PD23-10 A PILOT STUDY TO INVESTIGATE THE USE OF VIDEO VISITS IN REDUCING READMISSIONS AFTER MAJOR UROLOGIC SURGERY

Abstract

INTRODUCTION AND OBJECTIVE: Telemedicine is an innovative field that resulted in an increase in health care access and reduction of associated costs. The role of telemedicine in a postoperative setting and its impact upon readmission rates have not been studied. We aim to evaluate the feasibility of postoperative video visits and assess the impact in reducing readmissions following major urologic oncologic surgery. METHOD(S): Patients undergoing major urological surgery by a single provider (DSS) were screened to participate in our study. All patients with a compatible smartphone were included and were instructed on how to utilize the video-visit application. Video visits began the day after discharge and were made every other day for a total of 2 weeks. In each visit, we assessed current medications, oral fluid intake, urine output, food intake, flatus/bowel movements, use of spirometer, daily activity, fever, and surgical wound appearance. Video call providers utilized a script designed to provide a consistent structure to each visit. Specific patient answers triggered either an intervention (done by video call providers) or a "red flag", prompting video call providers to contact the attending surgeon for further management. The primary outcome was to assess the feasibility of post discharge video visits by number of completed calls as well as patient adherence to the post-operative care plan. Secondary outcomes were the impact upon the rate of thirty-day hospital readmission measured by comparing readmission rates to matched controls done before the study period. RESULT(S): Out of the 78 screened patients, a total of 66 (84.6%) were enrolled and 53 (68%) completed more than one call. Of these, 30.2% were after RC, 11 20.8% after RALP and 26.4% after nephrectomy/ureterectomy. A total of 243 calls (65.5% of expected calls and a mean 4.6 calls per patient) were completed. Overall, 83 interventions and 5 red flags were made (Figure 1). The most common reason for an intervention was poor oral fluid intake (24.1%) and for a red flag was poor bowel movements (60%). Oral intake was quantified for 73.3% of the calls and urine output for 67.1%. A total of 9 (17%) patients were readmitted within 30 days of surgery. The matched controls had a total of 13 (24.5%) readmissions, which translates into a 7.5% decrease in readmission rate in patients receiving video visits. CONCLUSION(S): Postoperative video visits after major urological surgery are feasible, with high patient adherence to the post-operative plan. Video visits in post-operative patients seem to reduce 30-day readmissions. Further large, randomized studies should asses the reduction in readmission rates and higher-grade complications post-discharge.