Preoperative Telephone Research Articles

A Comparison of Preoperative Telephone Call Versus Mailed Educational Materials on Patient-Reported Outcomes in Mohs Micrographic Surgery.

Preoperative education has uncertain benefits on the preparedness and satisfaction of patients undergoing Mohs micrographic surgery (MMS). We sought to determine the effect of a preoperative telephone call on preparedness and satisfaction in patients undergoing same-day office consultation and MMS. All new patients ( N = 208) scheduled for same-day office consultation and MMS were mailed a standardized preoperative packet. Approximately half of those patients were randomly selected to also receive a preoperative phone call. On the day of the surgery, patients completed an anonymous preoperative and postoperative survey assessing their preparedness and satisfaction with the preoperative education received. There was no significant difference in patient preparedness between the letter only (LO) and phone call and letter study groups. There was a significant difference in preoperative satisfaction-a higher percentage of LO patients were "somewhat satisfied" or "not satisfied" with the preoperative education received ( p = .013). Preoperative phone consultation, in addition to mailed educational materials, did not have a statistically significant effect on patient preparedness in patients undergoing MMS; however, there was a trend toward increased satisfaction with the preoperative education provided in patients who received a preoperative phone call.

Cost Effectiveness of Additional Preoperative Telephone Call to Increase Surgical Preparedness: Analysis of a Randomized Clinical Trial.

There is a need for cost effective interventions that increase surgical preparedness in urogynecology. We performed an ancillary prospective economic evaluation of the Telehealth Intervention to Increase Patient Preparedness for Surgery (TIPPS) Trial, a randomized multicenter trial that evaluated the impact of a preoperative telehealth call on surgical preparedness in women undergoing urogynecologic surgery. A within-trial analysis from the health care sector and societal perspective was performed. Cost-effectiveness was computed from health care sector and societal perspectives, with an 8-week time horizon. A total of 126 women were included in our analysis. QALYs gained were similar between groups (telehealth 0.1414 + 0.0249; usual care 0.1409 + 0.0179). The cumulative mean per-person costs at 8 weeks from the healthcare sector perspective were telehealth call: $8696 +/- 3341; usual care: $8473 +/- 3118 (p = 0.693) and from the societal perspective were telehealth call: $11,195 + 5191; usual care: $11,213 +/- 4869 (p = 0.944). The preoperative telehealth call intervention was not cost effective from the health care sector perspective with an ICER of $460,091/QALY (95%CI -$7,382,608/QALY, $7,673,961) using the generally accepted maximum willingness to pay threshold of $150,000/QALY (Neumann et al. N Engl J Med. 371(9):796-7, 2014). From the societal perspective, because incremental costs per QALY gained were negative $-35,925/QALY (95%CI, -$382,978/QALY, $317,226), results suggest that preoperative telehealth call dominated usual care. A preoperative telehealth call is cost effective from the society perspective. Registered with http://ClinicalTrials.gov . Date of registration: March 26, 2019 Date of initial participant enrollment: June 5, 2019 URL: https://clinicaltrials.gov/ct2/show/record/NCT03890471 Clinical trial identification number: NCT03890471.

(478) Patient and Partner Expectations Before Inflatable Penile Implant Surgery: A Qualitative Analysis

Abstract Introduction Patient and partner expectations before inflatable penile prosthesis (IPP) surgery and satisfaction after IPP have not been well studied. Objective The purpose of this study is to qualitatively investigate preoperative expectations of patients and partners. Methods Participants included men undergoing IPP surgery for erectile dysfunction (ED) at our institution. We also included interested partners. Information was collected via preoperative telephone interview. Semantic and latent themes were identified using qualitative inductive thematic analysis. Results Sixteen patients and 6 partners were interviewed prior to IPP surgery. Patients reported penetrative sex as the preferred form of intercourse (100%), orgasm as the desired endpoint for both participants (86.7%), and diminished self-confidence secondary to erectile dysfunction (66.7%). Partners preferred penetrative sex (60%) and the majority denied orgasm as necessary for their satisfaction (80%). Ideally, patients desired intercourse more than three times per week (87.5%), while partners desired intercourse less than 2 times per week (80%). Most patients reported that their partner was unsatisfied with their sexual activity (93.8%), however patients and partners denied communication with their partner regarding sexual desires or satisfaction (86.7%). All patients (100%) and nearly half of partners (40%) hoped to engage in penetrative sex following IPP placement, while most partners desired restored confidence for the patient following surgery (80%). Conclusions Preoperative expectations differ between patients undergoing IPP surgery and their partners. Understanding the impact of these differences on postoperative satisfaction is necessary to identify favorable surgical candidates and provide appropriate preoperative counseling. Disclosure No

