESULTS 83 procedures were performed during M1 vs. 77 during M2. During M1, 33 families (40%) were surveyed; 39 families (51%) were surveyed in M2. Among the 22 who received the atlas, nearly all respondents reported that the atlas was helpful (59% very helpful, 27% moderately helpful, 9% somewhat helpful). All but one family used the atlas. On the post-operative survey, there was no significant difference between M1 and M2 in total scores (11.8 vs. 12.4, p=0.62), the number satisfied with the care provided (76% vs. 82%, p=0.31) or the number whose expectations were met (58% vs. 55%, p=0.21). Families receiving the atlas were more comfortable with post-operative instructions, although the difference was not significant (64% vs. 82% very comfortable, p=0.12). The number of phone calls decreased from M1 to M2 (24 vs. 12), and as a proportion of total cases performed (29% vs. 16%, p=0.04). 42% of callers reported that the atlas was useful. CONCLUSIONS The circumcision atlas was well-received by families and was associated with a significant decrease in post-surgical telephone calls. Parental anxiety did not change measurably. The atlas has been put into routine clinical use with excellent response. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e131 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Caleb Nelson Boston, MA More articles by this author Ilina Rosoklija Boston, MA More articles by this author Rosemary Grant Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...