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Study: Patients who undergo TJA are willing to use perioperative surveillance system
According to recently published results, patients who underwent total joint arthroplasty were willing to use a surveillance system, which consisted of electronic messages and telephone calls with trained nurses, to enhance perioperative communication.
Researchers performed a retrospective study using a prospectively collected database of information for patients who underwent primary TJA between January 2015 to April 2016. The surveillance system was implemented to optimize perioperative communication. Under the system, nurse navigators scheduled telephone calls with patients at 1 week preoperatively and 11, 30 and 90 days postoperatively. Patients could also engage in scheduled communication about logistical and medical concerns through phone calls or electronic messages using a web-based platform. The total number of messages and calls exchanged was used to measure use of the surveillance system in response to clinical scenarios.
Results showed communication was greater in patients who experienced a complication, went to the ED and were readmitted to the hospital compared with patients who had an uncomplicated course. Investigators noted communication was also greater in patients who presented to outside facilities for ED visits and readmissions compared with those who returned to the index hospital for ED visits and readmissions. Patients who had more distance to travel to their health care facility had a decreased follow-up attendance; however, they did not have a compensatory increase in utilization of the surveillance system – by Monica Jaramillo
Disclosures: Luzzi reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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The authors evaluated data from communication encounters of 8,359 patients up to 90 days after TJR surgery. A complication occurred in 5.6% of patients, with 3% seen in the ED and 2.9% readmitted. For uncomplicated cases, the median number of communication events was five. For patients with complications, as well as those readmitted, the number was eight. For patients readmitted to an outside hospital, the median communication was nine, significantly higher than six for patients readmitted at the index hospital.
The communication network was accepted by patients, and the correlation of increased numbers of communication episodes with complications demonstrated utility of the system. The costs of setting up such a program was not discussed. They also did not discuss the effectiveness of preventing ED visits or readmissions, which would offset the costs. It would be of interest to learn details of the types of complications, such as medical vs. surgical (uncontrolled pain, constipation, wound issues and edema). Some surgical complications may potentially be mitigated with communication of proper pain medication and laxative usage, elevation of limbs and education of expected wound appearance. This is a timely and interesting study which will stimulate further investigation.