Accuracy of Self-Estimated BMI in the Context of Telephone Assessment Before Elective General Surgery.

Background This study aimed to determine if self-estimated body mass index (BMI) from telephone consultation was accurate and useful for surgical planning prior to elective general surgery. Methods A prospective cohort study was performed under a single surgeon at a district general hospital in the United Kingdom. Estimated BMI was collected from consecutive patients attending a pre-operative telephone consultation. Actual BMI was measured on the day of surgery and compared. Patient age and gender were also collected. Results Data were collected from 124 participants (median age 59 years, 49.2% male). A total of 33 participants under-estimated, 53over-estimated, and 38 accurately estimated their BMIs. The median change in BMI was 0.0 (IQR -0.1, 0.3, p = 0.003). The median change in males was 0.0 (-0.1, 0.2, p = 0.479) compared to 0.1 (0.0, 0.7, p = 0.002) in females. Those with an actual BMI > 29.9 had a significantly higher median change (0.2 {0.0, 1.1}) compared to those with BMI≤ 29.9 (0.0 {-0.2, 0.1}; p <0.001). Only two patients could have required a change in surgeon on the day of the procedure and this was not statistically significant (p = 0.500). Conclusions Self-estimated BMI, collected via telephone consultation, is a suitable method for assessing patients for surgical planning ahead of elective general surgery procedures, particularly for males. However, it is important to be aware that those with higher BMIs, particularly females, may underestimate their BMIs.

WE8.5 Can self-estimated BMI be used for pre-operative planning in elective general surgery?

AimsTelemedicine is being increasingly used in outpatient settings following the COVID-19 pandemic. This study aimed to determine if self-estimated body mass index (BMI), from telephone consultation, was accurate and useful for planning prior to elective general surgery.MethodsAge, gender and estimated BMI were collected from consecutive patients attending a pre-operative telephone clinic under a single surgeon at a district general hospital in the South of England between April and October 2021. Actual BMI was measured on the day of surgery and compared.Results124 patients were included (median age 59 years, 49.2% male). BMI was accurately estimated by 38, under-estimated by 33 and over-estimated by 53 participants. Overall, there was a significant difference in the pre-operative and post-operative BMI (p = 0.003). This was significant for females (median change 0.1, IQR 0.0–0.7, p = 0.002) but not for males (median change 0.0, IQR -0.1, 0.2, p = 0.479). Those with an actual BMI >29.9 had a significantly higher median change (0.2 (0.0, 1.1) compared to those with BMI ≤29.9 (0.0 (-0.2, 0.1); p <0.001). Only 2 patients could have required a change in surgeon on the day of the procedure (p = 0.500).ConclusionsSelf-estimated BMI is a suitable method for assessing patients for planning in elective general surgical procedures, particularly for males. However, it is important to be aware of those with higher BMIs, particularly females, who may underestimate their BMI.

"I Wish Someone had Asked Me Earlier"-Perspectives on Advance Care Planning in Surgery.

"I Wish Someone had Asked Me Earlier"-Perspectives on Advance Care Planning in Surgery.

Effect of preoperative telephone interview in the cancellation rate of daytime surgery in eye hospitals

Effect of preoperative telephone interview in the cancellation rate of daytime surgery in eye hospitals

Preoperative telephone medical clearance for ophthalmic surgeries.

From the Northeast Ohio Medical University, Rootstown, Ohio (A.G. Miller, Obri); Retina Associates of Cleveland Inc., Cleveland, Ohio (D.G. Miller). Corresponding author: David G. Miller, MD, Retina Associates of Cleveland, 3401 Enterprise Pkwy, Suite 300, Cleveland, Ohio 44122. Email: [email protected]. Disclosures: None reported. First author:Alexander G. Miller, BSNortheast Ohio Medical University, Rootstown, Ohio

20 Cost effectiveness of additional preoperative telephone visit: Analysis of a randomized trial on surgical preparedness

20 Cost effectiveness of additional preoperative telephone visit: Analysis of a randomized trial on surgical preparedness

Patient and Parent Engagement in Preoperative Telephone Call for Efficiency in Elective Surgery

Introducton Late starts in the operating room (OR) create inefficiency, wasting resources including time, labor, and money. The purpose of this project was to determine how a modified preoperative telephone call could impact first-case start times, using Pareto's theory of efficiency and Homans's social exchange theory to bring the patient in as a partner in care. Method This preintervention–postintervention project compared telephone call methodologies and its effect on first-case start time. Previously, the OR clerk called the patient/parent and read a list of instructions. For this study, the clerk was retrained by the researcher to involve the patient/parent in the dialogue. Instead of “Be sure to do all prescribed tests ordered by physician before you come,” the language was “Did your doctor give you any instructions for Billy? Tell me about it? What have you done already?” The control group was measurement of late starts for 120 cases before the intervention and matched to 120 cases after the intervention. Results Statistical analysis showed a 7.5% improvement in the number of late start cases, from 31/120 to 22/120. The number of late minutes decreased from 500 to 171 (p = .010). Discussion As each hour in the OR is billed at approximately $3,000, implementation of this modified preoperative telephone call significantly improved operational efficiency with $0 cost to the organization. The number of late cases was decreased, and the time saved was surprisingly compelling.

The impact of pre-operative telephone support and education on symptoms of anxiety, depression, pain and quality of life post total knee replacement: An exploratory case study

The impact of pre-operative telephone support and education on symptoms of anxiety, depression, pain and quality of life post total knee replacement: An exploratory case study

Preoperative telephone consultation does not decrease patient anxiety before Mohs micrographic surgery

Many factors influence anxiety and satisfaction of patients undergoing Mohs micrographic surgery (MMS). We sought to determine the effect of a preoperative educational telephone call on anxiety and satisfaction for patients undergoing same-day office consultation and MMS. Patients with skin cancer (N=104) scheduled for same-day office consultation and MMS were randomly assigned to receive or not to receive an educational telephone call during the week before surgery. All patients rated their anxiety levels immediately before and after the same-day office consultation and MMS by completing the State-Trait Anxiety Inventory and an anxiety visual analog scale. Patients also rated satisfaction immediately after MMS by completing the Visit-Specific Patient Satisfaction Questionnaire. Patients undergoing same-day office consultation and MMS reported similar levels of increased anxiety and high satisfaction, regardless of whether they received a preoperative educational telephone call. Lack of control for patients' prior surgery or self-education is a limitation. Preoperative educational telephone calls did not relieve anxiety or improve satisfaction for patients undergoing same-day office consultation and MMS. Preoperative education and counseling has uncertain benefits to anxiety and satisfaction of patients undergoing MMS.

Effectiveness of an Advanced Practice Nurse-Led Preoperative Telephone Assessment.

The purpose of this project was to determine the effectiveness of an advanced practice nurse-led preoperative telephone assessment in reducing day-of-surgery cancellations of patients at an ambulatory surgery center. We concluded that a good history obtained by a trained and experienced advanced practice nurse or registered nurse can reduce day-of-surgery cancellations. Patients who were identified at high risk for preoperative complications during the telephone assessment were referred to the preoperative evaluation clinic for further evaluation.

Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial.

ObjectivesTo assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial).DesignMulticenter, two-arm, parallel-group, open-label randomized controlled trial.Setting11 university hospital ambulatory surgery units in Paris, France.ParticipantsPatients scheduled for ambulatory surgery and able to be reached by telephone.InterventionA 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone.Main Outcome MeasuresRate of cancellation on the day of surgery or the day before.ResultsThe study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65–1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state.ConclusionsA standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes.Trial RegistrationClinicalTrials.gov NCT01732159

Day of surgery cancellation rate after preoperative telephone nurse screening or comprehensive optimization visit.

BackgroundStructured preoperative assessment has been reported to improve operating room efficiency as measured by metrics such as day of surgery cancellations (DOSCs). However, not all patients require comprehensive assessment; routine full assessments can result in unnecessary duplication of tests and investigations. Selective nurse screening under the supervision of anesthesiology may provide adequate information gathering in lower risk patients. This study is undertaken to assess if DOSC rates vary with different assessment processes.MethodsAt a single academic tertiary care hospital, from Jan 2 to May 31, 2013, the consecutive patients undergoing comprehensive preoperative assessment (CPA) and nurse screening (NS), as well as the patients not assessed by the anesthesiology-supervised preoperative process, were followed for the occurrence and reason for DOSC. The operating room schedule of all elective surgery patients was analyzed to allow calculation of rates of DOSCs. Reasons for cancellations were documented as one of ten structured reasons by preoperative holding area clerical staff.ResultsOverall, there were 14,893 elective surgery patients in this time period, with 183 DOSCs, giving a rate of 1.23 % (95 % CI 1.06, 1.42). Patients who received CPA numbered 5980; 29 of them had a DOSC, giving a rate of 0.48 % (95 % CI 0.33–0.70) (P < 0.0001 vs. no assessment). Patients receiving NS numbered 1840; 11 of them had a DOSC, giving a rate of 0.60 % (95 % CI 0.30–1.10) (P < 0.0001 vs. no assessment). The most common reason for cancellation was new medical condition.ConclusionsA very low DOSC rate can be achieved with a comprehensive preoperative process where some patients are selectively telephone screened by nurses, with complete assessment deferred to the anesthesiologist on the day of surgery.

A nursing analysis on 68 patients receiving psychological health education after implantation surgery

Objective To analyze the nursing care for 68 patients receiving psychological health education after implantation surgery.Methods 68 patients schedualed for implantation surgery received preoperative telephone followup and psychological guidance.Harmonious background music was play intraoperatively and created relaxed atmosphere;the speech and behavior were standardized in the nursing staff,; psychological support was offered to patients; and postoperative telephone visits were made to provide psychological guidance.Results All the patients were able to accept and actively cooperate with surgical treatment and had better feeling after surgery.Conclusions Correct psychological health education for patients undergoing implantation surgery can effectively relieve patient anxiety and fear,and increase patient confidence on medical staff to ensure smooth surgical performance and to improve the efficiency and success rate of surgery. Key words: Implantation; Health education; Psychological intervention; Nursing analysis

Using Nurse-to-Patient Telephone Calls to Reduce Day-of-Surgery Cancellations

Day-of-surgery cancellations are costly and frustrating for both the patient and the health care team. This is especially true in ambulatory surgical centers where it can be difficult to schedule a replacement procedure on short notice. Preoperative nurses at the University of North Carolina Health Care ambulatory surgical center were able to decrease the daily cancellation rate by 53%, increase patient satisfaction scores, and increase OR use by targeting three main reasons for cancellations during a preoperative telephone call. A nurse calls each patient three business days before the scheduled surgery and uses a script to communicate important preoperative information and to address any questions or concerns. The nurse then reports any new information or concerns he or she has learned from the telephone call to the scheduling clinic, anesthesia team, or the surgeon. These calls have resulted in major decreases in cancellations related to no shows, NPO requirements, and lack of a responsible adult present to drive the patient home.

The systematic review of the effectiveness and meaningfulness of telephone pre-operative assessment for adults.

Questions: 1. Is telephone preoperative assessment as effective as face‐to‐face preadmission clinic visits in terms of preparing the patient for elective surgery? 2. What are the perioperative experiences of adult patients who have received telephone based preoperative preparation prior to elective surgery? Objectives: This review will examine the best available evidence in regard to preoperative telephone patient assessment and preparation to determine the impact of this intervention on patient knowledge and expectations of their surgery and anaesthesia, compliance with preoperative and postoperative preparations, their levels of fear and anxiety, reduction in cancellations on day of surgery in comparison to face‐to‐face assessment. This review will also examine the patient experiences and satisfaction with this method of assessment. Thus both the evidence related to effectiveness and meaningfulness of telephone preoperative preparation on patient preparedness for elective surgery will be explored and synthesized. This will include a comparison of telephone assessment with face to face consultation in the preoperative preparation of the adult patient in day of surgery admission patients. Inclusion Criteria: Types of Participants: For both the quantitative and qualitative components this review will consider studies that include adult (> 18 years) patients having elective day or inpatient surgery in a hospital setting who have had a telephone preoperative consultation or face‐to‐face preadmission clinic visit. Emergency surgery is to be excluded. Phenomena of interest: The qualitative component of this review will focus on the experiences of patients who have utilised telephone based preoperative assessment. The quantitative component will focus on the comparison of effect of telephone‐based patient preparation for elective surgery with face‐to‐face preparation. Type of outcome: The quantitative component of the review will consider studies that include the following outcome measures related to the patient preparation for surgery including: • patient understanding and expectations of postoperative pain, nausea, anxiety, medication management and discharge planning • knowledge of procedure and anaesthetic, and informed consent • informed consent • anxiety • pain management • medication management • patient understanding and compliance with preoperative and postoperative activities

The systematic review of the effectiveness and meaningfulness of telephone pre-operative assessment for adults.

Questions: 1. Is telephone preoperative assessment as effective as face‐to‐face preadmission clinic visits in terms of preparing the patient for elective surgery? 2. What are the perioperative experiences of adult patients who have received telephone based preoperative preparation prior to elective surgery? Objectives: This review will examine the best available evidence in regard to preoperative telephone patient assessment and preparation to determine the impact of this intervention on patient knowledge and expectations of their surgery and anaesthesia, compliance with preoperative and postoperative preparations, their levels of fear and anxiety, reduction in cancellations on day of surgery in comparison to face‐to‐face assessment. This review will also examine the patient experiences and satisfaction with this method of assessment. Thus both the evidence related to effectiveness and meaningfulness of telephone preoperative preparation on patient preparedness for elective surgery will be explored and synthesized. This will include a comparison of telephone assessment with face to face consultation in the preoperative preparation of the adult patient in day of surgery admission patients. Inclusion Criteria: Types of Participants: For both the quantitative and qualitative components this review will consider studies that include adult (> 18 years) patients having elective day or inpatient surgery in a hospital setting who have had a telephone preoperative consultation or face‐to‐face preadmission clinic visit. Emergency surgery is to be excluded. Phenomena of interest: The qualitative component of this review will focus on the experiences of patients who have utilised telephone based preoperative assessment. The quantitative component will focus on the comparison of effect of telephone‐based patient preparation for elective surgery with face‐to‐face preparation. Type of outcome: The quantitative component of the review will consider studies that include the following outcome measures related to the patient preparation for surgery including: • patient understanding and expectations of postoperative pain, nausea, anxiety, medication management and discharge planning • knowledge of procedure and anaesthetic, and informed consent • informed consent • anxiety • pain management • medication management • patient understanding and compliance with preoperative and postoperative activities

Cataract Surgery Takes Longer in Functionally Monocular Patients

To determine differences in the amount of work involved in caring for functionally monocular patients who undergo cataract surgery compared with binocularly sighted patients. This was a retrospective study that included 100 consecutive functionally monocular patients and 100 binocularly sighted control patients matched by age (+/-5 years) and date of surgery ( +/-1 year). Office records were reviewed to determine several measures of office and operating room work effort. There was no difference between groups in preoperative telephone calls (P = .136), postoperative telephone calls (P = .580), preoperative office visits (P = .875), postoperative office visits (P = .601), or the number of times surgery was scheduled (P = 1.00). Monocular patients required more time for surgery (37.4 minutes) than binocular patients (32.4 minutes) (P= .010). It takes longer to perform cataract surgery on functionally monocular patients than on binocularly sighted patients.